Woge Matthew J, Ryu Jay H, Moua Teng
Department of Pathology, Mayo Clinic, Rochester, United States.
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, United States.
Respir Med. 2017 Aug;129:173-178. doi: 10.1016/j.rmed.2017.06.019. Epub 2017 Jun 27.
The diagnostic evaluation of patients with interstitial lung disease (ILD) often involves serologic assessment for identifiable causes such as hypersensitivity pneumonitis (HP). While not on its own defining of HP, precipitin serologies are often obtained to support clinical suspicion if other findings are inconclusive. We studied the clinical relevance of positive avian serology in patients undergoing ILD evaluation.
We identified individuals with positive avian serology (>53.3 mg/L) and undifferentiated ILD seen at our institution over a three-year period. Clinical, laboratory, pathologic, and radiologic findings were evaluated for consensus HP diagnosis by two expert pulmonologists, blinded to presenting serology levels.
Ninety-one ILD subjects with positive avian serology were identified; mean age was 62.7 ± 15.3 years with a slight male predominance (56%). Forty-nine (54%) received a consensus HP diagnosis. Those with HP had higher mean avian serology titer (95.0 ± 38.7 mg/L vs. 68.3 ± 16.7, (P < 0.0001). Never-smokers also had higher titers compared to prior or active smokers (P = 0.0008). Positive avian protein exposure (P < 0.0001, OR 21.3 (6.4-87)), DLCO% (P = 0.04, unit OR 0.96 (0.92-0.99)), and increasing serology titer (P < 0.015, unit OR 1.03 [1.01-1.06]) were independent predictors of HP diagnosis.
Among patients with positive avian serology, those with higher titers were more likely to have HP diagnosis. Nonsmokers also manifested higher titers compared to those with smoking history. These results may guide the usage and interpretation of avian serology screening in the initial assessment of suspected HP.
间质性肺疾病（ILD）患者的诊断评估通常包括针对可识别病因（如过敏性肺炎（HP））的血清学评估。虽然沉淀素血清学本身并非HP的确诊依据，但如果其他检查结果不明确，通常会进行此项检查以支持临床怀疑。我们研究了ILD评估患者中禽类血清学阳性的临床相关性。
我们确定了在三年期间于本机构就诊的禽类血清学阳性（>53.3mg/L）且ILD未分化的个体。由两名专家肺科医生对临床、实验室、病理和影像学检查结果进行评估，以达成HP的诊断共识，且评估时对血清学水平不知情。
共识别出91例禽类血清学阳性的ILD患者；平均年龄为62.7±15.3岁，男性略占优势（56%）。49例（54%）获得了HP的诊断共识。HP患者的平均禽类血清学滴度更高（95.0±38.7mg/L对68.3±16.7，（P<0.0001））。与既往吸烟者或现吸烟者相比，从不吸烟者的滴度也更高（P = 0.0008）。禽类蛋白暴露阳性（P<0.0001，比值比21.3（6.4 - 87））、DLCO%（P = 0.04，单位比值比0.96（0.92 - 0.99））以及血清学滴度升高（P<0.015，单位比值比1.03 [1.01 - 1.06]）是HP诊断的独立预测因素。
在禽类血清学阳性的患者中，滴度较高者更有可能被诊断为HP。与有吸烟史者相比，不吸烟者的滴度也更高。这些结果可能会指导在疑似HP的初始评估中禽类血清学筛查的应用和解读。
