Idiopathic Pulmonary Fibrosis: What do we Know about the Role of Occupational and Environmental Determinants? A Systematic Literature Review and Meta-Analysis

The objectives of this systematic review of original articles published up until August 2021 and meta-analyses were to identify the links between occupational and non-occupational environmental exposures, types of occupations and idiopathic pulmonary fibrosis (IPF). Sixteen selected case-control studies were qualified as good level with Newcastle-Ottawa quality assessment scale. Sensitivity analyses highlighted the role of choice of control group, tobacco adjustment and diagnostic tools. Significantly increased risks of IPF were observed (OR (95%CI): for metals (1.42(1.05–1.92)), wood (OR:1.32(1.02–1.71)), and general dust (OR:1.32(1.08–1.63)) exposures. Subgroup analyses found a significantly elevated risk for: hardwood (OR:1.75 (1.13–2.70)), organic dusts (OR:1.72 (1.20–2.46)) and pesticides (OR:2.30 (1.30–4.08)), while no significant change was noted for softwoods and solvents. Smoking adjustments: general dust (1.45 (1.04–2.03)/organic dust (2.5 (1.49–4.22)/metals (1.87 (1.16–3)/wood dust OR: 1.16 (0.86–1.61)/pesticide exposure 2.4 (0.84–6.9) were calculated. Among agricultural workers, the risk was also increased (OR:2.06 (1.02–4.16)). Few environmental data were available and no significant associations detected. Thus, these meta-analyses highlighted the role of some occupational exposures in IPF occurrence. A more accurate and thorough assessment of exposures over the entire working life as well as on the duration and intensity of exposure and complex of multi-pollutant exposure is needed in future research and clinical practice.

本项针对截至2021年8月发表的原创性论文与荟萃分析（meta-analyses）的系统综述，旨在明确职业与非职业环境暴露、职业类型与特发性肺纤维化（idiopathic pulmonary fibrosis, IPF）之间的关联。本研究纳入的16项病例对照研究经纽卡斯尔-渥太华质量评估量表（Newcastle-Ottawa Quality Assessment Scale）评定为高质量等级。敏感性分析揭示了对照组选择、烟草暴露校正与诊断工具的关键影响。研究观察到特发性肺纤维化（IPF）的发病风险显著升高：金属暴露的比值比（OR, 95%置信区间CI：1.42(1.05–1.92)）、木材暴露（OR:1.32(1.02–1.71)）以及一般性粉尘暴露（OR:1.32(1.08–1.63)）均呈现此特征。亚组分析显示，硬木暴露（OR:1.75 (1.13–2.70)）、有机粉尘暴露（OR:1.72 (1.20–2.46)）与农药暴露（OR:2.30 (1.30–4.08)）的发病风险显著升高，而软木暴露与溶剂暴露未观察到显著风险变化。经吸烟校正后的分析结果为：一般性粉尘（1.45 (1.04–2.03)）、有机粉尘（2.5 (1.49–4.22)）、金属暴露（1.87 (1.16–3)）、木尘暴露（OR: 1.16 (0.86–1.61)）以及农药暴露（2.4 (0.84–6.9)）。在农业劳动者群体中，IPF发病风险同样升高（OR:2.06 (1.02–4.16)）。现有环境数据较为匮乏，未检测到显著关联。综上，本项荟萃分析揭示了部分职业暴露在特发性肺纤维化（IPF）发病中的作用。未来研究与临床实践中，需对整个职业生涯期间的暴露情况、暴露时长与强度，以及多污染物复合暴露开展更为精准且全面的评估。