Simone Petrarulo, Claudia Ravaglia, Sissel Kronborg White, Line Bille Madsen, Frederik Lex, Alessandra Dubini, Elisabetta Fabbri, Elisabeth Bendstrup, Paolo Spagnolo, Sara Piciucchi, Venerino Poletti
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引用次数: 0
Abstract
Fibrotic hypersensitivity pneumonitis (f-HP) is an interstitial lung disease in which various antigens in susceptible individuals may play a pathogenetic role. This study evaluates the role of transbronchial lung cryobiopsy (TBLC) and bronchoalveolar lavage (BAL) in identifying a UIP-like pattern and its association with fibrosis progression. We conducted a multicentre retrospective cohort study of patients diagnosed with f-HP who underwent BAL and TBLC between 2011 and 2023. A UIP-like pattern was defined by the presence of (A) patchy fibrosis and fibroblastic foci or (B) honeycombing ± (A). We investigated BAL's role in predicting UIP-like patterns within a clinical-radiological-serological framework, examining disease progression in these patients using spirometry and mortality data. A total of 195 patients were enrolled, 59 (30%) of whom exhibited a UIP-like pattern. These patients showed greater lung function decline, lower BAL lymphocytosis (14.4% vs. 37.4%, p < 0.001), higher nintedanib prescription (35% vs. 14%, p < 0.001), and higher 10-year mortality (HR 2.8, 95% CI 1.3-5.8, p = 0.004). f-HP patients with a UIP-like pattern exhibit worse clinical outcomes and higher mortality. In cases of low BAL lymphocytosis with a high pre-test clinical suspicion of f-HP, lung biopsy may not be necessary as it increases the likelihood of identifying a UIP-like pattern.
纤维化超敏性肺炎(f-HP)是一种肺间质性疾病,易感个体的多种抗原可能起致病作用。本研究评估了经支气管肺低温活检(TBLC)和支气管肺泡灌洗(BAL)在识别uip样模式及其与纤维化进展的关系中的作用。我们对2011年至2023年间接受BAL和TBLC的f-HP患者进行了一项多中心回顾性队列研究。(A)斑片状纤维化和成纤维细胞灶或(B)蜂窝状±(A)为upp样模式。我们研究了BAL在临床-放射学-血清学框架内预测upp样模式的作用,使用肺活量测定法和死亡率数据检查这些患者的疾病进展。共纳入195例患者,其中59例(30%)表现为uip样模式。这些患者表现出更大的肺功能下降,BAL淋巴细胞减少(14.4% vs. 37.4%, p p p = 0.004)。具有upp样模式的f-HP患者表现出更差的临床结果和更高的死亡率。对于低BAL淋巴细胞增多而检测前临床怀疑为f-HP的病例,肺活检可能不需要,因为它增加了识别upp样模式的可能性。
PulmonologyMedicine-Pulmonary and Respiratory Medicine
CiteScore
14.30
自引率
5.10%
发文量
159
审稿时长
19 days
期刊介绍:
Pulmonology (previously Revista Portuguesa de Pneumologia) is the official journal of the Portuguese Society of Pulmonology (Sociedade Portuguesa de Pneumologia/SPP). The journal publishes 6 issues per year and focuses on respiratory system diseases in adults and clinical research. It accepts various types of articles including peer-reviewed original articles, review articles, editorials, and opinion articles. The journal is published in English and is freely accessible through its website, as well as Medline and other databases. It is indexed in Science Citation Index Expanded, Journal of Citation Reports, Index Medicus/MEDLINE, Scopus, and EMBASE/Excerpta Medica.