An autopsy study of combined pulmonary fibrosis and emphysema: correlations among clinical, radiological, and pathological features.
An autopsy study of combined pulmonary fibrosis and emphysema: correlations among clinical, radiological, and pathological features.
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DOI：
10.1186/1471-2466-14-104
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发表时间：
2014-06-28
影响因子：
3.1
通讯作者：
Takemura T
中科院分区：
文献类型：
--
作者：
Inomata M;Ikushima S;Awano N;Kondoh K;Satake K;Masuo M;Kusunoki Y;Moriya A;Kamiya H;Ando T;Yanagawa N;Kumasaka T;Ogura T;Sakai F;Azuma A;Gemma A;Takemura T
在肺纤维化和肺气肿（CPFE）合并症患者中，鉴别肺纤维化和肺气肿特征性特征的临床评价通常很困难，但肺纤维化的诊断对于评估此类患者的治疗方案和间质性肺炎急性加重的风险非常重要。据我们所知，这是第一份报告描述了临床，放射学和全肺病理特征之间的相关性在尸检病例的CPFE患者。专家回顾性审查了22例CPFE患者尸检系列的临床图表，检查了胸部计算机断层扫描（CT）图像和病理结果，并将这些结果与8例特发性肺纤维化（IPF）患者和17例单纯肺气肿患者的结果进行了比较。所有患者均有重度吸烟史。单纯肺气肿组的1秒用力呼气量/用力肺活量（FEV 1/FVC%）显著低于单纯CPFE组和IPF组。CPFE组中预测的肺一氧化碳弥散量百分比（DLCO%）显著低于IPF和单纯肺气肿组。15例（68.2%）CPFE患者和8例（100%）单纯IPF患者在放射学上观察到肺间质性肺炎（UIP）模式，两组所有患者均进行了病理学观察。病理学上的厚囊性病变涉及一个或多个腺泡，伴致密壁纤维化和偶尔被蜂窝和正常肺泡包围的成纤维细胞病灶，通过尸检观察证实为厚壁囊性病变（TWCL）。在TWCL中观察到肺气肿性破坏和膜性和呼吸性细支气管扩大伴纤维化。囊性病变常大于蜂窝样囊肿。在CPFE患者中，放射学和病理学TWCL的患病率均为72.7%，但在IPF或单纯肺气肿患者中未观察到此类病变（p = 0.001）。肺气肿的程度在CPFE患者与TWCL大于患者没有这样的病变。11例CPFE患者还观察到蜂窝肺气肿。仅在CPFE患者中观察到TWCL。它们被归类为纤维化间质性肺炎和肺气肿并存的病变，应被视为CPFE的重要病理和放射学特征。
Clinical evaluation to differentiate the characteristic features of pulmonary fibrosis and emphysema is often difficult in patients with combined pulmonary fibrosis and emphysema (CPFE), but diagnosis of pulmonary fibrosis is important for evaluating treatment options and the risk of acute exacerbation of interstitial pneumonia of such patients. As far as we know, it is the first report describing a correlation among clinical, radiological, and whole-lung pathological features in an autopsy cases of CPFE patients. Experts retrospectively reviewed the clinical charts and examined chest computed tomography (CT) images and pathological findings of an autopsy series of 22 CPFE patients, and compared these with findings from 8 idiopathic pulmonary fibrosis (IPF) patients and 17 emphysema-alone patients. All patients had a history of heavy smoking. Forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC%) was significantly lower in the emphysema-alone group than the CPFE and IPF-alone groups. The percent predicted diffusing capacity of the lung for carbon monoxide (DLCO%) was significantly lower in the CPFE group than the IPF- and emphysema-alone groups. Usual interstitial pneumonia (UIP) pattern was observed radiologically in 15 (68.2%) CPFE and 8 (100%) IPF-alone patients and was pathologically observed in all patients from both groups. Pathologically thick-cystic lesions involving one or more acini with dense wall fibrosis and occasional fibroblastic foci surrounded by honeycombing and normal alveoli were confirmed by post-mortem observation as thick-walled cystic lesions (TWCLs). Emphysematous destruction and enlargement of membranous and respiratory bronchioles with fibrosis were observed in the TWCLs. The cystic lesions were always larger than the cysts of honeycombing. The prevalence of both radiological and pathological TWCLs was 72.7% among CPFE patients, but no such lesions were observed in patients with IPF or emphysema alone (p = 0.001). The extent of emphysema in CPFE patients with TWCLs was greater than that in patients without such lesions. Honeycombing with emphysema was also observed in 11 CPFE patients. TWCLs were only observed in the CPFE patients. They were classified as lesions with coexistent fibrosing interstitial pneumonia and emphysema, and should be considered an important pathological and radiological feature of CPFE.
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影响因子：
3.3
作者：
Katzenstein, Anna-Luise A.;Mukhopadhyay, Sanjay;Dexter, Elizabeth
通讯作者：
Dexter, Elizabeth
影响因子：
3.9
作者：
Ley B;Collard HR
通讯作者：
Collard HR
影响因子：
5.6
作者：
Fraig, M;Shreesha, U;Katzenstein, ALA
通讯作者：
Katzenstein, ALA
影响因子：
158.5
作者：
NIEWOEHNER, DE;KLEINERMAN, J;RICE, DB
通讯作者：
RICE, DB
DOI：
10.1164/rccm.2009-040gl
发表时间：
2011-03-15
影响因子：
24.7
作者：
Raghu, Ganesh;Collard, Harold R.;Schuenemann, Holger J.
通讯作者：
Schuenemann, Holger J.