Rationale: Particulate matter with an aerodynamic diameter ⩽2.5 μm is associated with adverse outcomes in fibrotic interstitial lung disease (fILD), but the impact of ultrafine particulates (UFPs; aerodynamic diameter ⩽100 nm) remains unknown. Objective: To evaluate UFP associations with clinical outcomes in fILD. Methods: We conducted a multicenter, prospective cohort study enrolling patients with fILD from the University of Pittsburgh Dorothy P. and Richard P. Simmons Center and the Pulmonary Fibrosis Foundation Patient Registry (PFF-PR). Using a national-scale UFP model, we linked exposures using three approaches in the Simmons cohort (residential address geocoordinates, ZIP code centroid geocoordinates, and ZIP code average) and two in the PFF-PR for which only five-digit ZIP code was available (ZIP code centroid and ZIP code average). We tested UFP associations with transplantation-free survival using multivariable Cox proportional-hazards models, baseline percentage predicted FVC and DlCO using multivariable linear regressions, and decline in FVC and DlCO using linear mixed models adjusting for age, sex, smoking, race, socioeconomic status, site, particulate matter with an aerodynamic diameter ⩽2.5, and nitrogen dioxide. Measurements and Main Results: Annual mean outdoor UFP concentrations for 2017 were estimated for 1,416 Simmons and 1,919 PFF-PR patients. Increased UFP concentration was associated with transplantation-free survival in fully adjusted Simmons residential address models (hazard ratio, 1.08 per 1,000 particles/cm3 [95% confidence interval, 1.01-1.15]; P = 0.02) but not PFF-PR models, which used less precise linkage approaches. Higher UFP exposure was associated with lower baseline FVC and more rapid FVC decline in the Simmons registry. Conclusions: Increased UFP exposure was associated with transplantation-free survival and lung function in the cohort with precise residential location linkage. This work highlights the need for more robust regulatory networks to study the health effects of UFPs nationwide.

中文翻译：

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环境超细颗粒物和纤维化间质性肺病的临床结果。


理由：空气动力学直径≤2.5μm的颗粒物与纤维化间质性肺病（fILD）的不良后果相关，但超细颗粒物（UFP；空气动力学直径≤100nm）的影响仍不清楚。目的：评估 UFP 与 fILD 临床结果的关联。方法：我们进行了一项多中心、前瞻性队列研究，招募来自匹兹堡大学 Dorothy P. 和 Richard P. Simmons 中心以及肺纤维化基金会患者登记处 (PFF-PR) 的 fILD 患者。使用全国范围的 UFP 模型，我们使用 Simmons 队列中的三种方法（居住地址地理坐标、邮政编码质心地理坐标和邮政编码平均值）和 PFF-PR 中的两种方法（仅提供五位邮政编码）将暴露联系起来。 （邮政编码质心和邮政编码平均值）。我们使用多变量 Cox 比例风险模型测试了 UFP 与无移植生存的关联，使用多变量线性回归预测 FVC 和 DICO 的基线百分比，并使用调整年龄、性别、吸烟、种族、社会经济地位的线性混合模型测试 FVC 和 DICO 的下降，场地，空气动力学直径⩽2.5的颗粒物，二氧化氮。测量和主要结果：估计 1,416 名 Simmons 患者和 1,919 名 PFF-PR 患者 2017 年室外 UFP 平均浓度。在完全调整的 Simmons 居住地址模型中，UFP 浓度增加与无移植生存相关（风险比，1.08 每 1,000 个颗粒/cm3 [95% 置信区间，1.01-1.15]；P = 0.02），但与 PFF-PR 模型无关，其中使用不太精确的链接方法。较高的 UFP 暴露与较低的基线 FVC 和 Simmons 登记中的 FVC 下降更快相关。 结论：在具有精确居住位置关联的队列中，UFP 暴露增加与无移植生存率和肺功能相关。这项工作强调需要更强大的监管网络来研究全国范围内 UFP 的健康影响。