目的:建立特发性肺纤维化(IPF)的准确和及时的诊断对于适当的治疗和预后至关重要。在某些情况下,进行外科肺活检(SLB),但具有不可忽视的风险。这项回顾性研究的目的是使用加拿大肺纤维化登记处确定SLB是否与IPF患者的肺功能加速下降有关。
方法:使用线性混合模型和Cox比例风险回归模型来比较强迫肺活量(FVC)%的下降,SLB和非SLB患者之间的肺扩散能力(DLCO%)和死亡或肺移植的风险。对基线年龄进行了调整,性别,吸烟史,抗纤维化使用,和肺功能。类似的分析比较了SLB前后12个月的肺功能变化。
结果:共纳入81例SLB患者和468例非SLB患者。在SLB组中,活检后的年度FVC%下降为2.0%(±0.8),在未经调整的情况下,调整后的模型为2.1%(±0.8)。FVC%下降没有差异,DLCO%下降,两组之间的死亡时间或肺移植,在调整或未调整的模型中(所有p值>0.07)。在pre-postSLB组中,在未校正或校正模型中,FVC%下降没有差异(两者p=0.07).
结论:在这项针对IPF患者的多中心研究中,未发现SLB与肺功能下降或死亡风险或肺移植之间存在关联。
OBJECTIVE: Establishing an accurate and timely diagnosis of idiopathic pulmonary fibrosis (IPF) is essential for appropriate management and prognostication. In some cases, surgical lung biopsy (SLB) is performed but carries non-negligible risk. The objective of this retrospective study was to determine if SLB is associated with accelerated lung function decline in patients with IPF using the Canadian Registry for Pulmonary Fibrosis.
METHODS: Linear mixed models and Cox proportional hazards regression models were used to compare decline in forced vital capacity (FVC)%, diffusion capacity of the lung (DLCO%) and risk of death or lung transplantation between SLB and non-SLB patients. Adjustments were made for baseline age, sex, smoking history, antifibrotic use, and lung function. A similar analysis compared lung function changes 12 months pre- and post-SLB.
RESULTS: A total of 81 SLB patients and 468 non-SLB patients were included. In the SLB group, the post-biopsy annual FVC% decline was 2.0% (±0.8) in unadjusted, and 2.1% (±0.8) in adjusted models. There was no difference in FVC% decline, DLCO% decline, or time to death or lung transplantation between the two groups, in adjusted or unadjusted models (all p-values >0.07). In the pre-post SLB group, no differences were identified in FVC% decline in unadjusted or adjusted models (p = 0.07 for both).
CONCLUSIONS: No association between SLB and lung function decline or risk of death or lung transplantation was identified in this multi-centre study of patients with IPF.