ObjectiveTo analyze the CT features of immune checkpoint inhibitor-related pneumonia (CIP) and improve the diagnostic accuracy of CIP. MethodsAmong patients with malignant tumor treated with immune checkpoint inhibitors, those who developed pneumonia and rule out other causes of disease were identified. Chest CT Imaging were reviewed to assess special signs, distribution characteristics, severity of pneumonia and radiographic patterns of CIP. ResultsA total of 28 patients were enrolled, including 26 males and 2 females. CT features include ground-glass opacity, centrilobular nodularity, reticular opacity, consolidation, traction bronchiectasis, honeycomb, etc. The lesions predominant involved peripheral lung zone (17/28), lower lung zone (18/28) and posterior lung zone (18/28), with a diffuse distribution (23/28). In most cases the disease involved both lungs (23/28), and a few involved unilateral or single lobe. The most common affected lobes were the lower lobe of the right lung (25/28) and the lower lobe of the left lung (20/28), followed by the upper lobe of the right lung (18/28). Mean pneumonia severity score was 5.5, standard deviation was 3.8, and range was 1 - 15. The most common radiographic patterns of CIP were nonspecific interstitial pneumonia (11/28) and hypersensitivity pneumonia (10/28). The second was organizing pneumonia (6/28). ConclusionsThe CT manifestations of CIP have certain specificity. Combined with the history of drug treatment and clinical symptoms of patients, the early and correct diagnosis can be obtained.
ObjectiveTo translate the King’s Brief Interstitial Lung Disease (K-BILD) to Chinese, so as to provide an well reliability and validity assessment instrument for health status of patients with interstitial lung disease.MethodsBrislin’s transition model, six expert’s panel and pre-survey were used for initial Chinese version of K-BILD. Items analysis, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), internal consistency reliability and test-retest reliability were used for validity and reliability test with 122 respondents.ResultsTen-item Chinese version of K-BILD were proved to have great psychometric qualities, two factors were extracted by EFA, which could explain 63.35% of the total variance. Furthermore, the CFA demonstrates the fit indices of two-factors mode: χ2/df=0.797, RMSEA=0.000, NFI=0.848, IFI=1.048, CFI=1.000, TLI=1.071. Cronbach’s α and Guttman Split-half were 0.893 and 0.861, respectively. Besides, the test-retest reliability of the scale was 0.805.ConclusionThe Chinese version of K-BILD scale has good validity and reliability, which is applicable for health status assessment in patient with interstitial lung disease.
Objective To enhance the understanding of nonfibrotic hypersensitivity pneumonitis (nfHP) by summarizing the clinical characteristics of 32 cases of nfHP. Methods The data of 32 cases with nfHP was collected and analyzed. They were diagnosed in Beijing Friendship Hospital, Capital Medical University from Jan 1st, 2017 to Oct 31, 2021. Results The median age of the nfHP patients was 54 years, among whom 75.0% were females. The cases developed in a majority of avian exposure (22 cases, 68.8%). The main symptoms were dyspnea/shortness of breath (28 cases, 87.5%), cough (25 cases, 78.1%）and sputum production (21 cases, 65.6%). High-resolution CT (HRCT) showed diffuse ground glass opacification (25 cases, 78.1%), centrilobular ground glass nodules (20 cases, 62.5%) and air trapping (9 cases, 28.1%). Bronchoalveolar lavage fluid (BALF) featured an increase of proportion of lymphocytes (>20%, 90.6% and >40%, 50%), and a decrease of CD4+/CD8+ T cell ratio (<1.2, 65.6% and <0.8, 40.6%). Most of the cases had reduced diffusion capacity for carbon monoxide (16 cases out of 26 cases, 61.5%) and decreased total lung capacity (13 cases out of 26 cases, 50%). Few cases showed obstructive ventilatory function (6 cases out of 26 cases, 23.1%). Most cases (22 cases, 68.8%) of nfHP showed an excellent survival with short-term corticosteroid treatment. Few cases (5 cases, 15.6%) experienced spontaneous remission after antigen avoidance. Conclusions The diagnosis of nfHP includes identifying antigenic exposures, featured chest HRCT and lymocytosis in BALF. nfHP patients showed an excellent survival with short-term corticosteroid treatment as well as antigen avoidance.
ObjectiveTo improve the knowledge of erlotinib-induced severe rash and fatal interstitial lung disease (ILD). MethodsThe clinical feature and radiology of erlotinib-associated severe rash and fatal ILD were analyzed in one patient with advanced non-small cell lung cancer (NSCLC) in the 81st Hospital of Chinese PLA,and the related literatures were reviewed. ResultsThe patient was a 78-year-old male non-smoker with stage Ⅳ right lower lobe squamous cell carcinoma,and his epidermal growth factor receptor gene showed mutation at exon 21.He had a history of chronic obstructive pulmonary disease and mild pulmonary fibrosis.Following one cycle of chemotherapy with gemcitabine plus cisplatin,he received erlotinib 150 mg daily.After 40 days of targeting therapy,the size of the lung cancer was decreased significantly concomitant with severe rash.Again,severe rash and fatal ILD appeared after using erlotinib 100 mg daily for 4 days and 50 mg daily for 2 days,respectively.The tumor progressed markedly although both rash and ILD were almost abolished following withdrawal of erlotinib as well as empirical impact of glucocorticoid and sequential therapy. ConclusionPhysicians should be alerted to the possibility of erlotinib-induced severe rash and fatal ILD.Those with pathologic findings of usual interstitial pneumonia on resected lung specimens or known pulmonary fibrosis may be at particular risk for erlotinib-related pulmonary toxicity.
【Abstract】 Objective To investigate the clinical characteristics and prognosis of secondary lymphocytic interstitial pneumonia ( LIP) . Methods Clinical data of 9 cases with secondary LIP diagnosed from1990 to 2010 were retrospectively analyzed. Results Of 9 patients there were 3 males and 6 females,the range of age was 7-64 years. In the 6 adult patients there were 5 females. 2 cases were infected by EB virus and 1 by recurrent pulmonary infection in 3 non-adult patients. In the adult patients, 1 case was diagnosed with Sjogren’s syndrome, 1 case with overlapping syndrome, 2 cases with primary biliary cirrhosis,1 case was probably caused by infection, and 1 case was complicated with eosinophilia. Dominant symptoms of pulmonary system were cough, expectoration, and shortness of breath on exertion. Dominant systematic symptoms were asthenia, pyrexia, weight lose, and arthralgia. CT revealed diffuse ground glass opacities with a lower lung zone predominance. Pathologic feature of LIP was a diffuse, polyclonal lymphoid cell infiltration surrounding airways and extending to the lung interstitium. The patients were treated by glucocorticoid and immunosuppressants. Two cases died with secondary infection. Follow-up did not comfirm malignant tumors in the survivors. Conclusions The clinical features of LIP are characteristic, but lacking of specificity. The final diagnosis depends on pathological examination. Treatment targeted on primary diseases can probably have a good efficacy, and the clinical outcome is favorable.
2000 年美国胸科学会/ 欧洲呼吸学会( ATS/ERS) 发表了特发性肺纤维化( idiopathic pulmonary fibrosis, IPF) 诊断和治疗的共识。历经11 年, IPF 的临床和基础研究均取得了许多重要进展。2011 年来自美国胸科学会( American Thoracic Society,ATS) 、欧洲呼吸学会( European Respiratory Society, ERS) 、日本呼吸学会( Japanese Respiratory Society,JRS) 和拉丁美洲胸科学会( Latin American Thoracic Association, ALAT) 的间质性肺疾病( ILD) 、特发性间质性肺炎( IIP) 和IPF领域的著名专家, 系统回顾了2010 年5 月前有关IPF的文献, 共同制定了第一部以循证为基础的IPF诊断和治疗指南( 简称2011 指南) , 于2011 年3 月正式颁布 。2011 指南涵盖当今对IPF 的最新知识, 囊括IPF 定义、流行病学、危险因素、诊断、自然病史、分期与预后、治疗和疾病过程监控、将来的研究方向等多方面的内容。限于篇幅, 本文对2011 指南中的主要内容作一简介, 以飨国内同道。
ObjectiveTo retrospectively analyze the clinical,pathological and imaging features of one case pathologically diagnosed as cryptogenic organizing pneumonia(COP) to improve clinical diagnosis and treatment. MethodsWith a case report and review of the related literatures,the clinical manifestations,radiological features,pathological features,differential diagnosis,management and prognosis of COP were discussed. ResultsThe clinical manifestations of COP had no specificity. The imaging manifestations were real shadows,ground glass shadows,nodules and all kinds of tape. Pathological features of lung specimen biopsy showed buds of granulation tissue within alveolar ducts and alveoli consisting of fibroblasts. Remarkable response to corticosteroids was found in this patient. The prognosis of COP was good. ConclusionsCOP is diagnosed on basis of clinical,pathologic,and imaging findings. The radiological features of COP which show mass with cavity are rare. It can be easy misdiagnosed as lung infection or tumor. The effects of ordinary anti-bacteria therapy are limited,while the corticosteroids therapy shows preferable effects. Therefore,it's important to acquire pathological evidences as early as possible to guide the diagnose and treatment.
Objective To evaluate the efficacy and safety of glucocorticoids (GC) monotherapy and GC combined with tacrolimus (TAC) therapy in patients with anti-synthetase syndrome-associated interstitial lung disease (ASS-ILD). Methods Through retrospective analysis and propensity score matching (PSM) analysis, the 2-year progression-free survival (PFS) and related side effects of ASS-ILD patients in TAC+GC group and GC monotherapy group were compared. Predictors associated with PFS were analyzed with COX. Results The 2-year PFS rate of TAC+GC group was better than that of GC group [P=0.0163; hazard ratio (HR) 0.347]; Univariate and multivariate analysis of the COX regression model for 2-year PFS in the two groups suggested that creatine kinase level (P=0.0019, HR 1.002) and initial treatment selection [(TAC+GC) vs. GC, P=0.0197, HR 0.207] were independent predictors of PFS; PSM analysis showed that the 2-year PFS rate of TAC+GC group (54.5%) was higher than that of GC group (18.2%) (P=0.0157, HR 0.275). In terms of adverse effect, there was no significant increase in GC+TAC group compared with GC group. Conclusion Compared with GC monotherapy, initial TAC+GC treatment significantly prolonged PFS in ASS-ILD patients and did not increase the incidence of drug-related complications.