Prognostication In Idiopathic Interstitial Pneumonia

描述(由申请人提供)： 有人建议将特发性间质性肺炎(IIP) 归入组织病理学范畴。总体预后不同于 组织病理学类别；然而，类别中的个别患者可以 对治疗和生存有不可预测的反应。潜在的 尽管接受了治疗，但疾病的进展往往会导致早期出现 肺移植患者的平均等待时间为2-3次 好几年了。供体肺短缺，这种方法可能导致 等待名单人口过多，有可能防止 将器官分配给最需要的患者。这个项目将 检查IIP患者的预后因素，并利用这些因素 开发一种预测生存的模型。这种模式将帮助患者和 医生决定肺移植的最佳时机。 IIP的组织学类型是最重要的，尽管不是排他性的， 影响生存的因素。组织学类型的确定需要 手术活检并不是所有患者都能做到的。半定量高 肝纤维化程度的分辨率CT(HRCT)评分也提供了预后 信息。这种技术的一个缺点是观察者的可变性，这可能 限制广泛使用。我们将与爱荷华大学合作 使用计算机化的量化评分系统来量化HRCT IIP患者的肺中存在各种类型(磨碎玻璃、纤维化)。 我们假设一种确定基线的计算机化技术 纤维化量的连续变化将提供关键的预后 给IIP患者的信息。有人建议放射科医生可以 准确诊断IIP的类别。我们将利用生存分析来 比较组织学诊断与HRCT诊断对 IIP患者。我们假设放射科医生会有适度的 诊断IIP的准确性和HRCT诊断将提供更多 预后信息与手术获得的组织病理学对照 诊断。临床、放射学和生理学(CRP)的变化 治疗3个月后的评分系统对预后也有影响。一个 缺点是心肺运动试验的要求。我们假设 一种利用六分钟内血氧饱和度变化的评分系统 大厅漫步将提供平等的信息，而不需要 心肺运动试验。在过去的10年里，患者接受了 CRP测试还进行了6分钟的步行测试。此信息将 用于开发用于修改的CRP评分的新练习组件 系统。我们将利用生存分析来定义患者群体 最有可能通过肺移植提高存活率。

DESCRIPTION (provided by applicant): It has been proposed that idiopathic interstitial pneumonia (IIP) be divided into histopathologic categories. The overall prognosis differs between histopathologic categories; however, individual patients within categories can have an unpredictable response to therapy and survival. The potential for disease progression despite therapy often leads to the early listing of patients for lung transplantation as the mean time on the waiting list is 2-3 years. There is a shortage of donor lungs and this approach can lead to overpopulation of the waiting list and has the potential of preventing allocation of organs to the patients with the greatest need. This project will examine prognostic factors in patients with IIP and use these factors to develop a model that predicts survival. This model will help patients and physicians decide on optimal timing for lung transplantation. The histologic type of IIP is the most important, although not exclusive, factor influencing survival. Determination of histologic type requires a surgical biopsy which is not possible in all patients. Semi-quantitative high resolution CT (HRCT) scoring for the amount of fibrosis also gives prognostic information. A drawback of this technique is observer variability, which could limit widespread utilization. We will collaborate with the University of Iowa to utilize a computerized quantitative scoring system which quantifies HRCT patterns (ground glass, fibrosis) present in the lungs of patients with IIP. We hypothesize that a computerized technique to determine the baseline and serial change in the amount of fibrosis will provide key prognostic information for patients with IIP. It has been suggested that radiologists can accurately diagnose categories of IIP. We will utilize survival analyses to compare the impact of a histologic diagnosis compared to a HRCT diagnosis for patients with IIP. We hypothesize that radiologists will have moderate accuracy in the diagnosis of IIP and that a HRCT diagnosis will provide more prognostic information when compared to a surgically obtained histopathologic diagnosis. The change in a clinical, radiographic, and physiologic (CRP) scoring system after three months of treatment also influences prognosis. A drawback is the requirement of a cardiopulmonary exercise test. We hypothesize that a scoring system utilizing the change in oxygen saturation during a six-minute hall walk will provide equal information without the need for a cardiopulmonary exercise test. During the past 10 years patients undergoing CRP testing have also performed a six-minute walk test. This information will be utilized to develop a new exercise component for a modified CRP scoring system. We will utilize survival analysis to define the patient population most likely to have improved survival through lung transplantation.