Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75219, USA.
Department of Statistics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
BMC Pulm Med. 2024 Aug 20;24(1):398. doi: 10.1186/s12890-024-03098-3.
Antigen removal is a cornerstone of treatment of hypersensitivity pneumonitis (HP), but its association with transplant-free survival remains unclear. Further, HP guidelines conflict as to whether antigen removal is a recommended diagnostic test in patients with suspected HP.
The purpose of this study is to (1) evaluate the impact of antigen removal on transplant-free survival and (2) to describe the impact of antigen removal on pulmonary function testing and imaging in a retrospective cohort of patients with HP.
We retrospectively identified HP patients evaluated between 2011 and 2020. Demographic, physiologic, radiographic, and pathologic data were recorded.
212 patients were included in the cohort. Patients who identified and removed antigen had a better transplant-free survival than patients who did not identify antigen and patients who identified but did not remove antigen. Antigen removal was associated with improvement in FVC by 10% predicted in 16.9% of patients with fibrotic HP and 56.7% of patients with nonfibrotic HP.
Our results suggest that over 50% of nonfibrotic HP patients and 16.9% of fibrotic HP patients improve with exposure removal. In addition, antigen removal, rather than antigen identification, is associated with transplant-free survival in HP.
抗原去除是治疗过敏性肺炎（HP）的基石，但它与无移植存活率的关系尚不清楚。此外，HP 指南存在冲突，即抗原去除是否是疑似 HP 患者的推荐诊断测试。
本研究的目的是（1）评估抗原去除对无移植存活率的影响，（2）描述抗原去除对 HP 患者回顾性队列中肺功能测试和影像学的影响。
我们回顾性地确定了 2011 年至 2020 年间评估的 HP 患者。记录了人口统计学、生理、放射学和病理学数据。
共有 212 名患者纳入该队列。识别并去除抗原的患者比未识别抗原的患者和识别但未去除抗原的患者具有更好的无移植存活率。抗原去除与 16.9%的纤维化 HP 患者和 56.7%的非纤维化 HP 患者的 FVC 预测值提高 10%相关。
我们的结果表明，超过 50%的非纤维化 HP 患者和 16.9%的纤维化 HP 患者可通过暴露去除而得到改善。此外，在 HP 中，与无移植存活率相关的是抗原去除，而不是抗原识别。
