Usefulness of new diagnostic criteria for chronic hypersensitivity pneumonitis established on the basis of a Delphi survey: A Japanese cohort study.

基于德尔菲调查建立的慢性过敏性肺炎新诊断标准的有用性: 一项日本队列研究。

  • 影响因子:1.77
  • DOI:10.1016/j.resinv.2019.10.001
  • 作者列表:"Takei R","Yamano Y","Kataoka K","Yokoyama T","Matsuda T","Kimura T","Johkoh T","Tabata K","Fukuoka J","Kondoh Y
  • 发表时间:2020-01-01

BACKGROUND:Chronic hypersensitivity pneumonitis (CHP) is a fibrotic interstitial lung disease (ILD) caused by repeated exposure to a variety of organic particles. In November 2017, new criteria for CHP diagnosis were proposed by Morisset et al. based on a modified Delphi survey of ILD experts. However, it remains unclear whether these criteria are useful to accurately diagnose CHP. We aimed to evaluate the newly proposed CHP diagnostic criteria. METHODS:We retrospectively applied Morisset's CHP diagnostic criteria to consecutive Japanese patients who underwent surgical lung biopsy for diagnosis of ILD from 2008 to 2015. All patients underwent bronchoalveolar lavage and pulmonary function testing. Patients who had connective tissue disease complications or showed an acute or subacute disease onset were excluded. RESULTS:A total of 251 patients were included. The diagnoses based on multidisciplinary discussion (MDD) were CHP (n = 27), idiopathic pulmonary fibrosis (n = 117), unclassifiable interstitial pneumonia (IP) (n = 65), and other diagnoses (n = 42). Of the 27 MDD-CHP patients, 14 were classified as a CHP group with diagnostic confidence >50% and 13 were not categorized (sensitivity, 51.9%; specificity, 77.7%). Morisset's CHP diagnostic criteria could help avoid SLB for the diagnosis of CHP in seven patients. Of the 13 MDD-CHP patients who were not categorized in the CHP group with diagnostic confidence >50%, the reason for the exclusion was an inconsistent with UIP pattern without CHP features. CONCLUSIONS:Half of the MDD-CHP patients were diagnosed with CHP using Morisset's CHP diagnostic criteria. Further investigation will be important for developing improved diagnostic criteria for CHP.


背景: 慢性过敏性肺炎 (CHP) 是一种因反复接触多种有机颗粒物而引起的纤维化间质性肺疾病 (ILD)。2017年11月,Morisset等人基于对ILD专家的改良德尔菲调查,提出了CHP诊断的新标准。然而,目前尚不清楚这些标准是否有助于准确诊断CHP。我们旨在评估新提出的CHP诊断标准。 方法: 我们回顾性地将Morisset的CHP诊断标准应用于2008年至2015年接受外科肺活检诊断ILD的连续日本患者。所有患者均行支气管肺泡灌洗和肺功能检测。排除有结缔组织病并发症或表现出急性或亚急性发病的患者。 结果: 共纳入251例患者。基于多学科讨论 (MDD) 的诊断为CHP (n = 27),特发性肺纤维化 (n = 117),不可分类的间质肺炎 (IP) (n = 65) 和其他诊断 (n = 42)。在27例mdd-chp患者中,14例被归类为诊断置信度> 50% 的CHP组,13例未被归类 (敏感性,51.9%; 特异性,77.7%).Morisset的CHP诊断标准有助于避免7例CHP患者的SLB诊断。在诊断置信度> 50% 的13例未归类于CHP组的mdd-chp患者中,排除的原因与没有CHP特征的UIP模式不一致. 结论: 使用Morisset的CHP诊断标准,一半的mdd-chp患者被诊断为CHP。进一步的研究对于制定改进的CHP诊断标准非常重要。



来源期刊:Medical mycology
作者列表:["Patel D","Popple S","Claydon A","Modha DE","Gaillard EA"]

METHODS::There is emerging evidence for the role of posaconazole in the management of Aspergillus-related cystic fibrosis (CF) lung disease. The tolerability and efficacy of posaconazole in paediatric CF is not well established. We report a prospective study over a fifty-three month period evaluating the safety, tolerability, and efficacy of posaconazole in pediatric CF. Fourteen children (seven males, median age 13 years, range 3-17 years) received a total of twenty-three courses of posaconazole (13 oral suspension and 10 tablet formulation). Of these patient episodes, nine received posaconazole for emerging or active allergic bronchopulmonary aspergillosis (ABPA) and two required a combination of posaconazole and systemic corticosteroids for difficult-to-treat ABPA. A subgroup of patients (n = 12) with persistent isolates of Aspergillus fumigatus, in the absence of serological markers of ABPA, received posaconazole monotherapy for pulmonary exacerbations not responding to conventional broad-spectrum antibiotic treatment. Posaconazole levels, full blood count, electrolytes, and liver function were monitored on day 7 of treatment and then monthly. Posaconazole was well tolerated in all but three patients. Therapeutic plasma levels >1 mg/l were achieved in all receiving the tablet formulation in comparison to 60% on the liquid preparation. There was a modest but significant improvement in FEV1 (% predicted) demonstrated for the cohort as a whole (p = 0.015) following posaconazole therapy. Posaconazole is well tolerated in children as young as six years old, improvements in lung function are observed, and therapeutic plasma levels are readily achieved in patients taking the tablet formulation and in adherent patients taking the liquid formulation.

翻译标题与摘要 下载文献
作者列表:["Gonçales JP","Nobrega CGO","Nascimento WRC","Lorena VMB","Peixoto DM","Costa VMA","Barbosa CS","Solé D","Sarinho ESC","Souza VMO"]

METHODS::The relationship between the cellular immune response during Trichuris trichiura infection and asthma has not yet been established. In this study, the cytokines interleukin (IL)-2, IL-4, IL-6, IL-10, TNF-α, IFN-γ and IL-17A were evaluated in asthmatic children harboring T. trichiura. For this assessment, asthmatic and non-asthmatic children (ISAAC questionnaire) were submitted to parasitological tests and blood samples were cultured (mitogen stimulation) for cytokine measurements in the supernatant. Asthma frequencies were similar in infected and uninfected children, but IL-4, IL-6, TNF-α and IL-10 levels were high in the infected asthmatic children. Additionally, infected non-asthmatic children exhibited high levels of these cytokines in relation to uninfected non-asthmatic children; however, cytokine levels were lower when compared with infected and asthmatic children. Therefore, T. trichiura infection positively modulated the pro- and anti-inflammatory cytokines in asthmatic children, but a background of asthma seemed to narrow the production of cytokines induced by this helminth.

翻译标题与摘要 下载文献
作者列表:["van der Schans J","Cao Q","Bos EH","Rours GIJG","Hoekstra PJ","Hak E","de Vries TW"]

METHODS::In a recent meta-analysis, we found that atopic diseases, like asthma and allergic rhinitis, occur more frequently prior to the onset of attention-deficit/hyperactivity disorder (ADHD). Our aim was to determine the temporal order of the association between daily fluctuations in atopic disease symptoms and in ADHD symptoms in individual participants. In this observational study among 21 participants, age 7-16 years, we performed a replicated time-series analysis of symptom fluctuations in asthma and/or allergic rhinitis and ADHD. Data were collected through parents who filled in a daily online questionnaire during up to 50 days. In each individual, we investigated the temporal order of fluctuations in atopic disease symptoms and ADHD symptoms using a vector autoregressive (VAR) model while using sleep problems and medication use as covariates. For 16 out of 21 participants, we constructed a VAR model. For a majority of the participants, significant associations were detected between atopic disease symptoms and ADHD symptoms. The results were heterogeneous; the direction, sign, and timing of the relationship between ADHD, atopy, sleep problems, and medication use varied between individuals. This study provides additional evidence that the symptom expression of atopy and ADHD are related. However, the connection between both diseases in children is found to be heterogeneous within our study population.

翻译标题与摘要 下载文献