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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
Abstract

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.

摘要

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。

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