High-Resolution CT Change over Time in Patients with Idiopathic Pulmonary Fibrosis on Antifibrotic Treatment
High-Resolution CT Change over Time in Patients with Idiopathic Pulmonary Fibrosis on Antifibrotic Treatment
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DOI：
10.3390/jcm8091469
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发表时间：
2019-09-01
影响因子：
3.9
通讯作者：
Spagnolo, Paolo
中科院分区：
文献类型：
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作者：
Balestro, Lisabetta;Cocconcelli, Elisabetta;Spagnolo, Paolo
抗纤维化治疗可减缓特发性肺纤维化（IPF）的功能衰退和疾病进展。高分辨率计算机断层扫描（HRCT）有助于诊断特发性肺纤维化（IPF）；然而，关于 HRCT 变化是否以及在多大程度上反映抗纤维化治疗期间的功能变化，人们知之甚少。因此，本研究的目的是评估治疗 1 年后 HRCT 随时间的变化，并评估这些变化是否与同一时期的功能衰退相关。 68 名接受抗纤维化治疗（即吡非尼酮或尼达尼布）的 IPF 患者根据其每年用力肺活量 (FVC) 是否下降 >5% 预测，在功能上被分类为稳定或进展者，并且他们的 HRCT 在治疗开始时 (HRCT1) 和治疗 1 年后 (HRCT2) 由两名胸部放射科医生专家进行盲法独立评分。对毛玻璃混浊（肺泡评分，AS）、网状结构（间质评分，IS）和蜂窝状（HC）进行量化，并与 HRCT1 和 HRCT2 之间的 FVC 下降相关。治疗开始时，稳定患者和进展患者的 HRCT 评分相似。治疗一年后，在整个人群中，AS 和 HC 显着增加，而 IS 则没有。然而，当按功能下降率分层时，在稳定的患者中，HC 显着增加，而 AS 和 IS 则没有。另一方面，在进展者中，AS 和 HC 显着增加，而 IS 则没有。在整个人群中，纤维化综合评分 (IS + HC) 与 FVC 下降显着相关。总之，接受抗纤维化治疗的 IPF 患者根据其功能衰退率，随着时间的推移表现出不同的 HRCT 变化模式。在评估 IPF 患者抗纤维化治疗的反应时，HRCT 数据应与肺功能数据整合。
Antifibrotic treatment slows down functional decline and disease progression in idiopathic pulmonary fibrosis (IPF). High-resolution computed tomography (HRCT) is useful to diagnose IPF; however, little is known about whether and to what extent HRCT changes reflect functional changes during antifibrotic therapy. The aim of this study was, therefore, to assess HRCT change over time after 1 year of treatment and to evaluate whether these changes correlate with functional decline over the same period of time. Sixty-eight IPF patients on antifibrotic treatment (i.e., pirfenidone or nintedanib) were functionally categorized as stable or progressors based on whether (or not) they had a decline in forced vital capacity (FVC) >5% predicted/year, and their HRCT were scored blindly and independently by two expert thoracic radiologists at treatment initiation (HRCT1) and after 1 year of treatment (HRCT2). Ground glass opacities (Alveolar Score, AS), reticulations (Interstitial Score, IS) and honeycombing (HC) were quantified and correlated with FVC decline between HRCT1 and HRCT2. At treatment initiation, HRCT scores were similar in both stable patients and progressors. After one year of treatment, in the entire population, AS and HC increased significantly, while IS did not. However, when stratified by the rate of functional decline, in stable patients, HC increased significantly while AS and IS did not. On the other hand, among progressors AS and HC increased significantly whereas IS did not. In the entire population, the combined score of fibrosis (IS + HC) correlated significantly with FVC decline. In conclusion, IPF patients on antifibrotic treatment exhibit different patterns of HRCT change over time based on their rate of functional decline. HRCT data should be integrated to lung function data when assessing response to antifibrotic treatment in patients with IPF.