Jeffrey J. Swigris, DO; Ware G. Kuschner, MD, FCCP; Jennifer L. Kelsey, PhD; and Michael K. Gould, MD, MS, FCCP () (1) (2) (3) CT γ-1b (interstitial); (lung diseases); (pulmonary fibrosis) (idiopathic pulmonary fibrosis ) (idiopathic interstitial pneumonias IIPs) (nonspecific interstitial pneumonia NSIP) [1] < 3 y 316
1 NSIP NSIP ( IIP ) NSIP NSIP (interstitial lung diseases IIP) IIPs [2] UIP / [2] ( / UIP) 7 (1) (2) NSIP [3] (3) (4) (5) UIP UIP / (6) (7) ( 1) CT (high-resolution CT HRCT) UIP [ (usual UIP interstitial pneumonia UIP)] / / ( ) IIP UIP UIP From the Division of Pulmonary and Critical Care Medicine (Dr. Swigris), Stanford University, Stanford; Veterans Affairs Palo Alto Health Care System (Drs. Kuschner and Gould), PaloAlto; and Division of Epidemiology (Dr. Kelsey), Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA. Correspondence to: Jeffrey J. Swigris, DO, Stanford University Medical Center, Division of Pulmonary and Critical Care Medicine, MC5236, Room #3143, 300 Pasteur Dr, Stanford, CA94305-5236; e-mail: jswigris@stanford. edu UIP ( ) UIP UIP www.chestjournal.org.cn CHEST 2005 5 2 5 317
( NSIP ) NSIP / % 80 40 NSIP NSIP 0 6 12 18 NSIP / y Katzenstein [4] 1994 NSIP 1 (UIP) NSIP IIP Bjoraker [7] NSIP IIP [5,6,8,9] UIP NSIP ( 1) UIP NSIP [4] NSIP ( NSIP ) ( NSIP ) NSIP ( 1) NSIP [5,6] 1994 NSIP NSIP 1998 NSIP UIP [10] UIP ( NSIP) UIP NSIP Katzenstein [11] 21 NSIP UIP NSIP Bjoraker [7] NSIP UIP NSIP 1976 1985 104 UIP 14% NSIP UIP 5 y 70% 5 y < 30% 24% ~ 36% NSIP NSIP Flaherty [10] UIP ( ) UIP 318
NSIP 2 NSIP ( ) UIP NSIP ; NSIP ( FEV 1 / FVC ) ( ); 1994 HRCT ; 13 ~ 20 / 100 000 [12] BAL > 50 ; [13] ( ) 3 mo NSIP [5,7~9] ( Velco ) [18~20] NSIP ( ) / [17] ( 2) UIP [1~16] 62% 97% UIP UIP [2,3,17] 40% [16] 3 91 UIP HRCT [16] 15% [21] UIP 72% 84% 1 77% (positive predictive value PPV) 87% 79% 87% PPV 87% 50% [16,21] 26 [22] 3 / 30% www.chestjournal.org.cn CHEST 2005 5 2 5 319
HRCT IIP HRCT HRCTs 77% 72% PPV 85% 3 (1) ( (2) 50%) 87% 95% PPV 96% HRCT [25] HRCT [23] HRCT [16] HRCT 3 ~ 5 y [10,14,26~29] [24] [30~32] HRCT (OR 11.45 P = 0.000 4) (78% 95%CI 6 min [24] 62% ~ 90%) < 88% HRCT 4 y (OR 5.36 P = 0.007) 35% 69% (OR 6.28 P = 0.004) ( FVC 6 [30] mo ) 81% [32] (95%CI 64% ~ 91%) HRCT HRCT HRCT [33] HRCT (3) Lama [31] 7 mo [1] 320
( ) [34,35] 10% ~ 30% [36] [15,37~40] [5~7] UIP [45] 0% ~ 10% 20% ~ 30% ( ); [41~43] ; UIP 2 / 3 [17,20,44] [46] [17] [41,42] [47] γ ( ) www.chestjournal.org.cn CHEST 2005 5 2 5 321
( ) [46] [50~52] ( ) ( ) (clinician s choice CC) (equipoisestratified ES) CC [48] CC IIP 1 ( ) ES IIP ( ) NSIP [49] IIP ES CC Lavori [49] 1 Selman M, et al. Ann Intern Med 2001;134:136 151 2 Joint Statement of the American Thoracic Society and the European Respiratory Society: American Thoracic Society/European Respiratory Society international multidisciplinary consensus classification of the idiopathic interstitial pneumonias. Am J Respir 322
Crit Care Med 2002;165:277 304 3 Katzenstein AL, et al. Am J Respir Crit Care Med 1998;157:1301 1315 4 Katzenstein AL, et al. Am J Surg Pathol 1994;18:136 147 5 Nicholson AG, et al. Am J Respir Crit Care Med 2000;162:2213 2217 6 Daniil ZD, et al. Am J Respir Crit Care Med 1999;160:899 905 7 Bjoraker JA, et al. Am J Respir Crit Care Med 1998;157:199 203 8 Nagai S, et al. Eur Respir J 1998;12:1010 1019 9 Travis W, et al. Am J Surg Pathol 2000;24:19 33 10 Flaherty KR, et al. Am J Respir Crit Care Med 2001;164:1722 1727 11 Katzenstein AL, et al. Am J Surg Pathol 2002;26:1567 1577 12 Coultas D, et al. Am J Respir Crit Care Med 1994;150:967 972 13 Coultas D, et al. Thorax 1996;51:717 720 14 King TE Jr, et al. Am J Respir Crit Care Med 2001;164:1171 1181 15 Flaherty KR, et al. Am J Med 2001;110:278 282 16 Hunninghake GW, et al. Am J Respir Crit Care Med 2001;164: 193 196 17 Joint Statement of the American Thoracic Society and the European Respiratory Society: idiopathic pulmonary fibrosis: diagnosis and treatment; international consensus statement. Am J Respir Crit Care Med 2000;161:646 664 18 Mapel D, et al. Chest 1996;110:1058 1067 19 Johnston I, et al. Thorax 1997;52:38 44 20 Johnston ID, et al. Eur Respir J 1993;6:891 893 21 Raghu G, et al. Chest 1999;116:1168 1174 22 Peckham R, et al. Chest 2002;122:47S 23 MacDonald S, et al. Radiology 2001;221:600 605 24 Hunninghake GW, et al. Chest 2003;124:1215 1223 25 Laupacis A, et al. JAMA 1997;277:488 494 26 Boomars KA, et al. Thorax 1995;50:1087 1092 27 Gay S, et al. Am J Respir Crit Care Med 1998;157:1063 1072 28 King TE Jr, et al. Am J Respir Crit Care Med 2001;164:1025 1032 29 Nicholson A, et al. Am J Respir Crit Care Med 2002;166:173 177 30 Flaherty KR, et al. Am J Respir Crit Care Med 2003;168:543 548 31 Lama V, et al. Am J Respir Crit Care Med 2003;168:1084 1090 32 Wells AU, et al. Am J Respir Crit Care Med 2003;167:962 969 33 Adamson I, et al. Am J Pathol 1988;130:377 383 34 Davies H, et al. Cochrane Database of Systematic Reviews 2003;1 35 Richeldi L, et al. Cochrane Database of Systematic Reviews 2003;1 36 Lynch J III, et al. Curr Opin Pulm Med 2001;7:298 308 37 Carrington C, et al. N Engl J Med 1978;298:801 809 38 Turner-Warwick M, et al. Thorax 1980;35:593 599 39 Tukiainen P, et al. Thorax 1983;38:349 355 40 Stack B, et al. Thorax 1972;27:535 542 41 Raghu G, et al. Am Rev Respir Dis 1991;144:291 296 42 Johnson M, et al. Thorax 1989;44:280 288 43 Douglas WW, et al. Mayo Clin Proc 1997;72:201 209 44 Douglas WW, et al. Am J Respir Crit Care Med 2000;161:1172 1178 45 Johnston ID, et al. Thorax 1997;52:38 44 46 Temple R, et al. Ann Intern Med 2000;133:455 463 47 Raghu G, et al. N Engl J Med 2004;350:125 133 48 Wyse DG, et al. N Engl J Med 2002;347:1825 1833 49 Lavori P, et al. Biol Psychiatry 2001;50:792 801 50 DeVries J, et al. Eur Respir J 2001;17:954 961 51 DeVries J, et al. Respir Med 2000;94:273 278 52 Martinez T, et al. Chest 2000;117:1627 1632 CHEST 2005;127:275-283 www.chestjournal.org.cn CHEST 2005 5 2 5 323