Factors influencing the phenotype of progressive pulmonary fibrosis in patients with connective tissue disease-associated interstitial lung disease
10.3760/cma.j.cn341190-20240402-00335
- VernacularTitle:结缔组织病相关间质性肺疾病患者呈进展性肺纤维化表型的影响因素
- Author:
Zhenbin ZHANG
1
;
Pei CAI
Author Information
1. 西安国际医学中心医院呼吸与危重症医学科，西安 710100
- Keywords:
Lung diseases, interstitial;
Connective tissue diseases;
Pulmonary fibrosis;
Biomarkers, tumor;
Leukocyte count;
Blood sedimentation;
Carcinoembryonic antig
- From:
Chinese Journal of Primary Medicine and Pharmacy
2024;31(11):1619-1626
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the clinical characteristics of progressive pulmonary fibrosis in patients with interstitial lung disease associated with connective tissue disease, identify the relevant influential factors, and construct a corresponding mathematical model to evaluate prediction efficiency.Methods:In a cross-sectional study, the clinical data of 219 patients with interstitial lung disease associated with connective tissue disease, who were treated at Xi'an International Medical Center Hospital from January 2020 to December 2023, were retrospectively collected and analyzed. Among these patients, 32 were diagnosed with progressive fibrotic interstitial lung disease (observation group), while the remaining 187 patients were diagnosed with non-progressive fibrotic interstitial lung disease (control group). Univariate analysis ( t-test and χ2 test) and multivariate analysis (logistic regression) were conducted to build a predictive model for progressive fibrotic interstitial lung disease. The prediction efficacy was evaluated using a column chart model and receiver operating characteristic curve analysis. Results:In the observation group, the proportions of patients experiencing cough and shortness of breath were 40.63% (13/32) and 40.63% (13/32), respectively, which were significantly higher than those in the control group [16.58% (31/187), 16.04% (30/187), χ2 = 9.84, 10.46, both P < 0.05]. The observation group also exhibited significantly higher levels of white blood cell count, neutrophil-to-lymphocyte ratio, erythrocyte sedimentation rate, and C-reactive protein, while albumin levels were significantly lower compared with the control group ( t = -2.69, -2.15, -9.27, -6.78, 2.18, all P < 0.05). The immunoglobulin A levels in the observation group [(3.18 ± 0.44) g/L] were significantly higher than those in the control group [(2.32 ± 0.32) g/L, t = -13.23, P < 0.05]. Additionally, the levels of carcinoembryonic antigen [(2.73 ± 1.03) μg/L] and carbohydrate antigen 19-9 [(14.35 ± 4.03) kU/L] in the observation group were significantly higher compared with the control group [(1.53 ± 0.24) μg/L, (8.98 ± 2.71) kU/L, t = 13.99, 9.56, both P < 0.05]. The proportion of reticular opacities in the observation group was significantly lower than that in the control group, whereas the proportion of honeycomb changes was significantly higher in the observation group compared with the control group (χ2 = 6.45, 14.55, both P < 0.05). Multivariate logistic analysis revealed that immunoglobulin A, carbohydrate antigen 19-9, and honeycomb changes were independent influential factors associated with the diagnosis of progressive fibrotic interstitial lung disease ( OR = 17.13, 1.42, 8.01, all P < 0.05). The multivariate logistic regression model demonstrated good fit (Hosmer-Lemeshow χ2 = 0.11, P > 0.05). A nomogram risk model was constructed based on the variables identified in the multivariate analysis, with a C-index of 0.71. Internal validation using the Bootstrap sampling method indicated an average absolute error of the calibration curve of 0.02. Receiver operating characteristic curve analysis based on the independent influential factors and their corresponding P-values showed areas under the curve of 0.73, 0.73, 0.68, and 0.86, respectively. The area under the curve for the predicted probability of the regression model was significantly higher than those for the other independent influential factors ( Z = -3.81, -3.66, -4.99, all P < 0.05). Conclusion:Increased immunoglobulin A concentration, elevated carbohydrate antigen 19-9 levels, and honeycomb changes observed on high-resolution CT scans may indicate the progression of pulmonary fibrosis in patients with interstitial lung disease associated with connective tissue disease. Close monitoring of clinical symptoms, comprehensive laboratory and imaging evaluations, and timely antifibrotic treatment are recommended for these patients.
