Division of Pulmonary, Sleep and Critical Care Medicine, Department of Medicine, NYU Langone Health, NYU Grossman School of Medicine, 550 1 Ave, New York, NY, 10016, USA.
Division of Biostatistics, Departments of Population Health and Environmental Medicine, NYU Grossman School of Medicine, New York, NY, USA.
Lung. 2020 Oct;198(5):811-819. doi: 10.1007/s00408-020-00387-6. Epub 2020 Sep 5.
Idiopathic Pulmonary Fibrosis is a progressive and fatal interstitial lung disease (ILD) characterized by a typical radiographic or histologic usual interstitial pneumonia (UIP) pattern. In 2018, diagnostic categories of UIP based on computed tomography patterns were revised by the Fleischner Society. The study aimed to describe differences in comorbidities and spirometry in ILD patients that were characterized by high-resolution computed tomography (HRCT) images as having a typical, probable, indeterminate, and alternative diagnosis of UIP.
We retrospectively studied 80 ILD patients from 2017 to 2019. Typical UIP was defined using the Fleischner Society diagnostic criteria for IPF. Atypical UIP was reached by consensus after a multidisciplinary clinical-radiological-pathological review of patient data. Baseline characteristics, comorbidities, and spirometry were compared among the four subgroups.
Among 80 patients, 59% were male, 61% had a history of smoking, and the mean age was 67.7 ± 10 years (SD). A typical UIP pattern was more frequently observed among patients with chronic obstructive pulmonary disease (COPD) (p < 0.001) and pulmonary hypertension (p = 0.03). Of 30 patients with COPD, 14 had emphysema, while 10 had IPF. After adjusting for forced expiratory volume in one second (FEV) in liters, change of FEV% from baseline to 6-12 months, age, and sex, only COPD remained significantly associated with typical UIP (p = 0.018). Tobacco use was not significantly associated with any radiographic type (p = 0.199).
Typical UIP was prevalent among COPD/emphysema patients. Although smoking has a strong association with IPF, we did not find a significant association with smoking and typical UIP in our cohort.
特发性肺纤维化（IPF）是一种进行性和致命的间质性肺疾病（ILD），其特征是具有典型的影像学或组织学普通间质性肺炎（UIP）模式。2018 年，弗莱希纳协会（Fleischner Society）修订了基于计算机断层扫描（CT）模式的 UIP 诊断类别。本研究旨在描述在高分辨率 CT（HRCT）图像表现为典型、可能、不确定和替代 UIP 诊断的ILD 患者中，合并症和肺量计检查结果的差异。
我们回顾性研究了 2017 年至 2019 年的 80 名ILD 患者。采用弗莱希纳协会（Fleischner Society）的 IPF 诊断标准定义典型 UIP。通过对患者数据进行多学科临床-放射-病理回顾，达成共识后确定非典型 UIP。比较四个亚组之间的基线特征、合并症和肺量计检查结果。
在 80 名患者中，59%为男性，61%有吸烟史，平均年龄为 67.7±10 岁（标准差）。在慢性阻塞性肺疾病（COPD）（p<0.001）和肺动脉高压（p=0.03）患者中更常观察到典型 UIP 模式。在 30 名 COPD 患者中，14 名患有肺气肿，10 名患有 IPF。在调整了用力呼气量（FEV）的升数、FEV 从基线到 6-12 个月的变化百分比、年龄和性别后，只有 COPD 与典型 UIP 显著相关（p=0.018）。吸烟与任何影像学类型均无显著相关性（p=0.199）。
典型 UIP 常见于 COPD/肺气肿患者。尽管吸烟与 IPF 密切相关，但在我们的队列中，吸烟与典型 UIP 之间并未发现显著相关性。
