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Clinical features of chronic summer-type hypersensitivity pneumonitis and proposition of diagnostic criteria.

慢性夏季型过敏性肺炎的临床特征及诊断标准的提出。

  • 影响因子:1.77
  • DOI:10.1016/j.resinv.2019.09.003
  • 作者列表:"Onishi Y","Kawamura T","Higashino T","Kagami R","Hirata N","Miyake K
  • 发表时间:2020-01-01
Abstract

BACKGROUND:Trichosporon asahii (T. asahii) causes chronic summer-type hypersensitivity pneumonitis (C-SHP); however, little is known about the clinical features of this condition. We aimed to elucidate the clinical features of C-SHP and propose practical diagnostic criteria for C-SHP based on the presence of serum anti-T. asahii antibody (TaAb). METHODS:Patients diagnosed with C-SHP and idiopathic pulmonary fibrosis (IPF) between January 2010 and May 2017 were reviewed retrospectively. Clinical findings were compared between the two groups. Criteria for C-SHP were proposed on the basis of significant characteristics and applied to the development and validation cohorts. RESULTS:Thirty-one patients with C-SHP and 26 with TaAb-negative IPF were identified. C-SHP patients were more likely to live in wooden houses; their serum Krebs von den Lungen-6 (KL-6) and serum surfactant protein-D (SP-D) levels were higher than those of IPF patients. C-SHP patients were more likely to have subpleural consolidation, micronodules, and extensive ground-glass opacification on high-resolution computed tomography (HRCT). The following 3 items were considered to have diagnostic value: I) TaAb positivity; II) an HRCT pattern consistent with chronic hypersensitivity pneumonitis, including mosaic attenuation or micronodules; and III) elevated serum biomarker levels (KL-6 > 1500 U/mL or SP-D > 250 ng/mL). We defined cases satisfying I) and II) as "probable C-SHP" and those satisfying all 3 criteria as "confident clinical diagnosis of C-SHP". The areas under the receiver-operating curve were 0.965 and 0.993 in the development and validation cohorts, respectively, which suggested that these criteria had good discriminative ability in clinical evaluations. CONCLUSIONS:Clinical features could be useful for distinguishing C-SHP from IPF and other etiologies of ILDs.

摘要

背景: 毛孢子菌asahii (T. asahii) 引起慢性夏季型过敏性肺炎 (C-SHP); 然而,对这种情况的临床特征知之甚少。我们旨在阐明C-SHP的临床特征,并根据血清抗asahii抗体 (TaAb) 的存在提出C-SHP的实用诊断标准。 方法: 回顾性分析2010年1月至2017年5月间诊断为C-SHP和特发性肺纤维化 (IPF) 的患者。比较两组患者的临床表现。根据重要特征提出了c-shp的标准,并将其应用于开发和验证队列。 结果: 发现31例C-SHP患者和26例TaAb阴性IPF患者。C-SHP患者更倾向于居住在木屋中; 其血清Krebs von den Lungen-6 (KL-6) 和血清表面活性蛋白-D (sp-d) 水平高于IPF患者。C-SHP患者在高分辨率计算机断层扫描 (HRCT) 中更容易出现胸膜下实变、微小结节和广泛的磨玻璃浑浊。以下3项被认为具有诊断价值: I) TaAb阳性; II) 符合慢性过敏性肺炎的HRCT模式,包括镶嵌衰减或微小结节; 和III) 血清生物标志物水平升高 (KL-6 > 1500 U/mL或sp-d> 250 ng/mL)。我们将满足I) 和II) 的病例定义为 “可能的C-SHP”,满足所有3个标准的病例定义为 “C-SHP的可靠临床诊断”。在开发和验证队列中,受试者工作曲线下面积分别为0.965和0.993,这表明这些标准在临床评价中具有良好的判别能力。 结论: 临床特征有助于鉴别C-SHP与IPF及其他病因。

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