Yazawa Shusuke, Suzuki Yuzo, Tanaka Yuko, Yokomura Koshi, Kono Masato, Hashimoto Dai, Fukada Atsuki, Inoue Yusuke, Yasui Hideki, Hozumi Hironao, Karayama Masato, Furuhashi Kazuki, Enomoto Noriyuki, Fujisawa Tomoyuki, Inui Naoki, Suda Takafumi
Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Allergol Int. 2025 Jan;74(1):78-85. doi: 10.1016/j.alit.2024.07.002. Epub 2024 Sep 5.
Hypersensitivity pneumonitis (HP) is a complex and heterogenous interstitial lung disease (ILD) that occurs in susceptible individuals due to certain inhaled antigens. Fibrotic-HP is a major underlying disease of progressive pulmonary fibrosis. Therefore, in addition to the radiological features of HP, quantitatively measuring fibrosis is important to evaluate disease severity and progression. The present study aimed to compare three-dimensional computed tomography (3D-CT)-derived lung volumes (LVs) of patients with HP and determine its association with mortality risk.
In this retrospective and multicenter cohort study, 126 patients diagnosed with HP (fibrotic, n = 72 and non-fibrotic, n = 54) with a confidence level higher than moderate were enrolled. Each lobe LV was measured using 3D-CT at the time of diagnosis and standardized using predicted forced vital capacity. The 3D-CT LV was compared with those of 42 controls and 140 patients with idiopathic pulmonary fibrosis (IPF).
Compared to patients with fibrotic-HP, the standardized total LV was significantly higher in controls and patients with non-fibrotic-HP and was similar in patients with IPF. Longitudinal analyses demonstrated that approximately half of the patients with fibrotic-HP had an annual decrease in total LV. Decreased total and lower-lobe LVs were associated with shorter survival, and were independently associated with mortality together with ongoing exposure to inciting antigens. A composite model consisting of ongoing exposure to inciting antigens and total or lower-lobe LV successfully classified mortality risk into three groups.
Quantitatively measuring standardized LV can help determine disease severity, progression, and mortality risk in patients with fibrotic-HP.
过敏性肺炎（HP）是一种复杂的异质性间质性肺疾病（ILD），发生于易感个体，由特定吸入抗原引起。纤维化型HP是进行性肺纤维化的主要潜在疾病。因此，除了HP的影像学特征外，定量测量纤维化对于评估疾病严重程度和进展很重要。本研究旨在比较HP患者的三维计算机断层扫描（3D-CT）得出的肺容积（LVs），并确定其与死亡风险的关联。
在这项回顾性多中心队列研究中，纳入了126例诊断为HP（纤维化型，n = 72；非纤维化型，n = 54）且置信水平高于中等的患者。在诊断时使用3D-CT测量每个肺叶的LV，并使用预测的用力肺活量进行标准化。将3D-CT得出的LV与42名对照者和140例特发性肺纤维化（IPF）患者的LV进行比较。
与纤维化型HP患者相比，对照组和非纤维化型HP患者的标准化总LV显著更高，而IPF患者的标准化总LV与之相似。纵向分析表明，约一半的纤维化型HP患者总LV每年下降。总LV和下叶LV降低与较短的生存期相关，并且与持续暴露于激发抗原一起独立与死亡率相关。由持续暴露于激发抗原以及总LV或下叶LV组成的复合模型成功地将死亡风险分为三组。
定量测量标准化LV有助于确定纤维化型HP患者的疾病严重程度、进展和死亡风险。
