Department of Medical Informatics Osaka University Graduate School of Medicine Suita Japan.
Division of Medical Informatics Tottori University Hospital Suita Japan.
Pharmacol Res Perspect. 2018 Jul 12;6(4):e00421. doi: 10.1002/prp2.421. eCollection 2018 Jul.
Because drug-induced interstitial pneumonia (DIP) is a serious adverse drug reaction, its quantitative risk with individual medications should be taken into due consideration when selecting a medicine. We developed an algorithm to detect DIP using medical record data accumulated in a hospital. Chest computed tomography (CT) is mainly used for the diagnosis of IP, and chest X-ray reports, KL-6, and SP-D values are used to support the diagnosis. The presence of IP in the reports was assessed by a method using natural language-processing, in which IP was estimated according to the product of the likelihood ratio of characteristic keywords in each report. The sensitivity and the specificity of the method for chest CT reports were 0.92 and 0.97, while those for chest X-ray reports were 0.83 and 1, respectively. The occurrence of DIP was estimated by the patterns of presence of IP before, during, and after the administration of the target medicine. The occurrence rate of DIP in cases administered Gefitinib; Methotrexate (MTX); Tegafur, Gimeracil, and Oteracil potassium (TS-1); and Tegafur and Uracil (UTF) was 6.0%, 2.3%, 1.4%, and 0.7%, respectively. The estimated DIP cases were checked by having the medical records independently reviewed by medical doctors. By chart review, the positive predictive values of DIP against Gefitinib, MTX, TS-1, and UFT were 69.2%, 44.4%, 58.6%, and 77.8%, respectively. Although the cases extracted by this method included some that did not have DIP, this method can estimate the relative risk of DIP between medicines.
由于药物性间质性肺炎（DIP）是一种严重的药物不良反应，在选择药物时应充分考虑个体用药的定量风险。我们开发了一种使用医院积累的病历数据检测 DIP 的算法。胸部计算机断层扫描（CT）主要用于 IP 的诊断，而胸部 X 射线报告、KL-6 和 SP-D 值用于支持诊断。使用自然语言处理方法评估报告中 IP 的存在，根据每个报告中特征关键字的似然比乘积来估计 IP。该方法对胸部 CT 报告的敏感性和特异性分别为 0.92 和 0.97，对胸部 X 射线报告的敏感性和特异性分别为 0.83 和 1。通过目标药物给药前后 IP 存在模式估计 DIP 的发生。在接受吉非替尼、甲氨蝶呤（MTX）、替加氟、吉美嘧啶和奥替拉西钾（TS-1）和替加氟和尿嘧啶（UTF）治疗的患者中，DIP 的发生率分别为 6.0%、2.3%、1.4%和 0.7%。通过让医生独立审查病历来检查估计的 DIP 病例。通过图表审查，DIP 对吉非替尼、MTX、TS-1 和 UTF 的阳性预测值分别为 69.2%、44.4%、58.6%和 77.8%。尽管该方法提取的病例中包括一些没有 DIP 的病例，但该方法可以估计药物之间 DIP 的相对风险。
