结缔组织病相关间质性肺病发生疾病进展的危险因素及血清铁蛋白对其预测价值

Risk Factors for Progression of Connective Tissue Disease Associated Interstitial Lung Disease and the Predictive Value of Serum Ferritin

目的:探讨结缔组织病相关间质性肺病(CTD-ILD)患者发生疾病进展的临床特点及危险因素分析。方法:收集2020年1-12月首次就诊于福建医科大学附属漳州市医院风湿免疫科并明确诊断CTD-ILD的患者91例,根据随访6个月期间是否出现疾病进展分为进展组(27例)和非进展组(64例),分析两组一般资料、临床指标并构建二分类Logistic回归模型分析CTD-ILD患者发生疾病进展的危险因素。结果:单因素分析提示,两组基线时有无吸烟史、血清铁蛋白、用力肺活量占预计值百分比(FVC%pred)、一氧化碳弥散量占预计值百分比(DLCO%pred)、CT受累范围方面差异均有统计学意义(P<0.05),进一步行Logistic回归模型发现,血清铁蛋白水平升高(OR=1.002,95%CI:1.000,1.003,P=0.004)是CTD-ILD患者发生疾病进展的独立危险因素,血清铁蛋白最佳临界值为303.25 ng/ml,敏感度与特异度分别为81.5%、54.7%,曲线下面积为0.747。结论:血清铁蛋白水平可能作为CTD-ILD患者发生疾病进展的独立预测指标。

Objective:To investigate the clinical characteristics and risk factors of disease progression in patients with connective tissue disease associated interstitial lung disease(CTD-ILD).Method:A total of 91 patients who were diagnosed with CTD-ILD in department of rheumatology and immunology,Zhangzhou Affiliated Hospital of Fujian Medical University from January to December 2020 were collected.The patients were divided into progressive group(n=27)and non progressive group(n=64)according to whether the disease progressed during the 6 months follow-up period.The general data and clinical indicators of the two groups were analyzed,and the risk factors for disease progression in CTD-ILD patients were analyzed by binary Logistic regression model.Result:Univariate analysis showed that there were significant differences in smoking history,serum ferritin,FVC% pred,DLCO% pred and CT involvement range between the two groups at baseline(P<0.05).Further Logistic regression model showed that serum ferritin levels increased(OR=1.002,95%CI:1.000,1.003,P=0.004)was an independent risk factor for disease progression in CTD-ILD patients.The optimal critical value of serum ferritin was 303.25 ng/ml,the sensitivity and specificity were 81.5%and 54.7%,respectively,and the area under the curve was 0.747.Conclusion:Serum ferritin level could be an independent predictor of disease progression in patients with CTD-ILD.