Gastroesophageal Reflux Therapy Is Associated with Longer Survival in Patients with Idiopathic Pulmonary Fibrosis
Gastroesophageal Reflux Therapy Is Associated with Longer Survival in Patients with Idiopathic Pulmonary Fibrosis
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DOI：
10.1164/rccm.201101-0138oc
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发表时间：
2011-12-15
影响因子：
24.7
通讯作者：
Collard, Harold R.
中科院分区：
文献类型：
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作者：
Lee, Joyce S.;Ryu, Jay H.;Collard, Harold R.
理由：胃食管反流（GER）在特发性肺纤维化（IPF）患者中非常普遍。 GER 继发的慢性微抽吸可能在 IPF 的发病机制和自然史中发挥作用。目的：调查 GER 相关变量与 IPF 患者生存时间之间的关系。方法：使用回归分析来研究来自两个学术医疗中心的一组具有良好特征的 IPF 患者的回顾性队列中的 GER 相关变量与生存时间之间的关系。测量和主要结果：确定纳入 204 名患者。 GER 相关变量在该队列中很常见：报告的 GER 症状 (34%)、GER 疾病史 (45%)、报告的 GER 药物使用情况 (47%) 和 Nissen 胃底折叠术 (5%)。在未经调整的分析中，这些 GER 相关变量与较长的生存时间显着相关。调整后，使用 GER 药物是延长生存时间的独立预测因素。此外，使用胃食管反流药物与较低的放射学纤维化评分相关。无论哪个中心，这些发现都存在。结论：据报道，GER 药物的使用与放射学纤维化的减少有关，并且是 IPF 患者生存时间延长的独立预测因素。这些发现进一步支持了 GER 和慢性微抽吸可能在 IPF 病理学中发挥重要作用的假设。
Rationale: Gastroesophageal reflux (GER) is highly prevalent in patients with idiopathic pulmonary fibrosis (IPF). Chronic microaspiration secondary to GER may play a role in the pathogenesis and natural history of IPF.Objectives: To investigate the relationship between GER-related variables and survival time in patients with IPF.Methods: Regression analysis was used to investigate the relationship between GER-related variables and survival time in a retrospectively identified cohort of patients with well-characterized IPF from two academic medical centers.Measurements and Main Results: Two hundred four patients were identified for inclusion. GER-related variables were common in this cohort: reported symptoms of GER (34%), a history of GER disease (45%), reported use of GER medications (47%), and Nissen fundoplication (5%). These GER-related variables were significantly associated with longer survival time on unadjusted analysis. After adjustment, the use of GER medications was an independent predictor of longer survival time. In addition, the use of gastroesophageal reflux medications was associated with a lower radiologic fibrosis score. These findings were present regardless of center.Conclusions: The reported use of GER medications is associated with decreased radiologic fibrosis and is an independent predictor of longer survival time in patients with IPF. These findings further support the hypothesis that GER and chronic microaspiration may play important roles in the pathobiology of IPF.