结缔组织病相关性间质性肺炎与特发性间质性肺炎的组织学分离方法的建议。

Proposed method of histological separation between connective tissue disease-associated interstitial pneumonia and idiopathic interstitial pneumonias.

机构信息

Nagasaki University Hospital, Nagasaki Educational and Diagnostic Center of Pathology (NEDCP), Nagasaki, Japan.

Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan.

出版信息

PLoS One. 2018 Nov 5;13(11):e0206186. doi: 10.1371/journal.pone.0206186. eCollection 2018.

DOI:10.1371/journal.pone.0206186

PMID:30395623

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6218032/

Abstract

OBJECTIVES

Idiopathic interstitial pneumonia (IIP) and connective tissue disease -associated interstitial pneumonia (CTD-IP) are the two most common types of interstitial pneumonia. IIP and CTD-IP share common histological features, yet their clinical management is different. Separation of the two conditions based solely on histology can be challenging, and there are no established criteria.

MATERIALS AND METHODS

We selected 105 consecutive cases of IIP (79 usual interstitial pneumonia and 26 non-specific interstitial pneumonia) and 49 cases of CTD-IP for derivation and 32 cases of IIP and 10 cases of CTD-IP for validation. Fourteen histological parameters were evaluated independently by two pathologists for derivation group and graded into 0 to 3. The association between the score for each marker and a diagnosis of CTD was investigated using Fisher's exact test and stepwise logistic regression analysis. A formula for calculating the probability of IIP and CTD-IP was constructed by the markers identified in the regression test with coefficients for each finding. The formula was confirmed using validation case group.

RESULTS

Stepwise logistic regression analysis showed that plasmacytosis, lymphoid follicle with germinal center, and airspace fibrin were suggestive of CTD-IP and that fibroblastic foci, smooth muscle hyperplasia, cellular IP, dense perivascular collagen, and fat metaplasia were suggestive of IIP. The formula used to calculate the probabilities based on estimated values for each finding was created, and user-friendly web based app was composed at www.ctdip.com. On the validation study, 30 out of 32 IIP and eight out of 10 CTD-IPs were distinguished correctly by the app (Specificity: 93%, Sensitivity: 80%).

CONCLUSIONS

We identified histological markers and derived a practical formula and user-friendly app to distinguish CTD-IPs from IIP.

摘要

目的

特发性间质性肺炎（IIP）和结缔组织病相关性间质性肺炎（CTD-IP）是两种最常见的间质性肺炎类型。IIP 和 CTD-IP 具有共同的组织学特征，但临床管理不同。仅基于组织学将两者区分开来可能具有挑战性，并且目前尚无既定标准。

材料和方法

我们选择了 105 例连续的 IIP（79 例寻常型间质性肺炎和 26 例非特异性间质性肺炎）和 49 例 CTD-IP 用于推导，以及 32 例 IIP 和 10 例 CTD-IP 用于验证。两位病理学家独立评估了 14 种组织学参数，在推导组中将其分为 0 至 3 分。使用 Fisher 精确检验和逐步逻辑回归分析研究每个标记物与 CTD 诊断之间的关联。通过回归检验中确定的标记物构建用于计算 IIP 和 CTD-IP 概率的公式，并用每个发现的系数对其进行验证。使用验证组病例对公式进行确认。

结果

逐步逻辑回归分析显示，浆细胞增多、含生发中心的淋巴滤泡和肺泡内纤维蛋白提示 CTD-IP，而纤维母细胞灶、平滑肌增生、细胞性间质性肺炎、密集的血管周围胶原和脂肪化生提示 IIP。基于每个发现的估计值创建了用于计算概率的公式，并在 www.ctdip.com 上构建了易于使用的基于网络的应用程序。在验证研究中，该应用程序正确区分了 32 例 IIP 中的 30 例和 10 例 CTD-IP 中的 8 例（特异性：93%，敏感性：80%）。