2024年 · 第47卷第03期

At the beginning of the new year, everything is renewed. In this spring when the ice and snow melt and everything is revived, the third issue of this magazine in 2024 meets your readers.

Background In previous observational studies, gastro-oesophageal reflux disease (GORD) has been associated with idiopathic pulmonary fibrosis (IPF). However, it is unclear whether this correlation is due to GORD causing IPF, IPF causing GORD, or due to confounding factors associated with both, such as smoking. In this study, two-way Mendelian randomization (MR) method was used to evaluate the relationship between exposure factors and outcome, using genetic variation as an instrumental variable, so as to explore the causal relationship between GORD and IPF. Methods A two-way, two-sample Mendelian randomized study of genetic data from the current largest GORD (78 707 patients and 288 734 controls) and IPF (4 125 patients and 20 464 controls) genome-wide association analysis (GWAS) was conducted to assess the causality of GORD and risk of IPF and IPF and GORD. Results Fifty-nine independent single nucleotide polymorphisms (SNPs) with significant correlation with GORD were selected from the GWAS results of GORD. Among them, two SNPs were deleted in the GWAS of IPF. One alternative SNP was selected. MR studies were performed on the above SNPs. The results showed that GORD increased the risk of IPF (OR=1.6，95%CI：1.04~2.49；P=0.032）。 Nineteen independently significantly correlated SNPs were selected from the GWAS results of IPF, of which 15 SNPs were missing from the GWAS of GORD, and nine alternative SNPs were selected for MR study. The results showed that IPF had no causal effect on the risk of GORD (OR=0.999，95%CI：0.997~1.000；P=0.245）。 Conclusion GORD can increase the risk of IPF, but IPF is not found to increase the risk of GORD. In future studies of IPF risk factors, GORD should be re-included in the management and treatment of IPF patients, and the possible mechanism of GORD in the pathogenesis of IPF should be further explored.

Background There are significant differences in the clinical manifestations of interstitial lung disease (ILD) associated with connective tissue disease (CTD), which makes the diagnosis and treatment of CTD-ILD difficult. Early identification and treatment of CTD-ILD with a multidisciplinary approach discussed improves the prognosis of such patients. The study extracts the clinical elements related to CTD-ILD, develops a screening tool that can be used to identify CTD in ILD in the early stage, and puts forward the guidelines for multidisciplinary management of CTD-ILD, which will help respiratory physicians to carry out joint diagnosis and treatment with rheumatologists in the early stage. Methods Twelve rheumatologists from the Middle East and North Africa (MENA) region formed an expert panel to discuss and select the most relevant clinical elements for early identification of CTD-ILD. The expert panel explored seven of the most common autoimmune inflammatory diseases and discussed how CTD-ILD can be recognized early. Results The panel reached the following consensus on the seven autoimmune inflammatory diseases discussed in this study: (1) the most common CTDs in the MENA population: rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Sjogren's syndrome (SS), systemic sclerosis (SSc), mixed connective tissue disease (MCTD), inflammatory myopathy (IM), sarcoidosis; (2) CTDs with the greatest correlation with ILD: SSc, SS, IM, RA, MCTD, SLE, and sarcoidosis; (3) Common symptoms or signs of patients with CTD-ILD: Raynaud's phenomenon, swollen fingers, skin lesions, technician hands, inflammatory joint pain, dry mouth/eyes, dysphagia, proximal muscle weakness, skin atrophy/sclerosis; (4) Laboratory tests with suggestive significance for the diagnosis of CTD-ILD: immunofluorescence antinuclear antibody detection (IF-ANA), extractable nuclear antigen autoantibody spectrum detection (ENA), rheumatoid factor (RF), creatine kinase (CK), anti-cyclic citrulline peptide antibody (ACPA), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP). Based on the above clinical characteristics and laboratory tests, a questionnaire was designed to guide the diagnosis of CTD-ILD and assist the respiratory physician in determining whether a referral to a rheumatologist and immunologist is required, with the following contents: (1) whether the patient has Raynaud's phenomenon; (2) whether finger swelling unrelated to external injury occurs repeatedly; (3) Whether there are skin lesions; (4) Whether there are technicians; (5) whether there is inflammatory joint pain; (6) Whether there is dry mouth and dry eyes; (7) whether there is dysphagia; (8) Whether there is proximal muscle weakness; (9) Whether there is skin tightening or thickening. Conclusion Rheumatologists believe that inflammatory joint pain, morning stiffness lasting more than 30 min, Raynaud's phenomenon, finger swelling, rash, proximal muscle weakness, etc. in ILD patients highly suggest the possibility of CTD; This system developed according to the clinical characteristics or laboratory test results of CTD-ILD helps respiratory doctors to identify potential CTDs in ILD patients early and see the rheumatology department early; However, it needs to be further verified in clinical practice.

In the article "Clinical Observational Study on the Preliminary Efficacy of Duprizumab in the Treatment of Severe Asthma" published in Volume 46, Issue 9, 2023, the value of "FeNO (ppb) after 12 months" in Table 2 should be "20.0 (13.0, 31.0)".