2020年 · 第43卷第03期

At the beginning of the new year of 2020, during the winter holiday and Spring Festival travel rush, a sudden outbreak of novel coronavirus infection swept across the country from Wuhan, the thoroughfare of nine provinces, causing a spreading situation. The World Health Organization declared the outbreak of SARS-CoV-2 infection as a global public health emergency on January 31, 2020. Thank you to each of our readers, authors and editors who have fought in the front line of the fight against novel coronavirus (COVID-19 for short), and to every colleague from all walks of life who has worked harder to support the front line. As of the publication of this magazine, the domestic epidemic situation has been well controlled, and there have been no new cases in many provinces, autonomous regions and municipalities for many consecutive days.

In December 2019, multiple cases of cluster unidentified pneumonia were found in Wuhan, which were confirmed by research to be caused by 2019 novel coronavirus (2019-nCoV). The novel coronavirus pneumonia epidemic has now spread to the whole country, and as of February 6, 2020, a total of 31,161 confirmed cases have been reported nationwide. The emergence of a large number of new cases has brought great challenges to disease management. In order to standardize clinical diagnosis and treatment, the National Health Commission quickly formulated the Diagnosis and Treatment Plan of Pneumonia Infected by Novel Coronavirus, which has been updated to the fifth edition of trial.

Previous studies have suggested that systemic sclerosis-associated interstitial lung disease (SSc-ILD) progresses rapidly in the early stage of the disease course, but the disease course stabilizes or even stops progressing 4 years after diagnosis. This study aims to determine whether there are different prognostic phenotypes of SSc-ILD by observing whether there is a significant plateau in the course of pulmonary function decline in SSc-ILD patients and whether there is a correlation between different prognostic types. Methods: This study cohort came from an SSc-ILD specialized clinic, and included SSc-ILD cases admitted from January 1998 to June 2016. The diagnostic criteria of SSc were referred to the diagnostic criteria of ACR, while ILD was determined by thoracic HRCT; Follow-up was performed every 6 months (pulmonary function, 6-min walk test, and annual color ultrasound). According to the survival period, they were divided into three groups: long-term survival group (survival>8 years), intermediate death group (survival 4 to 8 years) and short-term death group (survival<4 years). Follow-up period excluded<Patients of 8 years. The generalized linear model was used to calculate the FVC for each patient as % of the predicted value and D_LThe slope of the decrease in CO as % of the predicted value to compare the rate of decrease in FVC as % of the predicted value between different prognostic groups. Results: (1) A total of 171 patients with SSc-ILD were screened. The median survival time was 11.2 years, including 37 patients in the long-term survival group, 19 patients in the middle-term death group and 25 patients in the short-term death group. The remaining 90 patients who had been followed up for less than 8 years at the end of the study were excluded. (2) Throughout the entire cohort (FIG. 1A), FVC accounted for an average of 1.06% per year in % of the predicted value, showing a significant decrease in the first 4 years of the disease course, a significant plateau period between 4 and 8 years of the disease course, and a significant decrease after 8 years of the disease course. (3) Baseline FVC accounted for 80% of the projected value in the long-term survival group and 70% in the other two groups. The decreasing curves of FVC as % of the predicted value of the three groups all showed a nearly linear decreasing trend, and there was no obvious plateau period (Figure B). Annual FVC in the short-term death group as % of the projected value and D_LThe decrease rate of CO as % of the predicted value was greater than that of the other two groups (P =0.006 andP<0.001）。 (4) Through statistical analysis, it is found that the change trend of FVC in the previous year in % of the predicted value cannot predict the change of FVC in the next year. However, the previous year D_LThe change trend of CO as % of the projected value can predict the next year's D_LChanges in CO as % of the projected value, i.e. the previous yeard_LCO % of the projected value If the trend is stable or declining, the D of the next year_LCO accounted for % of the projected value also showed a flat or downward trend. Conclusion: Adult patients with SSc-ILD have different types of pulmonary function progression, and their progression trends show consistent before and after during long-term follow-up. However, in the short term, the recent trend of changes in FVC as % of the predicted value cannot predict the future changes in FVC as % of the predicted value in such patients. Clarifying the characteristics of pulmonary function decline in patients with SSc-ILD can help improve clinical decision-making for such patients and guide the design of rational clinical trials.