Clinical diagnosis of hypersensitivity pneumonitis
Clinical diagnosis of hypersensitivity pneumonitis
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DOI：
10.1164/rccm.200301-137oc
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发表时间：
2003-10-15
影响因子：
24.7
通讯作者：
Cormier, Y
中科院分区：
文献类型：
--
作者：
Lacasse, Y;Selman, M;Cormier, Y
过敏性肺炎（HP）的诊断是困难的，往往依赖于组织病理学。我们的目标是确定诊断标准，并制定一个临床预测规则，这种疾病。在鉴别诊断中考虑了HP的并发症患者接受了简单的标准化诊断程序。高分辨率计算机断层扫描和支气管肺泡灌洗（BAL）确定是否存在HP。当计算机断层扫描、BAL和其他诊断程序未能得出诊断时，患者接受手术肺活检。400例患者（1116例HP患者，284例对照受试者）的队列提供了规则推导的数据。确定了六个重要的HP预测因子：（1）暴露于已知的攻击性抗原，（2）攻击性抗原的阳性沉淀抗体，（3）症状的反复发作，（4）体格检查时的吸气性爆裂声，（5）暴露后4 - 8小时出现的症状，（6）体重减轻。受试者工作特征曲线下面积为0.93（95%置信区间：0.90-0.95）。当在一个单独的261名患者的队列中验证时，该规则保持了其准确性。HP的诊断通常可以作出或拒绝与信心，特别是在高或低流行率的地区，分别没有BAL或活检。
The diagnosis of hypersensitivity pneumonitis (HP) is difficult and often relies on histopathology. Our objective was to identify diagnostic criteria and to develop a clinical prediction rule for this disease. Consecutive patients presenting a condition for which H P was considered in the differential diagnosis underwent a program of simple standardized diagnostic procedures. High-resolution computed tomography scan and bronchoalveolar lavage (BAL) defined the presence or absence of HP. Patients underwent surgical lung biopsy when the computed tomography scan, BAL, and other diagnostic procedures failed to yield a diagnosis. A cohort of 400 patients (1116 with HP, 284 control subjects) provided data for the rule derivation. Six significant predictors of HP were identified: (1) exposure to a known offending antigen, (2) positive precipitating antibodies to the offending antigen, (3) recurrent episodes of symptoms, (4) inspiratory crackles on physical examination, (5) symptoms occurring 4 to 8 hours after exposure, (6) and weight loss. The area under the receiver operating characteristic curve was 0.93 (95% confidence interval: 0.90-0.95). The rule retained its accuracy when validated in a separate cohort of 261 patients. The diagnosis of HP can often be made or rejected with confidence, especially in areas of high or low prevalence, respectively, without BAL or biopsy.