背景:短端粒被认为是特发性肺纤维化(IPF)的危险因素。我们旨在评估端粒长度(TL)在与常见间质性肺炎(UIP)模式相关的纤维化间质性肺疾病(f-ILD)以及IPF急性加重(IPF-AE)中的作用。
目的:在连续的f-ILD患者中,使用多重定量聚合酶链反应从外周血白细胞中测量TL,所有在高分辨率胸部计算机断层扫描中都呈现UIP模式,并与年龄匹配的健康对照进行比较。
结果:纳入79名个体(平均年龄69.77±0.72岁);24名稳定的IPF,18IPF-AE,10合并肺纤维化和肺气肿,7类风湿性关节炎-UIP-ILD和20个对照。与对照组相比,所有患者的TL均明显较短[平均T/S比(SE)0.77(±0.05)vs2.26(±0.36),p<0.001]以及分别在每个f-ILD亚组中。与稳定的IPF相比,IPF-AE患者的TL明显较短(p=0.029)。IPF和短于中位数TL(0-0.72)的患者显示总生存期降低(p=0.004)。T/S<0.72与IPF-AE风险增加相关(OR=30.787,95%CI:2.153,440.183,p=0.012),与年龄无关。性别,吸烟和肺功能损害。观察到TL的保护作用,因为它与UIP-f-ILD(HR=0.174,95CI:0.036,0.846,p=0.030)和IPF患者(HR=0.096,95CI:0.011,0.849,p=0.035)的死亡风险呈负相关.
结论:较短的TL表征不同的UIPf-ILD。尽管在不同的UIP亚组之间没有观察到TL的差异,与稳定的IPF相比,IPF-AE呈现较短的TL。降低的总生存率和更高的死亡风险比与IPF中更短的TL相关。
BACKGROUND: Short telomeres are recognized as risk factor for idiopathic pulmonary fibrosis (IPF). We aimed to assess the role of telomere length (TL) in fibrotic-Interstitial Lung Diseases (f-ILDs) associated with a usual interstitial pneumonia (UIP) pattern as well as in IPF acute exacerbation (IPF-AE).
OBJECTIVE: TL was measured from peripheral white blood cells using a multiplex quantitative polymerase chain reaction in consecutive patients with f-ILDs, all presenting UIP pattern in the high-resolution chest-computed-tomography and compared to age-matched healthy controls.
RESULTS: Seventy-nine individuals were included (mean age 69.77 ± 0.72 years); 24 stable IPF, 18 IPF-AE, 10 combined pulmonary fibrosis and emphysema, 7 Rheumatoid arthritis-UIP-ILDs and 20 controls. TL in all patients was significantly shorter compared to controls [mean T/S ratio (SE) 0.77 (±0.05) vs 2.26 (±0.36), p < 0.001] as well as separately in each one of f-ILD subgroups. IPF-AE patients presented significantly shorter TL compared to stable IPF (p = 0.029). Patients with IPF and shorter than the median TL (0-0.72) showed reduced overall survival (p = 0.004). T/S < 0.72 was associated with increased risk for IPF-AE (OR = 30.787, 95% CI: 2.153, 440.183, p = 0.012) independent of age, gender, smoking and lung function impairment. A protective effect of TL was observed, as it was inversely associated with risk of death both in UIP-f-ILDs (HR = 0.174, 95%CI: 0.036, 0.846, p = 0.030) and IPF patients (HR = 0.096, 95%CI: 0.011, 0.849, p = 0.035).
CONCLUSIONS: Shorter TL characterizes different UIP f-ILDs. Although no difference was observed in TL among diverse UIP subgroups, IPF-AE presented shorter TL compared to stable IPF. Reduced overall survival and higher hazard ratio of death are associated with shorter TL in IPF.