美国胸科学会/日本呼吸学会/拉丁美洲胸科学会 加湿器肺和夏型过敏性肺炎的诊断指南。
ATS/JRS/ALAT Hypersensitivity Pneumonitis Guidelines for Diagnosis of humidifier lung and summer-type hypersensitivity pneumonitis.
机构信息
Division of Respiratory Medicine, Toho University Omori Medical Center, Ota-ku, Tokyo, Japan.
Division of Respiratory Medicine, Toho University Omori Medical Center, Ota-ku, Tokyo, Japan.
出版信息
Respir Investig. 2023 Sep;61(5):660-667. doi: 10.1016/j.resinv.2023.06.007. Epub 2023 Aug 2.
BACKGROUND
The ATS/JRS/ALAT Guidelines for the Diagnosis of Hypersensitivity Pneumonitis (GL for HP) were published in 2020. Humidifier lung and summer-type HP are forms of HP, but it is unclear whether they can be diagnosed using GL for HP. This study examined the level of confidence where humidifier lung and summer-type HP can be diagnosed with GL for HP.
METHODS
Data from 23 patients with humidifier lung and 20 patients with summer-type HP (mean age, 67.3 and 57.4 years, respectively) diagnosed between October 2012 and January 2022 were retrospectively reviewed. We evaluated high resolution computed tomography (HRCT) patterns, bronchoalveolar lavage fluid (BALF) findings, exposures, and histopathological findings to determine the level of confidence where a diagnosis of HP could be made using the GL for HP.
RESULTS
HRCT pattern was classified as typical HP in 5 (22%) and compatible with HP in 18 (78%) patients with humidifier lung and considered as typical HP in 17 (85%) and compatible with HP in 3 (15%) patients with summer-type. The confidence level for diagnosis of HP was definite in 2 (8.7%), moderate in 14 (60.9%), and low in 7 (30.4%) patients with humidifier lung. It was definite in 12 (60%), high in 3 (15%), and moderate in 5 (25%) patients with summer-type HP.
CONCLUSIONS
GL for HP showed utility in diagnosing humidifier lung in many patients with a moderate to low confidence. However, there was a definite to high confidence for patients with summer-type HP.
背景
美国胸科学会/日本呼吸学会/拉丁美洲胸科学会《过敏性肺炎诊断指南》（GL for HP）于 2020 年发布。加湿器肺和夏季型 HP 是 HP 的两种形式，但使用 GL for HP 是否可以诊断这两种疾病尚不清楚。本研究探讨了使用 GL for HP 诊断加湿器肺和夏季型 HP 的置信水平。
方法
回顾性分析 2012 年 10 月至 2022 年 1 月期间诊断的 23 例加湿器肺患者和 20 例夏季型 HP 患者的临床资料（平均年龄分别为 67.3 岁和 57.4 岁）。我们评估了高分辨率计算机断层扫描（HRCT）模式、支气管肺泡灌洗液（BALF）结果、暴露史和组织病理学发现，以确定使用 GL for HP 诊断 HP 的置信水平。
结果
加湿器肺患者中，HRCT 模式符合典型 HP 的有 5 例（22%），符合 HP 的有 18 例（78%）；夏季型 HP 患者中，HRCT 模式符合典型 HP 的有 17 例（85%），符合 HP 的有 3 例（15%）。加湿器肺患者中，HP 诊断的置信水平为明确的有 2 例（8.7%），中度的有 14 例（60.9%），低度的有 7 例（30.4%）。夏季型 HP 患者中，HP 诊断的置信水平为明确的有 12 例（60%），高度的有 3 例（15%），中度的有 5 例（25%）。
结论
GL for HP 对大多数加湿器肺患者的诊断具有中等至低度的可信度，但对夏季型 HP 患者具有明确至高度的可信度。
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