Related Studies Of Inflammatory Markers In The Progression Of Fibrosing Interstitial Lung Disease To Progressive Pulmonary Fibrosis

Background Interstitial lung disease(ILD)is a group of heterogeneous lung diseases that mainly affect the interstitial and alveolar spaces of the lungs,leading to the loss of alveolar capillary functional units.Fibrosing interstitial lung diseases(FILD)is a general term for a large class of ILD characterized by fibrosis on high resolution CT(HRCT)of the lung.Common diseases in FILD include idiopathic pulmonary fibrosis(IPF),connective tissue disease ? associated ILD(CTD ILD),hypersensitivity pneumonitis(HP),nonspecific interstitial pneumonia(NSIP),and poorly classified ILD.In recent years,clinicians and scholars have found that,in addition to IPF,some other non IPF types of FILD still exhibit rapid and progressive deterioration of lung function,respiratory symptoms,and chest CT after formal treatment,resulting in a natural course similar to IPF.This type of patient has a higher mortality rate and shorter survival cycle.In order to raise awareness of such diseases,the concept of "Progressive Pulmonary Fibrosis(PPF)" was first proposed in the 2022 Clinical Practice Guidelines for Adult Idiopathic and Progressive Pulmonary Fibrosis to include these non IPF ILDs with similar clinical disease behaviors.Currently,there are problems in clinical practice such as unclear general clinical characteristics of patients with PPF and risk factors for the progression of FILD to PPF.Objective(1)Understand the general clinical characteristics of patients with PPF.(2)To explore whether infection and inflammatory reactions play a catalytic role in the progression of FILD to PPF.(3)To explore the correlation between the levels of inflammatory indicators and baseline pulmonary diffusion function in patients with PPF.(4)To explore the value of inflammatory markers in predicting the progression of FILD to PPF.Methods(1)Patients with a discharge diagnosis of ILD admitted to the Second People’s Hospital of Yichang from January 2018 to September 2021 were collected,and the enrolled patients were followed up for no more than 1 year according to the inclusion and exclusion criteria,and patients who progressed to PPF were included in the case group and those who did not progress to PPF were included in the control group according to the 2022 PPF diagnostic guidelines;(2)retrospectively,all enrolled Patients’(i)general data: gender,age,disease subtype,smoking index,body mass index,duration of ILD disease,history of hormone and anti-rheumatic drug use,FVC% expected value,DLCO% expected value;(ii)previous medical history: COPD,gastroesophageal reflux,immune diseases,acute coronary syndrome,diabetes mellitus,osteoporosis;(iii)laboratory indices: white blood cell(WBC)count,neutrophil granulocyte percentage,NLR,LMR,PLR,ESR,CRP,glutathione aminotransferase,glutamic oxalacetic aminotransferase,blood creatinine;(3)SPSS 26.0 was used for statistical analysis.The differences between the general data,previous medical history conditions and laboratory indices between the two groups were compared and analyzed,and the variables with statistically significant differences in the univariate logistic regression analysis were used to explore the risk factors for the progression of FILD to PPF using multi-factor logistic regression;bivariate correlation analysis was performed using Spearman’s method;subject work characteristic(ROC)curves were used To explore the value of inflammatory indexes for the diagnosis of progression of FILD to PPF.Results(1)A total of 170 patients were included in this study,including 89 patients(52.35%)in the case group and 81 patients(47.65%)in the control group;the mean age,duration of disease,degree of FVC decline,and degree of diffusion hypoplasia were significantly higher in the case group than in the control group,and the body mass index was significantly lower than in the control group,with statistically significant differences(P<0.05);the differences between the two groups were statistically significant in terms of gender,smoking index,and The differences were not statistically significant when comparing the two groups in terms of gender,smoking index,and disease subtypes(P>0.05).(2)When comparing the past medical history of the two groups,there were significantly more patients with COPD,gastroesophageal reflux,acute coronary syndrome and osteoporosis in the case group than in the control group,and the difference was statistically significant(P<0.05);when comparing the history of immune diseases,diabetes mellitus,anti-rheumatic drugs and hormone administration in the two groups,the difference was not statistically significant(P>0.05).(3)Comparing the serological data of the two groups,the WBC count,neutrophil percentage,NLR,PLR,CRP and ESR of the patients in the case group were significantly higher than those in the control group,and the LMR was significantly lower than that of the control group,with statistically significant differences(P<0.05);there were no statistically significant differences(P>0.05)in the comparison of the indicators of glutamic aminotransferase,glutamic oxalacetic aminotransferase and creatinine.(4)The results of multi-factor logistic regression analysis showed that ESR,moderate and severe reduction in baseline DLCO% predicted and combined COPD,and osteoporosis were independent risk factors for progression to PPF in patients with FILD(P<0.05),and LMR and body mass index were protective factors for progression to PPF in patients with FILD(P<0.05).(5)Spearman’s correlation analysis was used to investigate the correlation between the levels of NLR,LMR,PLR,CRP,ESR and the degree of pulmonary diffusion decompensation,and the results showed that the ESR level was positively correlated with the degree of pulmonary diffusion decompensation(P<0.05).(6)The ROC curve was used to clarify the accuracy of NLR,LMR,PLR,ESR and the combination of the four in predicting progression to PPF in patients with FLD,and the results showed that the AUCs of NLR,LMR,PLR and ESR in diagnosing progression to PPF in patients with FLD were 0.683,0.664,0.618 and 0.674,respectively,and the AUC of the combined test of the four was 0.732;combining the area under the ROC curve,the combined test of the four had the highest accuracy in predicting progression to PPF in patients with FILD(sensitivity=78.7%,specificity=60.5%).Conclusion(1)Patients with PPF are older,have longer disease duration,and have poorer pulmonary diffusion function.(2)Patients with combined COPD,moderately and severely reduced pulmonary diffusion function,osteoporosis,and low body mass index with FIRD are more likely to develop PPF and should be focused on this group.(3)High ESR is an independent risk factor for progression to PPF in patients with FILD,suggesting that infection or inflammatory response will accelerate the progression of pulmonary fibrosis,therefore,such patients should avoid respiratory infections as much as possible,and if combined with autoimmune diseases,the primary disease should be treated actively.(4)Spearman correlation analysis of ESR and baseline DLCO decompensation suggests that there is a positive correlation between the ESR and the patient’s degree of decompensation,suggesting that the more severe the infection or inflammatory response,the worse the patient’s pulmonary diffusion function,and further suggesting that inflammation promotes PPF.(5)NLR,LMR,PLR,ESR and the combination of the four tests can be used as predictors of progression to PPF in patients with FILD,among which the accuracy of the combination of the four tests is the highest,and it is suggested that the above tests should be completed in time to assess patients’ conditions.