RATIONALE Particulate matter ≤2.5μm (PM2.5) is associated with adverse outcomes in fibrotic interstitial lung disease (fILD), but the impact of ultrafine particulates (UFPs; aerodynamic diameter ≤100nm) remains unknown. OBJECTIVE To evaluate UFP associations with clinical outcomes in fILD. METHODS Multicenter, prospective cohort study enrolling patients with fILD from the University of Pittsburgh Simmons Center and Pulmonary Fibrosis Foundation Patient Registry (PFF-PR). Using a national-scale UFP model, we linked exposures using three approaches in Simmons (residential address geocoordinates, zip centroid geocoordinates, zip average) and two in PFF-PR where only 5-digit zip code was available (zip centroid, zip average). We tested UFP associations with transplant-free survival using multivariable Cox, baseline percent predicted forced vital capacity (FVC) and diffusion capacity of the lung (DLCO) using multivariable linear regressions, and decline in FVC and DLCO using linear mixed models, adjusting for age, sex, smoking, race, socioeconomic status, site, PM2.5, and nitrogen dioxide. RESULTS Annual mean outdoor UFP levels for 2017 were estimated for 1416 Simmons and 1919 PFF-PR patients. Increased UFP level was associated with transplant-free survival in fully-adjusted Simmons residential address models (HR=1.08 per 1000 particles/cm3, 95%CI 1.01-1.15, p=0.02), but not PFF-PR models, which used less precise linkage approaches. Higher UFP was associated with lower baseline FVC and more rapid FVC decline in Simmons. CONCLUSIONS Increased UFP exposure was associated with transplant-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。

基本原理 颗粒物≤2.5μm (PM2.5) 与纤维化间质性肺疾病 (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 多中心、前瞻性队列研究，招募来自匹兹堡大学西蒙斯中心和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 中的三种方法（居住地址地理坐标、邮政编码质心地理坐标、邮政编码平均值）和 PFF-PR 中的两种方法（其中只有 5 位邮政编码可用）（邮政编码质心、邮政编码平均值）来关联暴露。 。我们使用多变量 Cox 测试了 UFP 与无移植生存的关联，使用多变量线性回归测试了预测用力肺活量 (FVC) 和肺弥散能力 (DLCO) 的基线百分比，并使用线性混合模型测试了 FVC 和 DLCO 的下降，并根据年龄进行了调整、性别、吸烟、种族、社会经济地位、地点、PM2.5 和二氧化氮。结果 估算了 1416 名 Simmons 患者和 1919 名 PFF-PR 患者 2017 年的年平均室外 UFP 水平。在完全调整的 Simmons 居住地址模型中，UFP 水平升高与无移植生存相关（HR=1.08 每 1000 个颗粒/cm3，95%CI 1.01-1.15，p=0.02），但与 PFF-PR 模型无关，该模型使用较少精准联动方式。西蒙斯较高的 UFP 与较低的基线 FVC 和较快的 FVC 下降相关。结论 在具有精确居住地点关联的队列中，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。