Organizing pneumonia and lymphoplasmacytic inflammation predict treatment response in idiopathic pulmonary fibrosis
Organizing pneumonia and lymphoplasmacytic inflammation predict treatment response in idiopathic pulmonary fibrosis
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DOI：
10.1111/j.1365-2559.2006.02554.x
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发表时间：
2007-01-01
期刊：
影响因子：
6.4
通讯作者：
Brown, K. K.
中科院分区：
文献类型：
--
作者：
Collard, H. R.;Cool, C. D.;Brown, K. K.
目的：确定普通间质性肺炎模式中的个体组织病理学特征，以预测对免疫抑制治疗的反应。方法和结果：纳入了来自接受皮质类固醇和细胞毒治疗的特发性肺纤维化受试者的 56 例回顾性证实的常见间质性肺炎模式手术肺活检标本。两位肺部病理学家专家评估了十一项前瞻性定义的组织病理学特征。回归分析确定了治疗反应的预测因子，定义为 6 个月内预测用力肺活量百分比的变化。其他终点包括 6 个月内呼吸困难评分的变化以及生存时间。预测用力肺活量百分比的改善与淋巴浆细胞炎症相关，而预测用力肺活量百分比的恶化与机化性肺炎和成纤维细胞病灶的存在相关。呼吸困难恶化与成纤维细胞灶有关。生存时间与年龄和预测用力肺活量的基线百分比相关，但与任何个体组织病理学特征无关。结论：在病理性常见间质性肺炎模式中，淋巴浆细胞炎症的存在预测对免疫调节治疗的反应，而空腔组织预测缺乏反应。
Aims: To identify individual histopathological features within usual interstitial pneumonia pattern that predict responsiveness to immunosuppressive therapy.Methods and results: Fifty-six retrospectively confirmed usual interstitial pneumonia pattern surgical lung biopsy specimens from subjects with idiopathic pulmonary fibrosis treated with corticosteroid and cytotoxic therapy were included. Eleven prospectively defined histopathological features were evaluated by two expert pulmonary pathologists. Regression analysis identified predictors of response to therapy, as defined by the change in percent predicted forced vital capacity over 6 months. Additional end-points were change in dyspnoea score over 6 months, and survival time. Improvement in percent predicted forced vital capacity was associated with lymphoplasmacytic inflammation, while worsening of percent predicted forced vital capacity was associated with the presence of organizing pneumonia and fibroblast foci. Worsening dyspnoea was associated with fibroblast foci. Survival time was associated with age and baseline percent predicted forced vital capacity, but not with any individual histopathological feature.Conclusions: In pathological usual interstitial pneumonia pattern, the presence of lymphoplasmacytic inflammation predicts responsiveness to immunomodulatory therapy, while airspace organization predicts lack of response.