Clinical diagnosis of hypersensitivity pneumonitis

被引:422
作者
Lacasse, Y
Selman, M
Costabel, U
Dalphin, JC
Ando, M
Morell, F
Erkinjuntti-Pekkanen, R
Müller, N
Colby, TV
Schuyler, M
Cormier, Y
机构
[1] Univ Laval, Hop Laval, Ctr Pneumol, Ste Foy, PQ G1V 4G5, Canada
[2] Univ British Columbia, Vancouver, BC V5Z 1M9, Canada
[3] Inst Nacl Enfermedades Resp, Mexico City, DF, Mexico
[4] Ruhrlandklinik, Essen, Germany
[5] CHU Besancon, F-25030 Besancon, France
[6] Kumamoto Univ, Sch Med, Kumamoto 860, Japan
[7] Univ Barcelona, Hosp Vall Hebron, Barcelona, Spain
[8] Kuopio Univ Hosp, SF-70210 Kuopio, Finland
[9] Mayo Clin Scottsdale, Scottsdale, AZ USA
[10] Univ New Mexico, Sch Med, Albuquerque, NM 87131 USA
关键词
lung diseases; interstitial; decision support techniques; probability;
D O I
10.1164/rccm.200301-137OC
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
The diagnosis of hypersensitivity pneumonitis (HP) is difficult and often relies on histopathology. Our objective was to identify diagnostic criteria and to develop a clinical prediction rule for this disease. Consecutive patients presenting a condition for which H P was considered in the differential diagnosis underwent a program of simple standardized diagnostic procedures. High-resolution computed tomography scan and bronchoalveolar lavage (BAL) defined the presence or absence of HP. Patients underwent surgical lung biopsy when the computed tomography scan, BAL, and other diagnostic procedures failed to yield a diagnosis. A cohort of 400 patients (1116 with HP, 284 control subjects) provided data for the rule derivation. Six significant predictors of HP were identified: (1) exposure to a known offending antigen, (2) positive precipitating antibodies to the offending antigen, (3) recurrent episodes of symptoms, (4) inspiratory crackles on physical examination, (5) symptoms occurring 4 to 8 hours after exposure, (6) and weight loss. The area under the receiver operating characteristic curve was 0.93 (95% confidence interval: 0.90-0.95). The rule retained its accuracy when validated in a separate cohort of 261 patients. The diagnosis of HP can often be made or rejected with confidence, especially in areas of high or low prevalence, respectively, without BAL or biopsy.
引用
收藏
页码:952 / 958
页数:7
相关论文
共 42 条
[2]  
[Anonymous], 1995, AM J RESP CRIT CARE, V152, P2185
[3]  
*BAL COOP GROUP ST, 1990, AM REV RESPIR DIS, V141, pS169
[4]  
BLOCH DA, 1990, ARTHRITIS RHEUM, V33, P1137
[5]   FARMERS LUNG AND VARIABLES RELATED TO THE DECISION TO QUIT FARMING [J].
BOUCHARD, S ;
MORIN, F ;
BEDARD, G ;
GAUTHIER, J ;
PARADIS, J ;
CORMIER, Y .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1995, 152 (03) :997-1002
[6]  
BOYD G, 1982, CLIN ALLERGY, V12, P53
[7]  
BURRELL R, 1981, EUR J RESPIR DIS, V62, P332
[8]  
Chi-Lem G, 1998, ARCH MED RES, V29, P57
[9]   HISTOLOGIC DIAGNOSIS OF EXTRINSIC ALLERGIC ALVEOLITIS [J].
COLEMAN, A ;
COLBY, TV .
AMERICAN JOURNAL OF SURGICAL PATHOLOGY, 1988, 12 (07) :514-518
[10]  
CORMIER Y, 1984, AM REV RESPIR DIS, V130, P1046