纤维化性间质性肺疾病进展预测模型构建研究

Construction of a prediction model for progression of fibrotic interstitial lung disease

  • 摘要: 背景 纤维化性间质性肺疾病(progressive fibrosing interstitial lung diseases,FILD),病死率高,预后差,目前关 于FILD进展的相关因素尚无明确定论。目的 分析FILD进展的相关因素并构建对应的预测模型。方法 本研究为多中心 回顾性研究。收集2019年1月1日至2023年12月31日在解放军总医院第四、第六、第八医学中心呼吸与危重症医学科住院 接受治疗的FILD患者临床资料。符合进行性纤维化性间质性肺疾病(progressive fibrosing interstitial lung diseases,P-FILD) 定义的纳入进展组,其余纳入稳定组,比较进展组与稳定组的基线临床资料。采用Lasso回归、多元全模logistic回归、多 元逐步 logistic 回归三种方式筛选与疾病进展相关的变量。绘制后两个多因素模型的受试者工作特征(receiver operating characteristic curve,ROC)曲线,并评估比较各模型的预测性能。结果 443例FILD患者中215例(48.5%)发生进展,其中男 性 123 例,女性 92 例,平均年龄(66.6±11.1)岁;228 例(51.5%)未进展(稳定组),其中男性 122 例,女性 106 例,平均年龄 (65.5±10.8)岁。进展组与稳定组相比,有吸烟史及合并肺动脉高压患者人数占比较高,mMRC评分、CA19-9、CEA及CA125 水平较高,FVC%pred 及 DLCO%pred 水平较低,差异均有统计学意义(P<0.05)。多元 Logistic 逐步回归结果显示: mMRC评分≥2分(OR=3.533,95% CI:1.950 ~ 6.401)、FVC%pred(OR=0.951,95% CI:0.935 ~ 0.967)、DLCO% pred (OR= 0.942,95% CI:0.926 ~ 0.958)、合并肺动脉高压(OR=2.745,95% CI:1.430 ~ 5.270)与 FILD 的进展独立关联, 与多元 Logistic全模回归及LASSO回归筛选结果一致。多元全模回归及多元逐步回归两个模型的ROC曲线下面积AUC值分别为: 0.844、0.840。结论 mMRC评分≥2分、基线FVC%pred及DLCO%pred低、合并肺动脉高压与FILD发生进展独立相关, 应针对具有这些特征患者密切随访尽早启动抗纤维化治疗,以降低FILD进展的风险。

     

    Abstract: Background Progressive fibrosing interstitial lung diseases (FILD) are associated with high mortality and poor prognosis. However, the factors influencing the progression of FILD have not yet been conclusively established.Objective To identify factors associated with the progression of FILD and develop a corresponding predictive model. Methods This study was a multicenter retrospective study. Clinical data about patients with FILD who were admitted to the Department of Respiratory and Critical Care Medicine at the Fourth, Sixth, and Eighth Medical Centers of Chinese PLA General Hospital from January 1, 2019, to December 31, 2023, were collected. Patients who met the definition of progressive fibrosing interstitial lung diseases (P-FILD) were included in the progression group, while the remaining patients were assigned to the stable group. Baseline clinical data were compared between the progression and stable groups. Variables associated with disease progression were selected using three methods: Lasso regression, multivariate full model logistic regression and multivariate stepwise logistic regression. Receiver operating characteristic (ROC) curves were generated for the latter two multivariate models, and the predictive performance of each model was evaluated and compared. Results A total of 443 patients were included, There were 245 (55.3%) males and 198 (44.7%) females with a mean age of (66.0±11.0) years. There were 215(48.5%) cases in the progressive group, with 123 (57.2%) males and 92 (42.8%) females, a mean age of (66.6±11.1) years. In the stable group, there were 228 cases (51.5%), 122 (53.5%) males and 106 (46.5%) females with a mean age of (65.5±10.8) years. Compared with the stable group, the progressive group had a higher number of patients with smoking history and combined pulmonary hypertension, higher levels of mMRC score, CA19-9, CEA and CA-125, and lower levels of FVC%pred and DLCO%pred, and the difference between the two groups was statistically significant (P<0.05). Multivariate stepwise logistic regression analysis showed that mMRC score of ≥2 (OR=3.533, 95%CI: 1.950 - 6.401), FVC% pred (OR=0.951, 95%CI: 0.935 - 0.967), DLCO% pred (OR=0.942, 95%CI: 0.926 - 0.958), and the presence of pulmonary hypertension (OR=2.745, 95%CI: 1.430 - 5.270) were independently associated with the progression of FILD. These results were consistent with those obtained from multivariate full model logistic regression and lasso regression. The AUC values of the ROC curves for the multivariate full-model regression and multivariate stepwise regression models were 0.844 and 0.840, respectively. Conclusion mMRC score of ≥2, low baseline levels of FVC%pred and DLCO%pred, and the presence of pulmonary hypertension are independently associated with the progression of FILD. Close follow-up and early initiation of antifibrotic therapy should be considered for patients with these factors to reduce the risk of disease progression.

     

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