类风湿关节炎相关性间质性肺病患者肺功能下降的相关因素

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation Pub Date : 2025-07-08 DOI:10.1016/j.resinv.2025.06.017

Takako Kawaguchi , Masahiro Tahara , Kei Yamasaki , Natsumi Tani , Yurie Kanda-Satoh , Takatoshi Aoki , Yoshiya Tanaka , Kazuhiro Yatera

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引用次数: 0

摘要

背景：抗纤维化药物最近被推荐用于间质性肺疾病伴肺功能进行性下降的患者。然而，类风湿关节炎相关间质性肺病（RA- ild）伴肺功能进行性下降的临床特征，包括与RA疾病活动性的关系尚不清楚。方法回顾性研究纳入2011年至2019年在我院诊断为RA-ILD的患者，这些患者的肺功能检查（PFTs）和胸部高分辨率计算机断层扫描（HRCT）数据可用。使用多变量回归分析确定与强迫肺活量（%FVC）绝对下降相关的因素，并根据多变量logistic回归分析的结果建立评分系统，以识别%FVC绝对下降≥5%的进行性RA-ILD患者。结果共纳入92例患者，多因素回归分析显示，老年人(β, - 0.27；95%可信区间[CI]，−0.49 ~−0.05)，疾病活动评分28-红细胞沉降率（DAS28-ESR） (β,−1.52；95% CI,−2.61 ~−0.42)，HRCT改良纤维化评分（FS）增加(β,−0.39；95% CI（- 0.53 ~ - 0.25）与植被覆盖度绝对变化%负相关。基于5个因素（高龄、男性、改良性fs增加、磨玻璃混浊增加、DAS28-ESR恶化）的新评分系统识别进展性ra - ild患者的曲线下面积为0.830 （95% CI, 0.731-0.929）。结论结合五个因素的评分系统可能有助于评估进展性RA- ild患者而不进行pfs，并帮助临床医生重新考虑使用抗纤维化药物和/或免疫抑制治疗来控制RA疾病活动和抑制进行性肺功能下降。

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Factors associated with pulmonary function decline in patients with rheumatoid arthritis-associated interstitial lung disease

Background

Antifibrotic drugs have recently been recommended for patients with interstitial lung disease with progressive pulmonary function decline. However, the clinical characteristics of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) with progressive pulmonary function decline, including the relationship with RA disease activity, are unclear.

Methods

This retrospective study included patients diagnosed with RA-ILD at our hospital from 2011 to 2019 for whom data on pulmonary function tests (PFTs) and chest high-resolution computed tomography (HRCT) were available. Factors associated with a percent forced vital capacity (%FVC) absolute decline were determined using multivariate regression analysis, and a scoring system based on the results of the multivariate logistic regression analysis was developed to identify patients with progressive RA-ILD with an absolute decline in %FVC of ≥5 %.

Results

A total of 92 patients were enrolled, and the multivariate regression analysis showed that older-age (β, −0.27; 95 % confidence interval [CI], −0.49 to −0.05), worse Disease Activity Score 28-erythrocyte sedimentation rate (DAS28-ESR) (β, −1.52; 95 % CI, −2.61 to −0.42), and HRCT modified-fibrosis score (FS) increase (β, −0.39; 95 % CI, −0.53 to −0.25) were negatively correlated with %FVC absolute change. The new scoring system to identify the progressive-RA-ILD patients based on five factors (advanced-age, male, increasing modified-FS, increasing ground-glass opacities, and worsening DAS28-ESR) showed an area under the curve of 0.830 (95 % CI, 0.731–0.929).

Conclusions

The scoring system combining five factors may be useful in estimating progressive-RA-ILD patients without conducting PFTs and help clinicians reconsider appropriate treatments with antifibrotic drugs and/or immunosuppressive therapies to control RA disease activity and suppress progressive pulmonary function decline.

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