QUANTITATIVE ASSESSMENT OF LUNG PATHOLOGY IN IDIOPATHIC PULMONARY FIBROSIS
QUANTITATIVE ASSESSMENT OF LUNG PATHOLOGY IN IDIOPATHIC PULMONARY FIBROSIS
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DOI：
10.1164/ajrccm/144.4.892
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发表时间：
1991-10-01
期刊：
影响因子：
--
通讯作者：
KING, TE
中科院分区：
文献类型：
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作者：
CHERNIACK, RM;COLBY, TV;KING, TE
大多数间质性肺疾病的诊断和分类需要肺组织的组织学评价，通过开放性肺活检获得以确认诊断。 此外，普遍认为特发性肺纤维化（IPF）对治疗的反应与细胞结构和纤维化的相对程度有关。 由于通常仅提供这些变化的相对范围和严重程度的定性评估，因此难以与临床和生理变化相关联。 本报告描述了由4名病理学家对50例IPF患者的炎症/渗出性变化、纤维化/修复性变化和气道改变进行半定量评估的结果，以及对细胞结构和纤维化的总体评估。 在10个随机选择的活检样本中，以设盲方式检查两次，给定病理学家评估之间的绝对一致性在54%和64%之间变化（平均值= 57.5%），在大多数情况下，一致性大于偶然发生的一致性。 在101个样本中，四位评分员的大多数变量都有很好的一致性。 某位评分者报告的某些参数的平均评分偶尔会偏离其他评分者的平均评分，但没有一位评分者与其他评分者一致。 主成分因子分析显示，病理学特征分为四大类：肺泡壁化生、纤维化、蜂窝样变、平滑肌和血管改变属于一类，肺泡壁细胞结构的严重程度和范围属于第二类，肺泡腔细胞结构的严重程度和范围属于第三类，第四组为间质性年轻结缔组织沿着伴气道肉芽组织。 这些因素的相关性显著（p < 0.0001），如下所示：纤维化为0.7588，肺泡壁细胞构成为0.5542，肺泡腔细胞构成为0.5112，结缔组织/肉芽组织为0.4858;这些系数的SE均为0.0406。 我们的结论是，评分系统是简单的，并提供了一个半定量评估的病理特征，可能是有用的评估IPF。 观察到的评分变化指出了病理学家小组在临床研究和IPF疾病活动报告中进行组织评价的重要性。
The diagnosis and classification of most interstitial lung diseases requires histologic evaluation of lung tissue, obtained by an open lung biopsy to confirm the diagnosis. In addition, it is generally accepted that response to therapy in idiopathic pulmonary fibrosis (IPF) is related to the relative degree of cellularity and fibrosis present. Because only a qualitative assessment of the relative extent and severity of these changes is generally provided, correlation with clinical and physiologic alterations is difficult. This report describes results of a semiquantitative assessment by four pathologists of inflammatory/exudative changes, fibrotic/reparative changes, and airway alterations, in addition to an overall assessment of cellularity and fibrosis in 50 patients with IPF. In 10 randomly selected biopsies examined twice in a blinded fashion, absolute agreement between assessments for a given pathologist varied between 54 and 64% (mean = 57.5%) and in the majority of instances the agreement was greater than would have occurred by chance. There was good agreement for most variables across the four raters on the 101 samples. The mean score for some of the parameters reported by a given rater deviated occasionally from those of the other raters, but no single rater was consistently different from the other raters. A principal component factor analysis revealed that the pathologic features fell into four general groupings: alveolar wall metaplasia, fibrosis, honeycombing, smooth muscle, and vascular changes fell into one group; severity and extent of cellularity in the alveolar wall into a second group; severity and extent of cellularity in the alveolar space into a third group; and interstitial young connective tissue along with granulation tissue in the airways formed the fourth group. The correlations for the factors were significant (p < 0.0001) as follows: 0.7588 for fibrosis, 0.5542 for alveolar wall cellularity, 0.5112 for alveolar space cellularity, and 0.4858 for connective/granulation tissue; the SE of each of these coefficients was 0.0406. We conclude that the scoring system is simple and provides a semiquantitative assessment of pathologic features that may be useful in the evaluation of IPF. The observed variations in scoring point out the importance of tissue evaluation by a panel of pathologists in clinical research and in reporting on the disease activity in IPF.