■特发性肺纤维化(IPF)的新诊断指南并未排除将常规间质性肺炎(UIP)和可能的UIP的放射学模式相结合的可能性,考虑到类似的管理和诊断能力。然而,这些模式的预后影响尚未完全阐明,不同的研究显示出异质性的结果。我们将新标准应用于一系列IPF患者的回顾性研究,根据放射学模式评估生存率,调查结果,和他们的延伸。
■两名胸部放射科医生回顾了146例IPF患者在诊断时拍摄的高分辨率计算机断层扫描图像,描述放射学的发现和模式。分析了每个放射学发现和放射学模式与两年死亡率的关联。
■具有UIP放射学模式的IPF患者的两年死亡率为40.2%,而可能具有UIP的患者为7.1%。与UIP模式相比,可能的UIP可以预防死亡,即使在调整了年龄之后,性别,肺功能,和纤维化程度(风险比(HR)0.23,95%置信区间(CI)0.06-0.99)。接受抗纤维化治疗也是一个保护因素(HR0.51,95CI0.27-0.98)。蜂窝(HR3.62,95CI1.27-10.32),急性加重模式(HR4.07,95CI1.84-8.96),和总体纤维化程度(HR1.04,95CI1.02-1.06)是死亡率的预测因子.
■在我们的系列中,初次扫描时出现UIP与可能的UIP的放射学模式的IPF患者的两年死亡率较高.蜜孔,急性加重模式,总体纤维化程度也是死亡率增加的预测因素.在我们的系列中,UIP的放射学模式和可能的UIP之间的预后差异将支持将它们维持为两种不同的模式。
UNASSIGNED: The new diagnostic guidelines for idiopathic pulmonary fibrosis (IPF) did not rule out the possibility of combining the radiological patterns of usual interstitial pneumonia (UIP) and probable UIP, given the similar management and diagnostic capacity. However, the prognostic implications of these patterns have not been fully elucidated, with different studies showing heterogeneous results. We applied the new criteria to a retrospective series of patients with IPF, assessing survival based on radiological patterns, findings, and their extension.
UNASSIGNED: Two thoracic radiologists reviewed high-resolution computed tomography images taken at diagnosis in 146 patients with IPF, describing the radiological findings and patterns. The association of each radiological finding and radiological patterns with two-year mortality was analysed.
UNASSIGNED: The two-year mortality rate was 40.2% in IPF patients with an UIP radiological pattern versus 7.1% in those with probable UIP. Compared to the UIP pattern, probable UIP was protective against mortality, even after adjusting for age, sex, pulmonary function, and extent of fibrosis (hazard ratio (HR) 0.23, 95% confidence interval (CI) 0.06-0.99). Receiving antifibrotic treatment was also a protective factor (HR 0.51, 95%CI 0.27-0.98). Honeycombing (HR 3.62, 95%CI 1.27-10.32), an acute exacerbation pattern (HR 4.07, 95%CI 1.84-8.96), and the overall extent of fibrosis (HR 1.04, 95%CI 1.02-1.06) were predictors of mortality.
UNASSIGNED: In our series, two-year mortality was higher in patients with IPF who presented a radiological pattern of UIP versus probable UIP on the initial scan. Honeycombing, an acute exacerbation pattern, and a greater overall extent of fibrosis were also predictors of increased mortality. The prognostic differences between the radiological pattern of UIP and probable UIP in our series would support maintaining them as two differentiated patterns.