Tsutsui Toshiharu, Miyazaki Yasunari, Okamoto Tsukasa, Tateishi Tomoya, Furusawa Haruhiko, Tsuchiya Kimitake, Fujie Toshihide, Tamaoka Meiyo, Sakashita Hiroyuki, Sumi Yuki, Inase Naohiko
Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan.
Respir Investig. 2015 Sep;53(5):217-24. doi: 10.1016/j.resinv.2015.04.003. Epub 2015 Jul 14.
Chronic hypersensitivity pneumonitis (HP) is induced by the inhalation of specific antigens. Patients with chronic HP may be able to improve their prognosis by avoiding these antigens. Chronic HP is often difficult to distinguish from idiopathic interstitial pneumonias (IIPs).
This study was performed to find out how antigen avoidance tests contribute to the diagnosis of chronic HP.
A retrospective analysis was conducted on 265 patients who underwent 2-week antigen avoidance tests between April 2002 and March 2012. The patients were classified into the following categories: acute HP, chronic HP, collagen vascular disease-associated interstitial pneumonia (CVD-IP), lung dominant connective tissue disease (LD-CTD), and IIPs. The following seven clinical parameters were evaluated: vital capacity, alveolar-arterial oxygen pressure difference, Krebs von den Lungen-6, surfactant protein-D, white blood cell count, C-reactive protein, and body temperature. These parameters were compared between the chronic HP group and a control group consisting of CVD-IP, LD-CTD, and IIPs.
One-hundred and ninety-six patients with chronic HP and 43 control subjects were evaluated. All clinical parameters improved significantly in the chronic HP group but showed no significant changes in the control group. Four of the parameters changed significantly compared with the control group. Diagnostic criteria established using these data had a sensitivity of 51.0% and a specificity of 80.7%.
It was difficult to diagnose chronic HP based solely on 2-week antigen avoidance tests; however, improved clinical parameters among patients supported the diagnosis of HP.
慢性过敏性肺炎（HP）由吸入特定抗原引起。慢性HP患者若避免接触这些抗原，其预后可能会改善。慢性HP常难以与特发性间质性肺炎（IIP）相区分。
本研究旨在明确抗原回避试验对慢性HP诊断的作用。
对2002年4月至2012年3月期间接受为期2周抗原回避试验的265例患者进行回顾性分析。患者分为以下几类：急性HP、慢性HP、胶原血管病相关间质性肺炎（CVD-IP）、肺部为主的结缔组织病（LD-CTD）和IIP。评估以下七个临床参数：肺活量、肺泡动脉氧分压差、克雷伯斯冯登龙-6、表面活性蛋白-D、白细胞计数、C反应蛋白和体温。比较慢性HP组与由CVD-IP、LD-CTD和IIP组成的对照组之间的这些参数。
对196例慢性HP患者和43例对照受试者进行了评估。慢性HP组所有临床参数均显著改善，但对照组无显著变化。其中四个参数与对照组相比有显著变化。利用这些数据建立的诊断标准敏感性为51.0%，特异性为80.7%。
仅基于为期2周的抗原回避试验难以诊断慢性HP；然而，患者临床参数的改善支持HP的诊断。
