Ichikado Kazuya, Ichiyasu Hidenori, Iyonaga Kazuhiro, Kawamura Kodai, Yasuda Yuko, Anan Keisuke, Okabayashi Hiroko, Akaike Kimitaka, Higashi Noritaka, Johkoh Takeshi, Fujimoto Kiminori, Saito Tetsuo, Morinaga Jun, Yoshida Minoru, Mitsuzaki Katsuhiko, Sakagami Takuro
Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Chu-oh Ku, Kumamoto, 861-4101, Japan.
Department of Respiratory Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto 1-1-1 Honjo, Chuo-ku, 860-8556, Japan.
BMC Pulm Med. 2025 Jan 29;25(1):47. doi: 10.1186/s12890-025-03520-4.
Fibrotic types of interstitial lung abnormalities seen on high-resolution computed tomography scans, characterised by traction bronchiolectasis/bronchiectasis with or without honeycombing, are predictors of progression and poor prognostic factors of interstitial lung abnormalities. There are no reports on the clinical characteristics of fibrotic interstitial lung abnormalities on high-resolution computed tomography scans. Therefore, we aimed to examine these clinical characteristics and clarify the predictive factors of fibrotic interstitial lung abnormalities on high-resolution computed tomography scans.
Clinical and paraclinical data of 164 patients enrolled in the initial year of a multicentre prospective observational study (Kumamoto interstitial lung abnormalities study in Japan) involving over 62,000 examinees during routine health examinations were analysed. Clinical laboratory evaluations are expressed as medians and interquartile ranges for each evaluation time point, and boxplots were created for graphical representation. The percentages of abnormal clinical laboratory results were compared between the groups using chi-square or Fisher's exact tests. Univariate or multivariate logistic regression analyses were performed to analyse the relationship between fibrotic interstitial lung abnormalities and other clinical factors.
Fibrotic interstitial lung abnormalities were observed on high-resolution computed tomography scans in 135 (82%) patients at the time of diagnosis. Multivariate analysis showed that older age (Odds ratio, 1.06; 95% confidence interval, 1.01-1.12; p = 0.021), auscultatory fine crackles (Odds ratio, 3.39; 95% confidence interval, 1.33-8.65; p < 0.01), and elevated serum surfactant protein-D (Odds ratio, 2.68; 95% confidence interval, 1.02-8.64; p = 0.045) were independent predictive factors of fibrotic interstitial lung abnormalities. The predicted area under the curve of the fibrotic interstitial lung abnormalities based on these three factors was 0.77 (95% confidence interval, 0.68-0.86). The proportion of undecided diagnoses in the fibrotic interstitial lung abnormalities group (14%) was significantly lower than that in the non-fibrotic interstitial lung abnormalities group (41%) (p = 0.0027).
Fine crackles on auscultation and elevated serum surfactant protein-D levels are predictors of fibrotic interstitial lung abnormalities in older patients with interstitial lung abnormalities. These findings may assist non-radiological physicians in referring patients to specialists for early intervention in progressive fibrotic interstitial lung diseases.
TRIAL REGISTRATION NUMBER/DATE: UMIN000045149/2021.12.1.
在高分辨率计算机断层扫描中可见的纤维化型间质性肺异常，其特征为牵拉性细支气管扩张/支气管扩张伴或不伴蜂窝状改变，是间质性肺异常进展的预测指标和不良预后因素。目前尚无关于高分辨率计算机断层扫描中纤维化间质性肺异常临床特征的报道。因此，我们旨在研究这些临床特征，并阐明高分辨率计算机断层扫描中纤维化间质性肺异常的预测因素。
分析了一项多中心前瞻性观察研究（日本熊本县间质性肺异常研究）首年纳入的164例患者的临床和辅助临床数据，该研究在常规健康检查期间对超过62000名受检者进行了调查。临床实验室评估结果以每个评估时间点的中位数和四分位间距表示，并绘制箱线图进行图形展示。使用卡方检验或Fisher精确检验比较各组异常临床实验室结果的百分比。进行单因素或多因素逻辑回归分析，以分析纤维化间质性肺异常与其他临床因素之间的关系。
诊断时，135例（82%）患者的高分辨率计算机断层扫描显示存在纤维化间质性肺异常。多因素分析显示，年龄较大（比值比，1.06；95%置信区间，1.01 - 1.12；p = 0.021）、听诊闻及细湿啰音（比值比，3.39；95%置信区间，1.33 - 8.65；p < 0.01）和血清表面活性蛋白-D升高（比值比，2.68；95%置信区间，1.02 - 8.64；p = 0.045）是纤维化间质性肺异常的独立预测因素。基于这三个因素的纤维化间质性肺异常预测曲线下面积为0.77（95%置信区间，0.68 - 0.86）。纤维化间质性肺异常组中诊断不明确的比例（14%）显著低于非纤维化间质性肺异常组（41%）（p = 0.0027）。
听诊闻及细湿啰音和血清表面活性蛋白-D水平升高是老年间质性肺异常患者纤维化间质性肺异常的预测指标。这些发现可能有助于非放射科医生将患者转诊给专科医生，以便对进行性纤维化间质性肺疾病进行早期干预。
试验注册号/日期：UMIN000045149/2021.12.1
