Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama, Kanagawa, 236-0051, Japan.
Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1 Tomioka-higashi, Kanazawa-ku, Yokohama, Kanagawa, 236-0051, Japan.
Respir Investig. 2024 Sep;62(5):832-837. doi: 10.1016/j.resinv.2024.07.008. Epub 2024 Jul 18.
According to international diagnostic guidelines for hypersensitivity pneumonitis (HP), cases with both nonfibrotic and fibrotic lesions are classified by the predominant feature. Therefore, some cases with nonfibrotic HP, have inflammatory lesions alone, while others have a mixture of fibrosis and inflammation. We investigated the impact of slight fibrotic lesions in nonfibrotic HP.
This retrospective study included nonfibrotic HP cases with <10% of lung distortion on high-resolution CT. We divided the cases into two groups: those with pure ground glass opacities (GGOs) without lung distortion and those with slight lung distortion of <10%.
In this study, 37 cases were included. The mean baseline forced vital capacity (FVC) was 109% in the pure GGO group and 96% in the slight lung distortion group (p = 0.038). After 1 year, the reticular shadows appeared or increased more in the slight lung distortion group than in the pure GGO group (16% vs. 8%, p = 0.030). The time to medication initiation was significantly shorter in the slight lung distortion group than in the pure GGO group (p = 0.044). %FVC decreased by ≥ 5% from diagnosis in no cases with the pure GGO and in two cases with the slight lung distortion (-11.0% for 9.5 years and -10.7% for 1.3 years, respectively).
The slight distortion group exhibited a higher rate of worsening and new appearance of reticular shadows after 1 year and a shorter time to first medication compared to the pure GGO group.
根据国际过敏性肺炎（HP）诊断指南，既有非纤维化又有纤维化病变的病例按主要特征分类。因此，一些非纤维化 HP 病例仅有炎症病变，而另一些则有纤维化和炎症的混合病变。我们研究了非纤维化 HP 中轻微纤维化病变的影响。
本回顾性研究纳入 HRCT 上肺扭曲度<10%的非纤维化 HP 病例。我们将病例分为两组：无肺扭曲的单纯磨玻璃影（GGO）组和肺扭曲<10%的轻微肺扭曲组。
本研究共纳入 37 例病例。单纯 GGO 组的基线用力肺活量（FVC）平均为 109%，轻微肺扭曲组为 96%（p=0.038）。1 年后，轻微肺扭曲组的网状阴影出现或增多的比例高于单纯 GGO 组（16%对 8%，p=0.030）。轻微肺扭曲组开始药物治疗的时间明显短于单纯 GGO 组（p=0.044）。在单纯 GGO 组中，无病例的 FVC 从诊断时下降≥5%，而在轻微肺扭曲组中有 2 例（分别为 9.5 年下降 11.0%和 1.3 年下降 10.7%）。
与单纯 GGO 组相比，轻微扭曲组在 1 年后的恶化和新出现网状阴影的比例更高，且首次用药的时间更短。
