Prevalence and Effects of Emphysema in Never-Smokers with Rheumatoid Arthritis Interstitial Lung Disease.
Prevalence and Effects of Emphysema in Never-Smokers with Rheumatoid Arthritis Interstitial Lung Disease.
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DOI：
10.1016/j.ebiom.2018.01.038
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发表时间：
2018-03
期刊：
影响因子：
11.1
通讯作者：
Wells AU
中科院分区：
文献类型：
--
作者：
Jacob J;Song JW;Yoon HY;Cross G;Barnett J;Woo WL;Adams F;Kokosi M;Devaraj A;Renzoni E;Maher TM;Kim DS;Wells AU
自身免疫性疾病，如类风湿性关节炎相关的间质性肺病（RA-ILD）与从不吸烟者的肺气肿有关。我们旨在量化RA-ILD从不吸烟者的肺气肿患病率，并研究肺纤维化和肺气肿（CPFE）是否会导致独立于基线疾病程度的预后恶化。在皇家布朗普顿医院（n = 90）和牙山医疗中心（n = 155）就诊的RA-ILD患者进行了CT评估，以确定普通型间质性肺炎（UIP）模式，以及肺气肿和ILD的可见程度。在31/116例（27%）RA-ILD从不吸烟者中发现的肺气肿与阻塞性功能指数相关，并符合CPFE表型：气体转移（DLco）不成比例减少，肺容量相对保留。使用多变量logistic回归，调整患者年龄，性别和ILD程度，肺气肿的存在与不吸烟者（0.009）和吸烟者（0.02）的CT-UIP模式独立相关。在多变量考克斯分析中，对患者年龄、性别、DLco和CT-UIP模式进行校正后，肺气肿存在（代表CPFE表型）与从不吸烟者（p = 0.04）和吸烟者（p < 0.05）的死亡率独立相关。27%的RA-ILD从不吸烟者在CT上显示肺气肿。从不吸烟者的肺气肿存在与明确的CT-UIP模式以及根据基线疾病严重程度调整后的恶化结局独立相关。约25%的从不吸烟的RA-ILD患者存在肺气肿。肺气肿与从不吸烟的RA-ILD患者的结局恶化独立相关。从不吸烟的患者存在肺气肿与明确的CT常见间质性肺炎模式独立相关。我们研究了类风湿性关节炎相关间质性肺间质性疾病（RA-ILD）患者的计算机断层扫描成像肺气肿的发生率。在31/116（27%）从不吸烟的患者中发现了肺气肿，标记为肺气肿的区域与阻塞性功能指数相关。在从不吸烟的RA-ILD患者中，肺气肿与结局恶化相关，与基线疾病严重程度无关。我们的研究结果表明，肺气肿，独立地与一个贫穷的结果，可能有原因以外的吸烟患者的RA-ILD。
Autoimmune conditions such as rheumatoid arthritis-related interstitial lung disease (RA-ILD) have been linked to the existence of emphysema in never-smokers. We aimed to quantify emphysema prevalence in RA-ILD never-smokers and investigate whether combined pulmonary fibrosis and emphysema (CPFE) results in a worsened prognosis independent of baseline disease extent. RA-ILD patients presenting to the Royal Brompton Hospital (n = 90) and Asan Medical Center (n = 155) had CT's evaluated for a definite usual interstitial pneumonia (UIP) pattern, and visual extents of emphysema and ILD. Emphysema, identified in 31/116 (27%) RA-ILD never-smokers, was associated with obstructive functional indices and conformed to a CPFE phenotype: disproportionate reduction in gas transfer (DLco), relative preservation of lung volumes. Using multivariate logistic regression, adjusted for patient age, gender and ILD extent, emphysema presence independently associated with a CT-UIP pattern in never-smokers (0.009) and smokers (0.02). On multivariate Cox analysis, following adjustment for patient age, gender, DLco, and a CT-UIP pattern, emphysema presence (representing the CPFE phenotype) independently associated with mortality in never-smokers (p = 0.04) and smokers (p < 0.05). 27% of RA-ILD never-smokers demonstrate emphysema on CT. Emphysema presence in never-smokers independently associates with a definite CT-UIP pattern and a worsened outcome following adjustment for baseline disease severity. Emphysema is present in approximately 25% of never-smokers with RA-ILD Emphysema independently links to a worsened outcome in never-smokers with RA-ILD Emphysema presence in never-smokers independently associates with a definite CT-usual interstitial pneumonia pattern Autoimmune pathways have been implicated in the occurrence of emphysema in patients with interstitial lung disease (ILD) who have never smoked. We examined the occurrence of emphysema on computed tomographic imaging in patients with rheumatoid arthritis-related ILD (RA-ILD). Emphysema was identified in 31/116 (27%) of patients who had never smoked and regions labeled as emphysematous were associated with obstructive functional indices. In never-smoker patients with RA-ILD, emphysema was associated with a worsened outcome, independent of baseline disease severity. Our findings suggest that emphysema, which independently links to a poor outcome, may have causes other than smoking in patients with RA-ILD.
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影响因子：
--
作者：
Saag, KG;Kolluri, S;Schwartz, DA
通讯作者：
Schwartz, DA
影响因子：
3.1
作者：
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Takemura T
影响因子：
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作者：
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通讯作者：
Galbiati, Ferruccio
影响因子：
9.6
作者：
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通讯作者：
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影响因子：
15.9
作者：
Rangel-Moreno, Javier;Hartson, Louise;Randall, Troy D.
通讯作者：
Randall, Troy D.