Effect of Emphysema Extent on Serial Lung Function in Patients with Idiopathic Pulmonary Fibrosis
Effect of Emphysema Extent on Serial Lung Function in Patients with Idiopathic Pulmonary Fibrosis
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DOI：
10.1164/rccm.201612-2492oc
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发表时间：
2017-11-01
影响因子：
24.7
通讯作者：
Wells, Athol U.
中科院分区：
文献类型：
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作者：
Cottin, Vincent;Hansell, David M.;Wells, Athol U.
理由：特发性肺纤维化和肺气肿患者可能需要人工保存肺容量。目的：在这个事后分析中，我们调查了基线肺气肿和纤维化程度以及肺功能变化之间的关系，超过48周。方法：数据来自两项ifn - γ -1b治疗特发性肺纤维化的III期、随机、双盲、安慰剂对照试验（GIPF-001 [NCT00047645]和GIPF-007 [NCT00075998]）。纳入48周数据、基线高分辨率计算机断层图像、FEV1/FVC比值小于0.8或大于0.9 （GIPF-007中< 0.7或> 0.9）的患者，以及随机选择比值为0.8-0.9和0.7-0.8的患者。通过肺气肿程度分析第48周肺功能与基线的变化。使用多元线性回归评估肺气肿和纤维化程度与肺功能变化之间的关系。测量和主要结果：38%的患者发现肺气肿。纤维化与肺气肿程度呈负相关（r = -0.232; P < 0.001）。在四分位数分析中，肺气肿程度最大的患者（28% ~ 65%）的FVC下降最小，在第48周时与无肺气肿的患者相比差异为3.32% （P = 0.047）。在多变量分析中，与没有肺气肿或肺气肿小于15%相比，肺气肿程度大于或等于15%与48周内FVC下降显著降低相关。没有观察到这种关联的扩散能力的肺一氧化碳或复合生理指标。结论：对于特发性肺纤维化和肺气肿程度大于或等于15%的患者，FVC测量可能不适合监测疾病进展。
Rationale: Patients with idiopathic pulmonary fibrosis and emphysema may have artificially preserved lung volumes.Objectives: In this post hoc analysis, we investigated the relationship between baseline emphysema and fibrosis extents, as well as pulmonary function changes, over 48 weeks.Methods: Data were pooled from two phase III, randomized, double-blind, placebo-controlled trials of IFN-gamma-1b in idiopathic pulmonary fibrosis (GIPF-001 [NCT00047645] and GIPF-007 [NCT00075998]). Patients with Week 48 data, baseline high-resolution computed tomographic images, and FEV1/FVC ratios less than 0.8 or greater than 0.9 (< 0.7 or > 0.9 in GIPF-007), as well as randomly selected patients with ratios of 0.8-0.9 and 0.7-0.8, were included. Changes from baseline in pulmonary function at Week 48 were analyzed by emphysema extent. The relationship between emphysema and fibrosis extents and change in pulmonary function was assessed using multivariate linear regression.Measurements and Main Results: Emphysema was identified in 38% of patients. A negative correlation was observed between fibrosis and emphysema extents (r = -0.232; P < 0.001). In quartile analysis, patients with the greatest emphysema extent (28 to 65%) showed the smallest FVC decline, with a difference of 3.32% at Week 48 versus patients with no emphysema (P = 0.047). In multivariate analyses, emphysema extent greater than or equal to 15% was associated with significantly reduced FVC decline over 48 weeks versus no emphysema or emphysema less than 15%. No such association was observed for diffusing capacity of the lung for carbon monoxide or composite physiologic index.Conclusions: FVC measurements may not be appropriate for monitoring disease progression in patients with idiopathic pulmonary fibrosis and emphysema extent greater than or equal to 15%.