Antigen avoidance tests for diagnosis of chronic hypersensitivity pneumonitis

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• 作者：Toshiharu Tsutsui ^{ttsutsui.pulm@tmd.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Yasunari Miyazaki ; ^{miyazaki.pilm@tmd.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Tsukasa Okamoto ^{tokamoto.pulm@tmd.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Tomoya Tateishi ^{tateishi.pulm@tmd.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Haruhiko Furusawa ^{hfurusawa.pulm@tmd.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Kimitake Tsuchiya ^{tsucpulm@tmd.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Toshihide Fujie ^{tfujie.pulm@tmd.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Meiyo Tamaoka ^{meiyou2.pulm@tmd.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Hiroyuki Sakashita ^{hsakpulm@tmd.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Yuki Sumi ^{ysumi.pulm@tmd.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Naohiko Inase ^{ninase.pulm@tmd.ac.jp" class="auth_mail" title="E-mail the corresponding author}
• 关键词：HP ; hypersensitivity pneumonitis ; IIPs ; idiopathic interstitial pneumonias ; CVD-IP ; collagen vascular disease-associated interstitial pneumonia ; LD-CTD ; lung dominant connective tissue disease ; IPF ; idiopathic pulmonary fibrosis ; ILD ; interstitial lung disease ; HRCT ; high-resolution computed tomography ; LPT ; lymphocyte proliferation test ; VC ; vital capacity ; A-aDO2 ; alveolar&ndash ; arterial oxygen pressure difference ; KL-6 ; Krebs von den Lungen-6 ; SP-D ; surfactant protein-D ; WBC ; white blood cell
• 刊名：Respiratory Investigation
• 出版年：2015
• 出版时间：September 2015
• 年：2015
• 卷：53
• 期：5
• 页码：217-224
• 全文大小：502 K

文摘

Chronic hypersensitivity pneumonitis (HP) is induced by the inhalation of specific antigens. Patients with chronic HP may be able to improve their prognosis by avoiding these antigens. Chronic HP is often difficult to distinguish from idiopathic interstitial pneumonias (IIPs).

Objective

This study was performed to find out how antigen avoidance tests contribute to the diagnosis of chronic HP.

Methods

A retrospective analysis was conducted on 265 patients who underwent 2-week antigen avoidance tests between April 2002 and March 2012. The patients were classified into the following categories: acute HP, chronic HP, collagen vascular disease-associated interstitial pneumonia (CVD-IP), lung dominant connective tissue disease (LD-CTD), and IIPs. The following seven clinical parameters were evaluated: vital capacity, alveolar–arterial oxygen pressure difference, Krebs von den Lungen-6, surfactant protein-D, white blood cell count, C-reactive protein, and body temperature. These parameters were compared between the chronic HP group and a control group consisting of CVD-IP, LD-CTD, and IIPs.

Results

One-hundred and ninety-six patients with chronic HP and 43 control subjects were evaluated. All clinical parameters improved significantly in the chronic HP group but showed no significant changes in the control group. Four of the parameters changed significantly compared with the control group. Diagnostic criteria established using these data had a sensitivity of 51.0% and a specificity of 80.7%.

Conclusions

It was difficult to diagnose chronic HP based solely on 2-week antigen avoidance tests; however, improved clinical parameters among patients supported the diagnosis of HP.