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2021年8月前发表的原创性研究及荟萃分析开展的系统综述，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）之间的潜在关联。本研究共纳入16项经纽卡斯尔-渥太华质量评估量表（Newcastle-Ottawa Quality Assessment Scale）评定为高质量的病例对照研究。敏感性分析结果显示，对照组选择方案、烟草暴露校正策略及诊断工具的选用对研究结果存在显著影响。研究观察到IPF发病风险显著升高的暴露类型包括：金属暴露（比值比[95%置信区间]：1.42[1.05–1.92]）、木材暴露（1.32[1.02–1.71]）及一般性粉尘暴露（1.32[1.08–1.63]）。亚组分析进一步显示，硬木粉尘暴露（1.75[1.13–2.70]）、有机粉尘暴露（1.72[1.20–2.46]）及农药暴露（2.30[1.30–4.08]）对应的IPF发病风险显著升高；而软木粉尘与溶剂暴露则未观察到显著关联。经吸烟校正后的分析结果显示：一般性粉尘暴露（1.45[1.04–2.03]）、有机粉尘暴露（2.5[1.49–4.22]）、金属暴露（1.87[1.16–3.00]）、木材粉尘暴露（1.16[0.86–1.61]）及农药暴露（2.4[0.84–6.90]）。针对农业从业者的亚组分析显示，其IPF发病风险同样升高（2.06[1.02–4.16]）。本研究纳入的非职业环境相关数据较为有限，未检测到具有统计学意义的关联。综上，本项荟萃分析证实部分职业暴露在特发性肺纤维化的发病过程中发挥了一定作用。未来研究与临床实践中，需针对整个职业生涯的暴露情况、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。