Monocyte Count as a Prognostic Biomarker in Patients with Idiopathic Pulmonary Fibrosis.
Monocyte Count as a Prognostic Biomarker in Patients with Idiopathic Pulmonary Fibrosis.
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在特发性肺纤维化患者中，单核细胞视为预后生物标志物。
DOI：
10.1164/rccm.202003-0669oc
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发表时间：
2021-07-01
影响因子：
24.7
通讯作者：
Maher TM
中科院分区：
文献类型：
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作者：
Kreuter M;Lee JS;Tzouvelekis A;Oldham JM;Molyneaux PL;Weycker D;Atwood M;Kirchgaessler KU;Maher TM
理论基础：迫切需要简单、经济有效的特发性肺纤维化(IPF)预后生物标记物；显示潜力的生物标记物包括单核细胞计数。目的：我们使用来自吡非尼酮和干扰素γ-1b试验的混合数据来探讨单核细胞计数与特发性肺纤维化患者预后的关系。方法：这项回顾合并分析包括来自以下四个第三阶段随机安慰剂对照试验的患者(活动组和安慰剂组)：ASCED(NCT01366209)、CAPTABLE(NCT00287729和NCT00287716)和INSPIRE(NCT00075998)。结果包括肺间质纤维化进展(预计≥在FVC%中绝对下降10%，≥在6分钟步行距离内下降50m，或死亡)，全因住院，全因死亡率超过1年。使用双变量和多变量模型评估单核细胞计数(定义为时间依赖性)和结果之间的关系。测量和主要结果：这项分析包括2,067例患者，按单核细胞计数分层(基线：0.60 × 109细胞/L[n = 1,609]，0.60到<；0.95 × 109细胞/L[n = 408]，和≥0.95 × 109细胞/L[n = 50])。在调整后的分析中，单核细胞计数在0.6至0.95 × 109细胞/L或≥0.95 × 109细胞/L与单核细胞计数为0.60 × 109细胞/L的患者发生肺功能衰竭进展(分别为P = 0.016和P = 0.002)、全因住院(分别为P = 0.030和P = 0.003)和全因死亡(P = 0.005和P <；分别为 0.001)，超过1年。单核细胞计数从基线开始的变化与一年内的任何结果都没有关联，似乎也不受研究治疗的影响。结论：在IPF患者中，单核细胞计数升高与IPF进展、住院和死亡风险增加相关。单核细胞计数可作为预测IPF预后的一种简便、廉价的生物标志物。
Rationale: There is an urgent need for simple, cost-effective prognostic biomarkers for idiopathic pulmonary fibrosis (IPF); biomarkers that show potential include monocyte count. Objectives: We used pooled data from pirfenidone and IFNγ-1b trials to explore the association between monocyte count and prognosis in patients with IPF. Methods: This retrospective pooled analysis included patients (active and placebo arms) from the following four phase III, randomized, placebo-controlled trials: ASCEND (NCT01366209), CAPACITY (NCT00287729 and NCT00287716), and INSPIRE (NCT00075998). Outcomes included IPF progression (≥10% absolute decline in FVC% predicted, ≥50 m decline in 6-minute-walk distance, or death), all-cause hospitalization, and all-cause mortality over 1 year. The relationship between monocyte count (defined as time-dependent) and outcomes was assessed using bivariate and multivariable models. Measurements and Main Results: This analysis included 2,067 patients stratified by monocyte count (at baseline: <0.60 × 109 cells/L [n = 1,609], 0.60 to <0.95 × 109 cells/L [n = 408], and ≥0.95 × 109 cells/L [n = 50]). In adjusted analyses, a higher proportion of patients with monocyte counts of 0.60 to <0.95 × 109 cells/L or ≥0.95 × 109 cells/L versus <0.60 × 109 cells/L experienced IPF progression (P = 0.016 and P = 0.002, respectively), all-cause hospitalization (P = 0.030 and P = 0.003, respectively), and all-cause mortality (P = 0.005 and P < 0.001, respectively) over 1 year. Change in monocyte count from baseline was not associated with any of the outcomes over 1 year and did not appear to be affected by study treatment. Conclusions: In patients with IPF, elevated monocyte count was associated with increased risks of IPF progression, hospitalization, and mortality. Monocyte count may provide a simple and inexpensive prognostic biomarker in IPF.