Influencing factors for occurrence and progression of interstitial lung disease in patients with systemic sclerosis
Objective To investigate the clinical characteristics and influencing factors of interstitial lung disease(ILD)and progressive pulmonary fibrosis(PPF)in patients with systemic sclerosis(SSc).Methods Seventy-five patients with SSc in the Department of Rheumatology of Ningbo Medical Center Lihuili Hospital from January 2017 to December 2021 were collected.Among them,41 patients with SSc complicated with ILD(SSC-ILD group)and 34 patients without ILD(SSC-nILD group).The independent risk factors for ILD in SSc patients were analyzed by univariate and multivariate logistic regression analysis,while influencing factors for PPF were analyzed by univariate logistic regression.With high-resolution computed tomography diagnosis of ILD as the observation starting point and PPF as the observation end point,Kaplan-Meier survival curve was drawn,and the median time to develop PPF was compared between antitopoisomerase I antibodies(ATA)positive group and ATA negative group by log-rank test.Results The course of disease in the SSc-ILD group was longer than that of the SSc-nILD group,the proportion of dcSSc,the incidence of finger/phalangeal ulcer and/or depressed scar,gastroesophageal reflux,pulmonary hypertension,modified Rodnan Skin Score,and the positive rate of ATA in the SSC-ILD group were higher than those of the SSc-nILD group,while the positive rate of anticentromere antibodies(ACA)was lower than that of the SSc-nILD group,the differences were statistically significant(all P＜0.05).Multivariate logistic regression analysis showed that a long course of disease was an independent risk factor for ILD in SSc patients(OR=1.017,95％CI:1.005-1.029,P=0.005),while ACA positive was an independent protective factor for ILD of SSc patients(OR=0.102,95％CI:0.017-0.621,P=0.013).Among the 41 patients with SSc-ILD,11 cases progressed to PPF(PPF group)and 30 cases did not(nPPF group).There was a significant difference in the positive rate of ATA between PPF group and nPPF group(P＜0.05).Univariate logistic regression analysis showed that ATA positive was a risk factor for the progression of SSc-ILD to PPF(OR=5.330,95％CI:1.156-24.598,P=0.032).PPF patients were further divided into ATA positive group(n=8)and ATA negative group(n=3).Survival analysis showed that the median time of PPF in ATA positive group was 12.0(95％CI:6.8-17.2)months,which was significantly shorter than that of ATA negative group 48.0(95％CI:37.5-58.5)months,the difference between the two groups was statistically significant(P=0.033).Conclusion A long disease course can be regarded as an influencing factor for the occurrence of ILD in SSc,while positive ATA can be an influencing factor for the emergence of PPF in patients with SSc-ILD.
万方数据
维普
