Prognostication In Idiopathic Interstitial Pneumonia

描述（由申请人提供）： 特发性间质性肺炎（IIP）可分为 组织病理学分类总体预后不同， 组织病理学分类;然而，分类中的个体患者可以 对治疗和生存的反应是不可预测的。的潜力 尽管进行了治疗，但疾病进展通常导致早期列出 肺移植的患者，因为等待名单上的平均时间为2-3 年供体肺短缺，这种方法可能导致 等待名单上的人数过多，并有可能防止 把器官分配给最需要的病人。该项目将 检查IIP患者的预后因素，并使用这些因素 开发一个预测存活率的模型。该模型将帮助患者和 医生决定肺移植的最佳时机。 IIP的组织学类型是最重要的，尽管不是唯一的， 影响生存的因素。确定组织学类型需要 手术活检，这是不可能在所有患者。半定量高 纤维化程度的分辨率CT（HRCT）评分也可提供预后 信息.这种技术的一个缺点是观察者的可变性， 限制了广泛应用。我们将与爱荷华州大学合作 利用计算机定量评分系统， IIP患者的肺部存在毛玻璃样、纤维化。 我们假设，一种计算机化的技术，以确定基线和 纤维化数量的连续变化将提供关键的预后指标， 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， 比较组织学诊断与HRCT诊断的影响， IIP患者我们假设放射科医生会有中度的 IIP诊断的准确性，HRCT诊断将提供更多 与手术获得的组织病理学结果相比， 诊断.临床、放射学和生理学（CRP）的变化 治疗3个月后的评分系统也影响预后。一 缺点是需要心肺运动测试。我们假设 一个利用六分钟内氧饱和度变化的评分系统 大厅步行将提供平等的信息，而不需要 心肺运动试验在过去的10年里， CRP测试还进行了6分钟步行测试。这些信息将 用于开发改良CRP评分的新运动成分 系统我们将利用生存分析来定义患者人群 最有可能通过肺移植提高生存率。

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.