The Importance of Serial Pulmonary Function Tests in Determining Prognosis in Idiopathic Pulmonary Fibrosis "Retrospective Analysis
Öz
Objective: Our study aimed to retrospectively observe the value of serial pulmonary function test (PFT) parameters in predicting prognosis in patients with idiopathic pulmonary fibrosis (IPF). Secondarily, to determine the relationship between PFT parameters and other variables such as age, gender, smoking, and systolic pulmonary artery pressure (SPAP).
Materials and Methods: Demographic data and PFT’s at initial and follow-up (6,12,24,36,48, and 60.months) and SPAP values were recorded in 94 patients.
Results: The mean age of the population was 62.8±10.3 years, and 71.3% (67 patients) were male. The mean follow-up period was 41.03±27.02 months. Of the patients, 59.4% (60 patients) died during follow-up. Thirty-two patients (34%) had their diagnosis confirmed by surgical lung biopsy. Age was not associated with survival or PFT losses. However, patients under the age of 50 and with high SPAP had significantly lower survival (p=0.039,p<0.001).High SPAP was associated with the ratio of carbonmonoxide diffusion capacity to alveolar volume (DLCO/VA,p=0.05). The survival of patients who lost 10% and 15% of their baseline forced vital capacity and DLCO, respectively, within the first 6 and 12 months, was not different from those who didn’t experience this loss.
Conclusion: In our study, the parameters determining the prognosis in IPF were diagnosed under the age of 50 and high SPAP. In the under-50 group, prognosis was not associated with changes in PFT, whereas high SPAP was associated with DLCO/VA. With the introduction of effective treatments in IPF, prognostic studies are essential in monitoring and also directing patients to transplantation at appropriate time.
Anahtar Kelimeler
Idiopathic pulmonary fibrosis pulmonary function test systolic pulmonary artery pressure
Kaynakça
- American Thoracic Society, Idiopathic Pulmonary Fibrosis, Diagnosis and treatment, International Concensus Statement. Am J Respir Crit Care Med 2000; 161: 646-64.
- Raghu G, Weycker D, Edelsberg J et al, Incidence and Prevalence of Idiopathic Pulmonary Fibrosis. Am Journal of Respir Crit Care Med 2006; 174: 810-6.
- Gribbin J, Hubbard RB, Le Jeune I, et al, Incidence and mortality of idiopathic pulmonary fibrosis and sarcoidosis in the UK, Thorax 2006; 61: 980–5.
- Karakatsani A, Papakosta D, Rapti A, et al, Hellenic Interstitial Lung Diseases Group, Epidemiology of interstitial lung diseases in Greece, Respir Med 2009; 103: 1122-9.
- King TE Jr, Tooze JA, Schwarz MI, et al, Predicting survival in idiopathic pulmonary fibrosis, Scoring system and survival model, Am J Respir Crit Care Med 2001; 164: 1171-81.
- Fell CD, Martinez FJ, Liu LX, et al, Clinical predictors of a diagnosis of idiopathic pulmonary fibrosis, Am J Respir Crit Care Med 2010; 181: 832-7.
- Iommi M, Faragalli A, Bonifazi M, et al, Prognosis and Survival in Idiopathic Pulmonary Fibrosis in the Era of Antifibrotic Therapy in Italy: Evidence from a Longitudinal Population Study Based on Healthcare Utilization Databases, Int J Environ Res Public Health, 2022; 19: 16689.
- Mogulkoc N, Martin HB, Bishop PW et al, Pulmonary Function in Idiopathic Pulmonary Fibrosis and Referral for Lung Transplantation, Am J Respir Crit Care Med 2001; 164: 103-8.
- An Official ATS/ERS/JRS/ALAT Statement: Idiopathic Pulmonary Fibrosis: Evidence-based Guidelines for Diagnosis and Management, Am J Respir Crit Care Med 2011; 183: 788-824.
- Ley B, Collard H, King T Jr, Clinical Course and Prediction of Survival in İdiopathic Pulmonary Fibrosis, Am J Respir Crit Care Med 2011; 183: 431-40.
- Erbes R, Schaberg T, Loddenkemper R, Lung function tests in patients with idiopathic pulmonary fibrosis, Are they helpful for predicting outcome? Chest 1997; 111: 51-57.
- Nalysnyk L, Ruzafa J, Rotella P, et al, Incidence and prevalence of idiopathic pulmonary fibrosis: review of the literature, Eur Respir Rev 2012; 21: 355-61.
- Han MK, Murray S, Fell CD, et al, Sex differences in physiological progression of idiopathic pulmonary fibrosis, Eur Respir J 2008; 31: 1183-8.
- Mejia M, Carrillo G, Rojas-Serrano J, et al, Idiopathic pulmonary fibrosis and emphysema: decreased survival associated with severe pulmonary arterial hypertension, Chest 2009; 136: 10-15.
- Kitamura H, Ichinose S, Hosoya T et al, Inhalation of inorganic particles as a risk factor for idiopathic pulmonary fibrosis: elemental microanalysis of pulmonary lymph nodes obtained at autopsy cases, Pathol Res Pract 2007; 203: 575-85.
- Mejia M, Carrillo G, Rojas-Serrano J, et al, Idiopathic pulmonary fibrosis and emphysema: decreased survival associated with severe pulmonary arterial hypertension, Chest 2009; 136: 10-15.
- Ryu JH, Colby TV, Hartman TE, et al, Smoking-related interstitial lung diseases: a concise review, Eur Respir J 2001; 17: 122-32.
- Nadrous HF, Pellikka PA, Krowka MJ, et al, Pulmonary hypertension in patients with idiopathic pulmonary fibrosis, Chest 2005; 128: 2393-9.
- Galie N, Hoeper M, Humbert M, et al, Guidelines on diagnosis and treatment of pulmonary hypertension, European Heart Journal 2009; 30: 2493-537.
- Nathan SD, Shlobin OA, Barnett SD, et al, Right ventricular systolic pressure by echocardiography as a predictor of pulmonary hypertension in idiopathic pulmonary fibrosis, Respir Med, 2008; 102: 1305–10.
- Latsi PI, du Bois RM, Nicholson AG, Fibrotic Idiopathic Interstitial Pneumonia: The Prognostic Value of Longitudinal Functional Trends Am J Respir Crit Care Med 2003; 168: 531-7.
- Peelen L, Wells AU, Prijs M, at al, Fibrotic idiopathic intestitial pneumonias: Mortality is linked to a decline in gas transfer Respirology 2010; 15: 1233-43.
İdiyopatik Pulmoner Fibroziste Seri Solunum Fonksiyon Testlerinin Prognozu Belirlemedeki Önemi "Retrospektif Analiz''
Öz
Amaç: Çalışmamızın amacı; idiyopatik pulmoner fibrozisli (IPF) hastaların seri solunum fonksiyon testi (SFT) ölçüm parametrelerinin prognozu öngörmedeki değerini retrospektif olarak gözlemlemektir. İkincil olarak ise yaş, cinsiyet, sigara öyküsü, sistolik pulmoner arter basıncı (SPAB) yüksekliği gibi diğer değişkenlerle prognoz ve SFT parametreleri arasındaki ilişkiyi saptamaktır.
Gereç ve Yöntem: Çalışmaya dahil edilen 94 olgunun demografik verileri yanısıra ilk başvurudaki ve izlemdeki (6.ay, 12.ay, 24.ay, 36.ay, 48.ay ve 60.ay) SFT ölçümleri ve SPAB değerleri kaydedilmiştir.
Bulgular: Çalışma grubunun yaş ortalaması 62.8±10.3 olup %71.3’ü (67 olgu) erkektir. Ortalama izlem süreleri 41.03±27.02 aydır. Hastaların %59.4’ü (60 hasta) çalışma izleminde hayatını kaybetmiştir. Otuziki olgunun (%34) tanısı cerrahi akciğer biyopsisi ile doğrulanmıştır. Yaşın genel sağkalımla veya izlemdeki SFT kayıplarıyla ilişkisiz olduğu saptanmıştır. Ancak 50 yaş altı olgu grupta ortalama sağkalımın belirgin düşük olduğu gözlenmiştir (p=0.039). SPAB düzeyi yüksek olan olguların gerek genel sağkalım gerekse ekokardiyografi sonrası sağkalım sürelerinin anlamlı düşük olduğu saptanmış (p=0.006 ve p<0.001) ve SPAB yüksekliğinin karbonmonoksit difüzyon kapasitesinin alvoler volüme oranı (DLCO/VA) ile ilişkili olduğu gözlenmiştir (p=0.05). Bazal zorlu vital kapasite ve DLCO değerinin sırasıyla %10 ve %15’ini ilk 6 ve 12 ay içerisinde kaybeden olguların sağkalımlarının bu kaybı yaşamayanlarla farklı olmadığı görülmüştür.
Sonuç: Çalışmamızda IPF’de prognozu belirleyen parametreler; 50 yaşın altında tanı almak ve SPAB’nın yüksek saptanması olarak belirlenmiştir. 50 yaş altı grubun prognozu SFT’deki değişimlerle ilişkisiz, SPAB yüksekliği ise DLCO/VA’daki değişim ile ilişkili saptanmıştır. IPF’de etkili tedavilerin kullanılmaya başlanmasıyla birlite tedavi izleminin yanısıra hastaların uygun zamanda transplantasyona yönlendirilmesi açısından prognostik çalışmalar önem taşımaktadır.
Anahtar Kelimeler
İdiyopatik pulmoner fibrozis solunum fonksiyon testi sistolik pulmoner arter basıncı
Etik Beyan
İntihal raporundaki %45 intihal görülen kısmın %44'ü yine kendi çalışmama aittir. Çalışmam bir tez çalışması olduğundan kendisi ile intihal göstermektedir. Dikkatinize sunarım
Kaynakça
- American Thoracic Society, Idiopathic Pulmonary Fibrosis, Diagnosis and treatment, International Concensus Statement. Am J Respir Crit Care Med 2000; 161: 646-64.
- Raghu G, Weycker D, Edelsberg J et al, Incidence and Prevalence of Idiopathic Pulmonary Fibrosis. Am Journal of Respir Crit Care Med 2006; 174: 810-6.
- Gribbin J, Hubbard RB, Le Jeune I, et al, Incidence and mortality of idiopathic pulmonary fibrosis and sarcoidosis in the UK, Thorax 2006; 61: 980–5.
- Karakatsani A, Papakosta D, Rapti A, et al, Hellenic Interstitial Lung Diseases Group, Epidemiology of interstitial lung diseases in Greece, Respir Med 2009; 103: 1122-9.
- King TE Jr, Tooze JA, Schwarz MI, et al, Predicting survival in idiopathic pulmonary fibrosis, Scoring system and survival model, Am J Respir Crit Care Med 2001; 164: 1171-81.
- Fell CD, Martinez FJ, Liu LX, et al, Clinical predictors of a diagnosis of idiopathic pulmonary fibrosis, Am J Respir Crit Care Med 2010; 181: 832-7.
- Iommi M, Faragalli A, Bonifazi M, et al, Prognosis and Survival in Idiopathic Pulmonary Fibrosis in the Era of Antifibrotic Therapy in Italy: Evidence from a Longitudinal Population Study Based on Healthcare Utilization Databases, Int J Environ Res Public Health, 2022; 19: 16689.
- Mogulkoc N, Martin HB, Bishop PW et al, Pulmonary Function in Idiopathic Pulmonary Fibrosis and Referral for Lung Transplantation, Am J Respir Crit Care Med 2001; 164: 103-8.
- An Official ATS/ERS/JRS/ALAT Statement: Idiopathic Pulmonary Fibrosis: Evidence-based Guidelines for Diagnosis and Management, Am J Respir Crit Care Med 2011; 183: 788-824.
- Ley B, Collard H, King T Jr, Clinical Course and Prediction of Survival in İdiopathic Pulmonary Fibrosis, Am J Respir Crit Care Med 2011; 183: 431-40.
- Erbes R, Schaberg T, Loddenkemper R, Lung function tests in patients with idiopathic pulmonary fibrosis, Are they helpful for predicting outcome? Chest 1997; 111: 51-57.
- Nalysnyk L, Ruzafa J, Rotella P, et al, Incidence and prevalence of idiopathic pulmonary fibrosis: review of the literature, Eur Respir Rev 2012; 21: 355-61.
- Han MK, Murray S, Fell CD, et al, Sex differences in physiological progression of idiopathic pulmonary fibrosis, Eur Respir J 2008; 31: 1183-8.
- Mejia M, Carrillo G, Rojas-Serrano J, et al, Idiopathic pulmonary fibrosis and emphysema: decreased survival associated with severe pulmonary arterial hypertension, Chest 2009; 136: 10-15.
- Kitamura H, Ichinose S, Hosoya T et al, Inhalation of inorganic particles as a risk factor for idiopathic pulmonary fibrosis: elemental microanalysis of pulmonary lymph nodes obtained at autopsy cases, Pathol Res Pract 2007; 203: 575-85.
- Mejia M, Carrillo G, Rojas-Serrano J, et al, Idiopathic pulmonary fibrosis and emphysema: decreased survival associated with severe pulmonary arterial hypertension, Chest 2009; 136: 10-15.
- Ryu JH, Colby TV, Hartman TE, et al, Smoking-related interstitial lung diseases: a concise review, Eur Respir J 2001; 17: 122-32.
- Nadrous HF, Pellikka PA, Krowka MJ, et al, Pulmonary hypertension in patients with idiopathic pulmonary fibrosis, Chest 2005; 128: 2393-9.
- Galie N, Hoeper M, Humbert M, et al, Guidelines on diagnosis and treatment of pulmonary hypertension, European Heart Journal 2009; 30: 2493-537.
- Nathan SD, Shlobin OA, Barnett SD, et al, Right ventricular systolic pressure by echocardiography as a predictor of pulmonary hypertension in idiopathic pulmonary fibrosis, Respir Med, 2008; 102: 1305–10.
- Latsi PI, du Bois RM, Nicholson AG, Fibrotic Idiopathic Interstitial Pneumonia: The Prognostic Value of Longitudinal Functional Trends Am J Respir Crit Care Med 2003; 168: 531-7.
- Peelen L, Wells AU, Prijs M, at al, Fibrotic idiopathic intestitial pneumonias: Mortality is linked to a decline in gas transfer Respirology 2010; 15: 1233-43.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Göğüs Hastalıkları |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 9 Aralık 2024 |
| Gönderilme Tarihi | 22 Mayıs 2024 |
| Kabul Tarihi | 14 Ağustos 2024 |
| Yayımlandığı Sayı | Yıl 2024 |