关于肺功能参数在特发性肺纤维化随访中的作用的评论。

IF 1.9 4区 医学 Q3 RESPIRATORY SYSTEM Clinical Respiratory Journal Pub Date : 2024-06-23 DOI:10.1111/crj.13797
Guliz Degirmenci, Celal Satici
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引用次数: 0

摘要

特发性肺纤维化(IPF)是一种进展性疾病,死亡率很高[1]。虽然 IPF 的总体预后不佳,但肺功能检测结果的下降和进展到死亡的程度却有很大差异 [2]。识别进展缓慢或进展迅速的患者对后续研究(包括基因分析和 IPF 临床表型调查)很有价值。此外,它还能影响治疗决策,包括移植时机。我们祝贺 Doubkova 及其同事的研究,他们的研究旨在确定人口学参数、肺功能参数和高分辨率计算机断层扫描评分的影响[1]。研究显示,在预测死亡率方面,肺弥散一氧化碳(DLCO)下降似乎优于用力肺活量(FVC)下降。FVC 是研究 IPF 患者病程最常用的结果,FVC 预测百分比随时间的变化是预测死亡率的一个众所周知的指标[3]。INPULSIS[4]、ASCEND[5]、CAPACITY[6]和TOMORROW[7]等研究都将FVC下降作为主要终点。然而,在这项研究中,经过多变量分析发现 DLCO 下降是预测死亡率的独立指标,而不是 FVC 下降[1]。从统计学角度来看,只有那些显示出高度相关性的参数才应被纳入多变量分析中,只有那些临床意义更大的参数才应被纳入多变量分析中。与此相一致,需要注意的是,FVC 和 DLCO 下降均被纳入多变量分析,而这两个参数预计会有较高的相关性。这可能会导致多重共线性问题,影响结果的准确性。关于基线特征,存活和死亡患者的肺部受累程度、FVC(%)和 DLCO(%)存在显著差异。死亡患者的肺泡和间质评分更高,DLCO(%)和FVC(%)更低。由于基线 FVC (%) 和 DLCO (%) 未纳入单变量 Cox 分析,我们无法确定 FVC (%) 和 DLCO (%) 下降的独立影响。这一点很重要,因为基线情况更严重的患者更有可能病情恶化并死亡。然而,这可能会影响 DLCO(%)的预后作用,这也是本研究的主要结论,因为预计肺动脉高压患者的 DLCO 会明显偏低。事实上,由于 IPF 的临床过程千变万化,患者之间的治疗反应也存在显著差异。因此,抗纤维化治疗数据的缺失可能会影响对研究结果的解释。Guliz Degirmenci 和 Celal Satici 参与了研究的设计和实施、结果分析评估和文章撰写。
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A Commentary on the Role of Pulmonary Function Parameters in Idiopathic Pulmonary Fibrosis Follow-Up

Idiopathic pulmonary fibrosis (IPF) is a progressive disease and has a high mortality rates [1]. While the overall prognosis of IPF is poor, the decline in pulmonary function tests and progression to death varies widely [2]. Identification of patients with slow progression or rapid progression would be valuable for subsequent studies, including genetic analyses and investigation of IPF clinical phenotypes. Additionally, it could influence treatment decisions, including the timing of transplantation. We congratulate Doubkova and colleagues for their study aiming to establish the impact of demographic parameters, pulmonary function parameters and high-resolution computed tomography scores [1]. It was revealed that diffusing lung carbon monoxide (DLCO) decline seems to be superior to forced vital capacity (FVC) decline in predicting mortality. After a thorough review of their article, we offer the following comments to enrich the understanding of their study.

FVC is the most common outcome used in investigating the course of patients with IPF and change in FVC percentage predicted over time is a well-known predictor of mortality [3]. The primary endpoint as FVC decline in INPULSIS [4], ASCEND [5], CAPACITY [6] and TOMORROW [7] studies. However, DLCO decline was found to be an independent predictor of mortality after multivariate analysis instead of FVC decline in this study [1]. Statistically, only more clinically significant parameters should be included in the multivariate analysis among those showing high correlation. In line with this, it should be noted that both FVC and DLCO decline, which are expected to have a high correlation, were included in the multivariate analysis. This may lead to a multicollinearity problem and impact the accuracy of the results. To address this issue, it may be beneficial to create two separate models [Model 1: FVC model (not including DLCO) and Model 2: DLCO model (not including FVC)].

Regarding baseline characteristics, there were significant differences in the extent of lung involvement, FVC (%) and DLCO (%) found between alive and deceased patients. Deceased patients were more likely to have higher alveolar and interstitial scores, as well as lower DLCO (%) and FVC (%). Since baseline FVC (%) and DLCO (%) were not included in the univariate Cox analysis, we cannot determine the independent effect of decline in FVC (%) and DLCO (%). This is important because patients with more severe baseline conditions are more likely to deteriorate and experience mortality.

As authors indicated, pulmonary hypertension has not been assessed. However, this may affect the prognostic role of DLCO (%), which is the primary conclusion of this study, because DLCO is expected to be significantly low in patients with pulmonary hypertension. Indeed, given the highly variable clinical course of IPF, there are also significant differences in treatment response among patients. Therefore, the absence of data on antifibrotic treatment could potentially impact the interpretation of the findings.

Guliz Degirmenci and Celal Satici contributed to the design and implementation of the study, evaluation of the analysis of the results and writing of the article.

The authors declare no conflicts of interest.

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来源期刊
Clinical Respiratory Journal
Clinical Respiratory Journal 医学-呼吸系统
CiteScore
3.70
自引率
0.00%
发文量
104
审稿时长
>12 weeks
期刊介绍: Overview Effective with the 2016 volume, this journal will be published in an online-only format. Aims and Scope The Clinical Respiratory Journal (CRJ) provides a forum for clinical research in all areas of respiratory medicine from clinical lung disease to basic research relevant to the clinic. We publish original research, review articles, case studies, editorials and book reviews in all areas of clinical lung disease including: Asthma Allergy COPD Non-invasive ventilation Sleep related breathing disorders Interstitial lung diseases Lung cancer Clinical genetics Rhinitis Airway and lung infection Epidemiology Pediatrics CRJ provides a fast-track service for selected Phase II and Phase III trial studies. Keywords Clinical Respiratory Journal, respiratory, pulmonary, medicine, clinical, lung disease, Abstracting and Indexing Information Academic Search (EBSCO Publishing) Academic Search Alumni Edition (EBSCO Publishing) Embase (Elsevier) Health & Medical Collection (ProQuest) Health Research Premium Collection (ProQuest) HEED: Health Economic Evaluations Database (Wiley-Blackwell) Hospital Premium Collection (ProQuest) Journal Citation Reports/Science Edition (Clarivate Analytics) MEDLINE/PubMed (NLM) ProQuest Central (ProQuest) Science Citation Index Expanded (Clarivate Analytics) SCOPUS (Elsevier)
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