Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, 138-736, Seoul, South Korea.
Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, 138-736, Seoul, South Korea.
Eur Radiol. 2021 Jun;31(6):3993-4003. doi: 10.1007/s00330-020-07469-2. Epub 2020 Nov 25.
To evaluate the longitudinal changes of chest CT findings in patients with chronic hypersensitivity pneumonitis (HP) and identify risk factors for fibrotic progression and acute exacerbation (AE).
This retrospective study included patients with chronic HP with follow-up CT. Baseline and serial follow-up CT were evaluated semi-quantitatively. Fibrosis score was defined as the sum of the area with reticulation and honeycombing. The modified CT pattern of Fleischner Society idiopathic pulmonary fibrosis diagnostic guidelines was evaluated. Cox proportional hazards regression was performed to determine significant variables associated with fibrotic progression and AEs.
Of 91 patients, mean age was 59.1 years and 61.5% were women. The median follow-up period was 4.9 years. Seventy-nine patients (86.8%) showed fibrotic progression with persistent areas of mosaic attenuation, finally replaced by fibrosis, and 20 (22.0%) developed AE. Baseline fibrosis score and CT pattern of usual interstitial pneumonia (UIP)/probable UIP were independent risk factors for predicting fibrotic progression (hazard ratio [HR] = 1.05, 95% confidence interval [CI] = 1.02-1.09, p < 0.001, for fibrosis score; HR = 2.50, CI = 1.50-4.16, p < 0.001, for CT pattern) and AEs (HR = 1.07, CI = 1.01-1.13, p = 0.019, for fibrosis score; HR = 5.47, CI = 1.23-24.45, p = 0.026, for CT pattern) after adjusting clinical covariables.
Fibrotic progression and AE were identified in 86.8% and 22.0% of patients with chronic HP. Fibrosis score and CT pattern of UIP/probable UIP on baseline chest CT may predict fibrotic progression and AE.
• Most patients (87%) showed fibrotic progression on long-term follow-up with persistent areas of mosaic attenuation that were finally replaced by fibrosis at a later stage. • One-fifth of patients (22%) experienced acute exacerbation associated with worse prognosis. • Fibrosis score (sum of reticulation and honeycombing) and CT pattern of UIP/probable UIP on baseline CT were independent predictors for predicting fibrotic progression and acute exacerbation.
评估慢性超敏性肺炎（HP）患者胸部 CT 表现的纵向变化，并确定纤维化进展和急性加重（AE）的危险因素。
本回顾性研究纳入了有随访 CT 的慢性 HP 患者。对基线和系列随访 CT 进行半定量评估。纤维化评分定义为网状影和蜂窝影的总面积。评估了 Fleischner 学会特发性肺纤维化诊断指南的改良 CT 模式。采用 Cox 比例风险回归分析确定与纤维化进展和 AE 相关的显著变量。
91 例患者中，平均年龄为 59.1 岁，61.5%为女性。中位随访时间为 4.9 年。79 例（86.8%）患者出现纤维化进展，持续出现马赛克衰减区，最终被纤维化取代，20 例（22.0%）发生 AE。基线纤维化评分和普通间质性肺炎（UIP）/可能 UIP 的 CT 模式是预测纤维化进展（风险比[HR] = 1.05，95%置信区间[CI] = 1.02-1.09，p < 0.001，用于纤维化评分；HR = 2.50，CI = 1.50-4.16，p < 0.001，用于 CT 模式）和 AE（HR = 1.07，CI = 1.01-1.13，p = 0.019，用于纤维化评分；HR = 5.47，CI = 1.23-24.45，p = 0.026，用于 CT 模式）的独立危险因素，调整临床协变量后。
86.8%的慢性 HP 患者出现纤维化进展，22.0%的患者出现 AE。基线胸部 CT 上的纤维化评分和 UIP/可能 UIP 的 CT 模式可能预测纤维化进展和 AE。
在长期随访中，大多数患者（87%）出现纤维化进展，持续存在马赛克衰减区，后期最终被纤维化取代。
五分之一的患者（22%）经历了与预后较差相关的急性加重。
基线 CT 上的纤维化评分（网状影和蜂窝影之和）和 UIP/可能 UIP 的 CT 模式是预测纤维化进展和急性加重的独立预测因子。
