Peng Shouchun, Liu Yaxuan, Li Xueren, Wei Luqing
Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Logistics University of Chinese People's Armed Police Force, Tianjin 300162, China.
Zhonghua Nei Ke Za Zhi. 2016 Feb;55(2):131-4. doi: 10.3760/cma.j.issn.0578-1426.2016.02.013.
To compare the strengths and limitations of the old and revised guidelines for the diagnosis in patients with idiopathic pulmonary fibrosis(IPF).
Patients who were admitted and diagnosed as interstitial lung diseases (ILDs) in our hospital from 2009 to 2014 were enrolled in our study.Eachpatient was reevaluated respectively according to the old and revised guidelines of IPF.
A total of 553 cases were initially reviewed, among whom 355 cases were excluded for pulmonary fibrosis secondary to definite underlying diseases, 28 excluded due to high resolution computed tomography(HRCT) not done, 26 excluded because serum immunology examination was not available.The remaining 144 cases were finally enrolled in this study including 92 males and 52 females with median age 21-92 (68 ± 11) years old. Twenty five patients (17.4%, 25/144) met the diagnostic criteria of IPF by the old guideline.While by the revised guideline, 53 patients (36.8%, 53/144) were diagnosed as classical IPF, 29 patients(20.1%, 29/144) as probable cases, another 69 non-IPF patients accounting for 43.1% (62/144). The result revealed that there's a significant difference between the two guidelines in the diagnosis of IPF.
The revised guideline favors an early diagnosis of IPF and simplifies the diagnostic process.However the possibility of over diagnosis or missed diagnosis by the revised guideline does exist.On the other hand, despite of the delayed diagnosis by the old guideline, it may reduce the misdiagnosis of IPF in some circumstance.
比较特发性肺纤维化（IPF）患者诊断的旧版和修订版指南的优缺点。
纳入2009年至2014年在我院住院并诊断为间质性肺疾病（ILDs）的患者。根据IPF的旧版和修订版指南分别对每位患者进行重新评估。
最初共审查553例，其中355例因明确的基础疾病继发肺纤维化而排除，28例因未进行高分辨率计算机断层扫描（HRCT）而排除，26例因无法进行血清免疫学检查而排除。最终144例患者纳入本研究，其中男性92例，女性52例，年龄中位数21 - 92岁（68±11岁）。按照旧版指南，25例患者（17.4%，25/144）符合IPF诊断标准。而按照修订版指南，53例患者（36.8%，53/144）被诊断为典型IPF，29例患者（20.1%，29/144）为可能病例，另外69例非IPF患者占43.1%（62/144）。结果显示，两种指南在IPF诊断方面存在显著差异。
修订版指南有利于IPF的早期诊断并简化了诊断流程。然而，修订版指南存在过度诊断或漏诊的可能性。另一方面，尽管旧版指南诊断延迟，但在某些情况下可能减少IPF的误诊。
