A Retrospective Study Of The Clinical Characteristics Of Interstitial Lung Diseases Admitted To A Single Center And Their Correlation With Lung Cancer During 13 Years

Objective This study retrospectively analyzed the demographic characteristics,clinical characteristics,diagnosis and treatment methods and curative effects of patients with interstitial lung disease(ILD),explored the rules,and provided evidence-based medicine for clinical evidence.Methods(1)With the help of Inner Mongolia Medical University’s Yidu Cloud big data platform and electronic medical record lending system,ILD patients who were treated in the Department of Respiratory Medicine of the Affiliated Hospital of Inner Mongolia Medical University for 13 years(January 2008-December 2020)were collected.(2)Divide ILD patients into the following four cohorts: IIP cohort,CTD-ILD cohort,IPAF cohort,ILD-LC cohort.(3)Single-center observational cohort study(retrospective,prospective,non-interventional).(4)Retrospective analysis of its demographic characteristics,clinical characteristics,diagnosis and treatment,and efficacy and other indicators.(5)Use SPSS20.0 statistical software for statistical analysis.Results(1)During 13 years,our center has admitted 1737 patients with ILD,and the number of diagnoses has increased year by year,with the diagnosis rate rising from 2.4% to 7.2%.After excluding incomplete cases,there are 1473 cases remaining,including 891 males(60.5%)and582 females(39.5%).The male to female ratio is 1.53:1,and the average age of onset is 66±11.8years(22-95 years).(2)Men in the ILD-LC group(88.3%)had the highest smoking rate(77.5%)and the number of people with a smoking index> 400(51.4%).(3)There are 133 patients(9.0%)with a clear history of exposure to hazardous substances and animal exposure.The ranking of risk factors is dust(35%),toxic gases(18%),metals(16%),chemical agents 15%),animals(12%),wood chips(4%).(4)In the ILD-LC group,the incidence of cough(86.5%),hemoptysis(13.5%),and chest pain(25.2%)was the highest,while the incidence of fever(7.2%)was the lowest in the ILD-LC group.Dry mouth and dry eyes have the highest incidence in CTD-ILD(20.8%)and IPAF(40.5%).Raynaud’s phenomenon has the highest incidence in CTD-ILD(5.5%)and IPAF(7.1%)groups,while cyanosis has the highest incidence in IIP(56.3%)and CTD-ILD(55.8%)groups.Velcro rales are in CTD-ILD(44.2%)the highest incidence.(5)In terms of laboratory and auxiliary examinations,FVC and DLCO have the most significant decline in lung function,which has the largest decline in the CTD-ILD group,while the decline in lung function in the ILD-LC and IPAF groups is relatively small.The expression level of CEA in the IIP group was higher than that in the CTD-ILD group,but the ferritin level was lower than that in the CTD-ILD group.The expression level of CYFRA21-1 in the CTD-ILD group was higher than that in the IPAF group.(6)Among comorbidities and complications,the incidence of pulmonary hypertension in the IIP(35.5%)and CTD-ILD(39.6%)groups was the highest,and hypothyroidism in CTD-ILD(6.4%)and IPAF(7.1%)occurred The highest rate.(7)In terms of treatment,the treated patients received GC treatment(72%).The prognosis of GC treatment in the IIP cohort was the best,and the prognosis of GC combined with immunosuppressants in the CTD-ILD cohort was the best.The IPAF cohort had the best prognosis.The prognosis of internal GC treatment is the best.(8)The subgroup analysis of CTD-ILD is as follows:(1)The median time from the diagnosis of CTD to the onset of ILD is8 years(0.5-46 years)in terms of disease course,of which the median time for PM/DM and SS is the shortest(1.25 years and 1.5 years)),SLE and RA have the longest median time(10 years and 12 years).(2)Since the end of 2018,samples sent to our hospital for MDA5 antibody examination,a total of 18 cases have been found to be positive,of which 16 cases(88.9%)have combined ILD.Skin rash,decreased muscle strength,Gottron sign,and elevated ferritin are high-risk factors for patients with anti-MDA5-positive dermatomyositis-related ILD,of which3 cases developed RPILD.(3)In terms of complications,the incidence of pulmonary hypertension in the CTD-ILD group with dry mouth and dry eyes was higher than that in the group without dry mouth and eyes.(9)In this study,the incidence of ILD-LC in ILD was 7.5%,the pathological type was mainly adenocarcinoma(42.3%),the clinical stage IV was the most(64.8%),and the upper lobe of the right lung was mainly distributed(28.8%).The most common ILD-LCs related to CTD are RA,SSC and PM/DM.The median time from the diagnosis of IIP to the onset of LC was 36 months(29-60 months),and the median time from the diagnosis of CTD-ILD to the onset of LC was 60 months(12-144 months).The mutation rates of EGFR,ALK,and MET were 16%,4%,and 4%,respectively.The median PFS of NSCLC patients receiving chemotherapy,targeted therapy and SCLC patients receiving chemotherapy were 4.5,4.2,and 3.9 months,and the median OS was 9.7,8.6,and 8.2 months,respectively.One patient with targeted therapy and two patients with radiotherapy developed AEILD,with one death in each.There were 3 cases of AEILD in the chemotherapy group,and the condition was well controlled after the application of hormone therapy,and no death occurred.Conclusion(1)The number of patients diagnosed with ILD in our center is increasing year by year,the male to female ratio is 1.53:1,and the average age of onset is 66±11.8 years.In CTD-ILD,the median time from the diagnosis of CTD to the onset of ILD was 8 years(0.5-46years).Among them,the median time from PM/DM and SS was the shortest(1.25 years and1.5 years),and the median time from SLE and RA was the longest(10 years).Years and Years12),the most common types of exposure to hazardous substances are dust(35%),toxic gases(18%),and metals(16%).(2)The occurrence of hemoptysis and chest pain should be highly suspected of ILD-LC,while the occurrence of pulmonary Velcro rales,dry mouth and eyes,Raynaud’s phenomenon,hypothyroidism should consider the possibility of CTD-ILD or IPAF,skin rash,and decreased muscle strength,Gottron’s sign,and elevated ferritin are high risk factors for ILD associated with anti-MDA5-positive dermatomyositis.The CTD-ILD cohort had relatively poor pulmonary function,with the largest decrease in FVC and DLCO.CEA and ferritin can be used as the basis for the identification of IIP and CTD-ILD,and CYFRA21-1has suggestive significance for the identification of CTD-ILD and IPAF.(3)IIP and IPAF are more suitable for GC treatment,and CTD-ILD is more suitable for GC combined with immunosuppressive therapy.(4)The incidence of ILD-LC in ILD is 7.5%.ILD-LC is mainly pathological type adenocarcinoma(42.3%),with the most clinical stage IV(64.8%).The median time from IIP to LC was 36 months,and the median time from CTD-ILD to LC was 60 months.The EGFR mutation rate in ILD-LC is 16%,and its prognosis after receiving chemotherapy and targeted therapy is poor,suggesting that ILD is an influencing factor for the poor prognosis of LC.