Johannson Kerri A, Elicker Brett M, Vittinghoff Eric, Assayag Deborah, de Boer Kaïssa, Golden Jeffrey A, Jones Kirk D, King Talmadge E, Koth Laura L, Lee Joyce S, Ley Brett, Wolters Paul J, Collard Harold R
Department of Medicine, University of California, San Francisco, San Francisco, California, USA Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Radiology, University of California, San Francisco, San Francisco, California, USA.
Thorax. 2016 Oct;71(10):951-4. doi: 10.1136/thoraxjnl-2016-208286. Epub 2016 May 31.
The objective of this study was to develop a diagnostic model that allows for a highly specific diagnosis of chronic hypersensitivity pneumonitis using clinical and radiological variables alone. Chronic hypersensitivity pneumonitis and other interstitial lung disease cases were retrospectively identified from a longitudinal database. High-resolution CT scans were blindly scored for radiographic features (eg, ground-glass opacity, mosaic perfusion) as well as the radiologist's diagnostic impression. Candidate models were developed then evaluated using clinical and radiographic variables and assessed by the cross-validated C-statistic. Forty-four chronic hypersensitivity pneumonitis and eighty other interstitial lung disease cases were identified. Two models were selected based on their statistical performance, clinical applicability and face validity. Key model variables included age, down feather and/or bird exposure, radiographic presence of ground-glass opacity and mosaic perfusion and moderate or high confidence in the radiographic impression of chronic hypersensitivity pneumonitis. Models were internally validated with good performance, and cut-off values were established that resulted in high specificity for a diagnosis of chronic hypersensitivity pneumonitis.
本研究的目的是开发一种诊断模型，该模型仅使用临床和放射学变量就能对慢性过敏性肺炎进行高度特异性诊断。从一个纵向数据库中回顾性识别慢性过敏性肺炎和其他间质性肺疾病病例。对高分辨率CT扫描的影像学特征（如磨玻璃影、马赛克灌注）以及放射科医生的诊断印象进行盲法评分。然后使用临床和影像学变量开发候选模型并进行评估，并通过交叉验证的C统计量进行评估。共识别出44例慢性过敏性肺炎和80例其他间质性肺疾病病例。根据其统计性能、临床适用性和表面效度选择了两个模型。关键模型变量包括年龄、接触羽绒和/或鸟类、影像学上磨玻璃影和马赛克灌注的存在以及对慢性过敏性肺炎影像学印象的中度或高度信心。模型在内部验证中表现良好，并确定了能够对慢性过敏性肺炎诊断具有高特异性的临界值。
