Changes in serum KL-6 levels during short-term strict antigen avoidance are associated with the prognosis of patients with fibrotic hypersensitivity pneumonitis caused by avian antigens
Changes in serum KL-6 levels during short-term strict antigen avoidance are associated with the prognosis of patients with fibrotic hypersensitivity pneumonitis caused by avian antigens
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DOI：
10.1016/j.resinv.2020.05.007
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发表时间：
2020-11-01
影响因子：
3.1
通讯作者：
Miyazaki, Yasunari
中科院分区：
文献类型：
--
作者：
Hanzawa, Satoshi;Tateishi, Tomoya;Miyazaki, Yasunari
背景：鸟相关性过敏性肺炎（BRHP）是最常见的纤维化过敏性肺炎（HP）。抗原回避（AA）是HP诊断和治疗的关键步骤，但并非所有纤维化HP患者都能通过AA得到改善。由于预后不良的纤维化HP，预测生物标志物，以确定患者显示快速进展，在AA是迫切需要的。方法：从1941例间质性肺疾病的病历回顾性分析，75例纤维化BRHP证实的激发试验或手术肺活检。为了鉴定在诊断时或诊断前后获得的潜在预后标志物，评估了诊断时的生理学和血清学变量以及严格AA期间这些变量的相对变化。采用考克斯比例风险模型和对数秩检验比较这些变量与生存率之间的关系。单因素分析显示，性别、吸烟状况和血清KL-6水平的相对变化与预后相关（P值分别为0.02、0.04和0.02），但蜂窝样改变和用力肺活量与生存率无关。KL-6水平的相对变化（大于与小于10%的下降）与分层分析中的生存率显著相关（73.9与34.9个月; P = 0.04）。结论：KL-6水平的相对变化与纤维化BRHP患者的预后相关，与先前确定的预后生物标志物无关。这一发现可以帮助肺科医生识别可能显示快速进展的纤维化BRHP患者。(c)2020日本呼吸学会Elsevier B. V.出版，保留所有权利。
Background: Bird-related hypersensitivity pneumonitis (BRHP) is the most common type of fibrotic hypersensitivity pneumonitis (HP). Antigen avoidance (AA) is a key step in the diagnosis and management of HP, but not all fibrotic HP patients improve through AA. Because of the poor prognosis of fibrotic HP, predictive biomarkers to identify patients showing rapid progression during AA are urgently needed.Methods: From a retrospective review of the medical records of 1941 patients with inter-stitial lung disease, 75 cases of fibrotic BRHP confirmed by a provocation test or surgical lung biopsy were identified. To identify potential prognostic markers obtained at or around diagnosis, physiological and serological variables at diagnosis and the relative changes in those variables during strict AA were evaluated. Cox proportional hazards models with log rank testing were used to compare the associations between these variables and survival.Results: Univariate analyses showed that gender, smoking status, and the relative change in the serum levels of Krebs von den Lungen-6 (KL-6) were associated with prognosis (P = 0.02, 0.04, and 0.02, respectively), but the presence of honeycombing and the forced vital capacity were not associated with survival. The relative change in KL-6 levels (greater than vs. less than a 10% decrease) was significantly associated with survival in a stratified analysis (73.9 vs. 34.9 months; P = 0.04).Conclusions: The relative change in KL-6 levels is associated with the prognosis of patients with fibrotic BRHP independent of previously identified prognostic biomarkers. This finding could help pulmonologists identify fibrotic BRHP patients that are likely to show rapid progression. (c) 2020 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.