Respiratory investigation最新文献

Development and validation of a risk score to predict community-acquired pneumonia occurrence in the adult population 开发和验证预测成人社区获得性肺炎发生的风险评分

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-04-26 DOI: 10.1016/j.resinv.2025.04.012

Mateu Serra Prat , Angel Lavado Cuevas , Ignasi Bolibar Ribas , Elisabet Palomera Fanegas , Jordi Almirall Pujol , the GEMPAC Group

Background

Community-acquired pneumonia (CAP) preventive strategies can benefit from a quantification of individual CAP risk. This study develops and validates a CAP Risk Score (CAP-RS) for the adult population to predict CAP occurrence in the next five years.

Methods

The development phase was as follows: a population-based case-control study to identify potential CAP risk factors for inclusion in the CAP-RS after weighting according to odds ratios; development of a numerical scoring system for weighted risk factors; and establishment of cut-off points to discriminate between different risk levels. The validation phase consisted of a population-based case-control study and a retrospective cohort study (with 47 836 adults aged ≥18 years corresponding to three Maresme (Barcelona) primary care centres) followed up over a five-year period (2015–2019).

Results

786 new CAP cases were identified. 15 factors were included in the CAP-RS. Risk was higher in subjects with CAP than without CAP (4.5 vs 1.9; p < 0.001), and the association (OR) between the CAP-RS and the occurrence of CAP increased as the CAP-RS value increased. AUC-ROC was 0.67 (p < 0.001). Cut-offs were established at <1, <5, and <10 points as best discriminating between risk groups. Annual CAP incidence was 1.9, 3.1, 6.2, and 12.4 new cases/10³ inhabitants for the no, moderately, severely, and very severely increased risk groups, respectively. Significant differences in CAP-free survival were observed between the four CAR-RS categories.

Conclusions

The 15-item CAP-RS, which stratifies risk with good validity, can aid in the design and implementation of preventive CAP strategies for adult populations.

社区获得性肺炎（CAP）预防策略可以从个体CAP风险的量化中获益。本研究开发并验证了成人CAP风险评分（CAP- rs），以预测未来五年CAP的发生。方法：开展以人群为基础的病例对照研究，根据优势比加权后确定纳入CAP- rs的潜在危险因素；发展加权风险因素的数字评分系统；并建立分界点来区分不同的风险水平。验证阶段包括一项基于人群的病例对照研究和一项回顾性队列研究（47836名年龄≥18岁的成年人，对应于三个Maresme（巴塞罗那）初级保健中心），随访时间为5年（2015-2019年）。结果共发现新发CAP病例786例。CAP-RS共包括15个因素。有CAP的受试者风险高于无CAP的受试者(4.5 vs 1.9；p & lt;随着CAP- rs值的增加，CAP- rs与CAP发生之间的相关性（OR）增加。AUC-ROC为0.67 (p <；0.001)。临界值设为<；1, <；5和<；10点，作为风险组之间的最佳区分点。无、中度、重度和极重度风险增加组的年CAP发病率分别为1.9、3.1、6.2和12.4例/103名居民。在四种CAR-RS类型之间观察到无cap生存期的显著差异。结论15项CAP- rs量表具有较好的风险分层效度，可为成人预防CAP策略的设计和实施提供参考。

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引用次数: 0

Latest Advances in Perioperative care for Resectable Non-small lung cancer 可切除非小肺癌围手术期护理的最新进展

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-04-26 DOI: 10.1016/j.resinv.2025.04.001

Yuko Oya , Ichidai Tanaka

Resectable non-small cell lung cancer (NSCLC) has a relatively poor prognosis owing to the risk of developing local or distant metastatic recurrence, even at stage I. To overcome the high recurrence rate, perioperative therapies have been rapidly developed through the combination of existing cytotoxic chemotherapies with immune checkpoint inhibitors (ICIs) and molecular targeted therapies. These new therapeutic strategies have significantly improved the prognosis of patients with stage II–III NSCLC and have been approved for clinical use. However, new challenges have emerged in the selection of the optimal perioperative treatment in clinical practice. First, it is currently difficult to determine which perioperative treatment is superior, preoperative or postoperative. Additionally, since surgery alone is curative in some patients, the addition of anticancer agents such as ICIs raises concerns regarding toxicity, as serious side effects during preoperative treatment may lead to an inability to perform the surgery itself. Moreover, because various perioperative treatments are still being developed, treatment options for perioperative care are expected to increase soon. To summarize the increasingly complex perioperative treatment of resectable NSCLC, this review provides a comprehensive summary of the clinical efficacies of current perioperative therapies and future directions based on basic background, patient selection, ongoing trials, and enhancing immunotherapy.

可切除的非小细胞肺癌（NSCLC）预后相对较差，即使在i期也有发生局部或远处转移复发的风险。为了克服高复发率，通过现有的细胞毒性化疗与免疫检查点抑制剂（ICIs）和分子靶向治疗相结合，围手术期治疗迅速发展。这些新的治疗策略显著改善了II-III期NSCLC患者的预后，并已被批准用于临床。然而，在临床实践中，围手术期最佳治疗方案的选择出现了新的挑战。首先，目前很难确定术前或术后哪种围手术期治疗更好。此外，由于某些患者仅通过手术即可治愈，因此添加抗癌药物（如ICIs）引起了对毒性的担忧，因为术前治疗期间的严重副作用可能导致无法进行手术本身。此外，由于各种围手术期治疗仍在发展中，围手术期护理的治疗选择有望很快增加。为了总结可切除的非小细胞肺癌围手术期治疗日益复杂的情况，本综述基于基本背景、患者选择、正在进行的试验和增强免疫治疗，全面总结了当前围手术期治疗的临床疗效和未来发展方向。

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引用次数: 0

Clinical characteristics of drug-induced interstitial pneumonia in Japan 日本药物性间质性肺炎的临床特点

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-04-25 DOI: 10.1016/j.resinv.2025.04.015

Miwa Yamanaka , Atsuhito Ushiki , Koichiro Tatsumi , Akihiko Gemma , Noboru Hattori , Yoichi Tanaka , Yoshiro Saito , Masayuki Hanaoka

Background

Japan has a higher incidence of drug-induced interstitial pneumonia (IP) than other countries. Understanding the clinical characteristics of drug-induced IP in Japan will facilitate accurate diagnosis of the disease. The aim of this study was to analyze and report the clinical characteristics of drug-induced IP in Japan.

Methods

We analyzed the characteristics of drug-induced IP diagnosed between 2009 and 2022 in Japan. Case data were collated with the cooperation of pharmaceutical companies, as requested by the Ministry of Health, Labour and Welfare.

Results

We identified 285 patients with drug-induced IP diagnosed in medical institutions. The most common causative drugs identified were antineoplastic agents (56.1 %). Common subjective symptoms included dyspnea (158 patients [55.4 %]), cough (132 patients [46.3 %]), and fever (115 patients [40.4 %]). In addition, 177 patients (73.1 % of those measured) showed elevated serum KL-6, SP-D, or SP-A levels. Approximately 60 % of the patients developed IP within 90 days from the initiation of drug therapy, whereas 15 % developed the disease after >1 year. Regarding imaging findings, 249 patients (87.4 %) showed bilateral shadows. Corticosteroid therapy was administered to 222 patients (77.9 %). The treatment outcomes of drug-induced IP in Japan were favorable, with improvement observed in 273 patients (95.8 %).

Conclusions

Dyspnea, cough, and fever after administration of a drug; elevated serum KL-6, SP-D, and SP-A levels; and bilateral shadows were identified as clinical features of drug-induced IP in Japan. Drug-induced IP should be considered a differential diagnosis even if the patient started using the causative drug long ago.

日本药物性间质性肺炎（IP）的发病率高于其他国家。了解日本药物性IP的临床特点有助于对该病的准确诊断。本研究的目的是分析和报道日本药物性IP的临床特点。方法分析日本2009 ~ 2022年诊断的药物性IP的特点。根据厚生劳动省的要求，在制药公司的合作下对病例数据进行了整理。结果285例经医疗机构诊断为药物性IP的患者。最常见的致病药物是抗肿瘤药物（56.1%）。常见的主观症状包括呼吸困难（158例[55.4%]）、咳嗽（132例[46.3%]）和发热（115例[40.4%]）。此外，177例患者（73.1%）显示血清KL-6、SP-D或SP-A水平升高。大约60%的患者在药物治疗开始后90天内发展为IP，而15%的患者在1年后发展为IP。影像学表现249例（87.4%）出现双侧阴影。222例患者（77.9%）接受皮质类固醇治疗。在日本，药物性IP的治疗结果是良好的，273例患者（95.8%）观察到改善。结论用药后出现呼吸困难、咳嗽、发热；血清KL-6、SP-D和SP-A水平升高；在日本，双侧阴影被确定为药物性IP的临床特征。即使患者很久以前就开始使用致病性药物，药物性IP也应被视为鉴别诊断。

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引用次数: 0

Two cases of bronchial artery aneurysms in patients with long-standing precapillary pulmonary hypertension 支气管动脉瘤伴长期毛细血管前肺动脉高压2例

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-04-24 DOI: 10.1016/j.resinv.2025.04.011

Taku Komori , Takahiro Sato , Ichizo Tsujino , Daisuke Tamatsuki , Shuhei Yoshikawa , Hideki Shima , Junichi Nakamura , Ryo Morita , Daisuke Abo , Satoshi Konno

Bronchial artery aneurysm (BAA) is a rare but increasingly recognized condition due to advances in imaging. We report two cases of BAA in patients with long-standing pulmonary hypertension. Case 1 is a 30-year-old man with idiopathic peripheral pulmonary artery stenosis diagnosed at age 23. He developed a slightly dilated bronchial artery, which later enlarged, leading to bronchial artery embolization. Case 2 is a 30-year-old woman with pulmonary arterial hypertension diagnosed at age 3. Multiple BAAs were identified at age 24, and progressive enlargement was observed at age 28. Due to lesion complexity, she remains under careful observation.

支气管动脉动脉瘤（BAA）是一种罕见的疾病，但由于影像学的进步，越来越多的人认识到这种疾病。我们报告两例长期肺动脉高压患者的BAA。病例1是一名30岁男性，在23岁时被诊断为特发性肺外周动脉狭窄。他的支气管动脉轻微扩张，后来扩大，导致支气管动脉栓塞。病例2是一名30岁女性，在3岁时被诊断为肺动脉高压。24岁时发现多个baa， 28岁时观察到进行性扩大。由于病变复杂，她仍需仔细观察。

引用次数: 0

Macrolide-resistant Mycoplasma pneumoniae infection prevalence increases again in Osaka 大阪耐大环内酯肺炎支原体感染率再次上升

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-04-22 DOI: 10.1016/j.resinv.2025.04.009

Naoyuki Miyashita, Makoto Ogata, Naoki Fukuda, Akihisa Yamura, Tomoki Ito

Objectives

We investigated the prevalence rate and resistance mechanism of macrolide-resistant Mycoplasma pneumoniae strains between 2018 and 2024.

Methods

We analyzed 367 patients with M. pneumoniae infection by the polymerase chain reaction method.

Results

Macrolide-resistant M. pneumoniae was identified in nine of 51 patients (17.6 %) in 2018, 13 of 63 patients (20.6 %) in 2019, eight of 30 patients (26.7 %) in 2020, one of three patients in 2021, one of three patients in 2022, three of six patients in 2023, and 127 of 211 patients (60.2 %) in 2024. Prevalence of macrolide-resistant M. pneumoniae was significantly increased in 2024 compared to the years 2018–2020 (p < 0.0001). The majority of resistant strains had an A-to-G transition at position 2063 in the M. pneumoniae 23S rRNA domain V gene region, which is associated with high-level resistance to macrolides.

Conclusions

Our study demonstrated that the prevalence of macrolide-resistant M. pneumoniae is once again increasing in Osaka Prefecture.

目的了解2018 - 2024年耐大环内酯肺炎支原体的流行情况及耐药机制。方法采用聚合酶链反应法对367例肺炎支原体感染患者进行分析。结果2018年51例患者中有9例（17.6%）发现耐药肺炎支原体，2019年63例患者中有13例（20.6%），2020年30例患者中有8例（26.7%），2021年3例患者中有1例，2022年3例患者中有1例，2023年6例患者中有3例，2024年211例患者中有127例（60.2%）。与2018-2020年相比，2024年耐大环内酯肺炎支原体患病率显著增加(p <；0.0001)。大多数耐药菌株在肺炎支原体23S rRNA结构域V基因区2063位发生A-to-G转变，这与对大环内酯类药物的高水平耐药有关。结论大阪府地区大环内酯类耐药肺炎支原体感染率再次上升。

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引用次数: 0

Microbiological etiology of aspiration pneumonia in Japan: Insights from a systematic review and meta-analysis 日本吸入性肺炎的微生物病因学：来自系统回顾和荟萃分析的见解

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-04-21 DOI: 10.1016/j.resinv.2025.04.010

Shingo Noguchi , Kentaro Akata , Hiroshi Mukae , Kazuhiro Yatera

Background

Anaerobic bacteria were historically considered the primary causative agent of aspiration pneumonia. However, recent studies suggest their role may have been overemphasized, and the microbial profile of aspiration pneumonia remains uncertain owing to diagnostic limitations. This study explored its microbiological epidemiology through a systematic review and meta-analysis.

Methods

We searched for English and Japanese articles published since 1990, evaluating the etiological bacterial species associated with aspiration pneumonia using PubMed and Ichushi-Web databases. The detection frequency (%) of each bacterial species was calculated using Review Manager and analyzed separately for Japan and other countries. Regional differences in detection of bacteria between these countries were also compared.

Results

This study included 21 articles: 14 from Japan and 7 from other countries. The most prevalent bacteria were Streptococcus pneumoniae (11.7 %, 95 % confidence interval [CI] 8.5–15.0 %) and Klebsiella pneumoniae (11.8 %, 95 % CI: 2.5–21.1 %), respectively. Gram-negative bacteria such as K. pneumoniae, Escherichia coli, and Pseudomonas aeruginosa were frequently detected, whereas oral streptococci and anaerobic bacteria were uncommon in both regions. Significant regional differences were observed in the detection frequencies of Staphylococcus aureus, S. pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.

Conclusions

This study highlights the bacterial profile of aspiration pneumonia and clarified the current understanding, showing that S. pneumoniae and gram-negative bacteria were frequently detected in aspiration pneumonia, whereas anaerobes and oral streptococci were less commonly identified. However, further investigation is needed to better characterize the bacterial spectrum, as a standardized definition of aspiration pneumonia and the pathogenicity of detected microbes remains uncertain.

背景：需氧细菌历来被认为是吸入性肺炎的主要病原体。然而，最近的研究表明，它们的作用可能被过分强调了，并且由于诊断限制，吸入性肺炎的微生物谱仍然不确定。本研究通过系统综述和荟萃分析探讨其微生物流行病学。方法检索自1990年以来发表的英文和日文文章，使用PubMed和ichishi - web数据库评估与吸入性肺炎相关的病原细菌种类。使用Review Manager计算各菌种的检出率（%），并分别对日本和其他国家进行分析。还比较了这些国家在细菌检测方面的区域差异。结果本研究共纳入文献21篇，其中日本文献14篇，其他国家文献7篇。最常见的细菌分别是肺炎链球菌（11.7%，95%可信区间[CI] 8.5 ~ 15.0%）和肺炎克雷伯菌（11.8%,95% CI: 2.5 ~ 21.1%）。革兰氏阴性菌如肺炎克雷伯菌、大肠埃希菌和铜绿假单胞菌经常被检出，而口腔链球菌和厌氧菌在这两个地区都不常见。金黄色葡萄球菌、肺炎链球菌、流感嗜血杆菌和卡他莫拉菌的检测频率存在显著的地区差异。结论本研究突出了吸入性肺炎的细菌谱，澄清了目前的认识，表明肺炎链球菌和革兰氏阴性菌在吸入性肺炎中常见，而厌氧菌和口服链球菌较少被发现。然而，由于吸入性肺炎的标准化定义和检测到的微生物致病性仍然不确定，需要进一步的研究来更好地表征细菌谱。

{"title":"Microbiological etiology of aspiration pneumonia in Japan: Insights from a systematic review and meta-analysis","authors":"Shingo Noguchi , Kentaro Akata , Hiroshi Mukae , Kazuhiro Yatera","doi":"10.1016/j.resinv.2025.04.010","DOIUrl":"10.1016/j.resinv.2025.04.010","url":null,"abstract":"<div><h3>Background</h3><div>Anaerobic bacteria were historically considered the primary causative agent of aspiration pneumonia. However, recent studies suggest their role may have been overemphasized, and the microbial profile of aspiration pneumonia remains uncertain owing to diagnostic limitations. This study explored its microbiological epidemiology through a systematic review and meta-analysis.</div></div><div><h3>Methods</h3><div>We searched for English and Japanese articles published since 1990, evaluating the etiological bacterial species associated with aspiration pneumonia using PubMed and Ichushi-Web databases. The detection frequency (%) of each bacterial species was calculated using Review Manager and analyzed separately for Japan and other countries. Regional differences in detection of bacteria between these countries were also compared.</div></div><div><h3>Results</h3><div>This study included 21 articles: 14 from Japan and 7 from other countries. The most prevalent bacteria were <em>Streptococcus pneumonia</em><em>e</em> (11.7 %, 95 % confidence interval [CI] 8.5–15.0 %) and <em>Klebsiella pneumonia</em><em>e</em> (11.8 %, 95 % CI: 2.5–21.1 %), respectively. Gram-negative bacteria such as <em>K. pneumoniae</em>, <em>Escherichia coli,</em> and <em>Pseudomonas aeruginosa</em> were frequently detected, whereas oral streptococci and anaerobic bacteria were uncommon in both regions. Significant regional differences were observed in the detection frequencies of <em>Staphylococcus aureus, S. pneumoniae</em>, <em>Haemophilus influenzae</em>, and <em>Moraxella catarrhalis</em>.</div></div><div><h3>Conclusions</h3><div>This study highlights the bacterial profile of aspiration pneumonia and clarified the current understanding, showing that <em>S. pneumoniae</em> and gram-negative bacteria were frequently detected in aspiration pneumonia, whereas anaerobes and oral streptococci were less commonly identified. However, further investigation is needed to better characterize the bacterial spectrum, as a standardized definition of aspiration pneumonia and the pathogenicity of detected microbes remains uncertain.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 4","pages":"Pages 510-516"},"PeriodicalIF":2.4,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Primary ciliary dyskinesia in a Japanese woman caused by a novel RSPH4A variant 一种新型RSPH4A变异引起的日本女性原发性纤毛运动障碍

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-04-21 DOI: 10.1016/j.resinv.2025.04.007

Ryo Ogata , Takashi Kido , Noriho Sakamoto , Ritsuko Murakami , Takatomo Tokito , Hirokazu Yura , Hiroshi Ishimoto , Takashi Suematsu , Kazuhiko Takeuchi , Hiroshi Mukae

Primary ciliary dyskinesia (PCD) is a rare genetic disorder characterized by ciliary dysfunction. We report the case of a 50-year-old Japanese woman with chronic cough, sinusitis, hearing loss, and bronchiectasis. High-speed video analysis of the nasal mucosa revealed reduced ciliary beat frequency and amplitude. Electron microscopy revealed normal cilia mixed with cilia lacking central microtubules. Genetic testing identified a homozygous RSPH4A variant (NM_001010892.3: c.1484C > A). RSPH4A variants account for approximately 3–4 % and <2 % of cases of PCD worldwide and in East Asia, respectively. This is the third reported case in Japan and the first reported case of the c.1484C > A variant.

原发性纤毛运动障碍（PCD）是一种罕见的遗传性疾病，以纤毛功能障碍为特征。我们报告一个50岁的日本妇女慢性咳嗽，鼻窦炎，听力损失和支气管扩张的情况。高速视频分析鼻黏膜显示睫状搏动频率和幅度降低。电镜显示正常纤毛混杂着缺乏中心微管的纤毛。基因检测鉴定出一个纯合子RSPH4A变异(NM_001010892.3: c.1484C >；A). RSPH4A变异分别占全球和东亚PCD病例的约3 - 4%和2%。这是日本报告的第三例病例，也是首次报告的c.1484C >；一个变种。

引用次数: 0

Study protocol for a randomized trial comparing cryobiopsy and conventional biopsy for peripheral pulmonary lesions 一项随机试验的研究方案比较低温活检和常规活检周围肺病变

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-04-19 DOI: 10.1016/j.resinv.2025.03.017

Yuji Matsumoto , Tatsuya Imabayashi , Toshiyuki Nakai , Ching-Kai Lin , Sze Shyang Kho , Hidenori Tanaka , Dongil Park , Tetsuya Watanabe , Hideaki Furuse , Keigo Uchimura , Takaaki Tsuchida , Takuya Kawahara

Background

The introduction of radial endobronchial ultrasound (R-EBUS) and navigation has improved the diagnostic yield of bronchoscopy for peripheral pulmonary lesions (PPLs). Cryobiopsy could further raise the yield, and the advent of single-use cryoprobes has shown promise in enhancing yields even when used alone. This multicenter randomized controlled trial aims to compare the diagnostic performance of cryobiopsy with that of conventional biopsy during bronchoscopy for PPLs.

Methods

The study will enroll 660 patients with PPLs ≤30 mm. Eligible patients will undergo bronchoscopy with a thin bronchoscope and R-EBUS. If the target lesion is considered reachable based on R-EBUS findings, patients will be allocated equally to the conventional biopsy and cryobiopsy groups. Conventional biopsy will be performed using forceps and/or aspiration needles, whereas cryobiopsy will employ a single-use cryoprobe. The primary endpoint is to compare the histology-based diagnostic yield between the two groups. A subgroup analysis will also be conducted based on predetermined factors to explore the populations in which cryobiopsy is likely to be effective. The secondary endpoints are to evaluate differences in diagnostic value and safety characteristics between the two groups.

Discussion

This will be the first study to evaluate the efficacy of cryobiopsy in diagnostic bronchoscopy for PPLs. The results of this study directly comparing cryobiopsy with conventional biopsy will elucidate differences in their diagnostic performance.

Ethics and dissemination

The National Cancer Center Institutional Review Board approved this study (No. 2022-123, approval date: October 24, 2022).

Trial registration

The University Hospital Medical Information Network Clinical Trials Registry (UMIN000049329).

背景径向支气管内超声（R-EBUS）和导航的引入提高了支气管镜对周围性肺病变（ppl）的诊断率。低温活检可以进一步提高产量，一次性冷冻探针的出现显示出即使单独使用也能提高产量的希望。本多中心随机对照试验旨在比较支气管镜下低温活检与常规活检对ppl的诊断效果。方法纳入ppl≤30 mm的患者660例。符合条件的患者将接受薄支气管镜和R-EBUS的支气管镜检查。如果根据R-EBUS结果认为目标病变可及，则将患者平均分配到常规活检组和低温活检组。常规活检将使用镊子和/或抽吸针进行，而低温活检将使用一次性冷冻探针。主要终点是比较两组之间基于组织学的诊断率。还将根据预先确定的因素进行亚组分析，以探索低温活检可能有效的人群。次要终点是评估两组之间诊断价值和安全性特征的差异。这将是第一项评估低温活检在支气管镜诊断ppl中的疗效的研究。本研究的结果直接比较低温活检与常规活检将阐明其诊断性能的差异。美国国家癌症中心机构审查委员会批准了这项研究（No. 2022-123，批准日期：2022年10月24日）。试验注册大学医院医学信息网临床试验注册（UMIN000049329）。

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引用次数: 0

Challenges in the diagnosis and treatment of chronic pulmonary aspergillosis in Japan 日本慢性肺曲霉病诊断和治疗的挑战

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-04-17 DOI: 10.1016/j.resinv.2025.04.005

Takahiro Takazono , Masato Tashiro , Koichi Izumikawa , Hiroshi Mukae

Chronic pulmonary aspergillosis (CPA) is a refractory infectious disease that occurs in patients with mildly compromised immunity or an underlying pulmonary disease. The mortality rate associated with pulmonary aspergillosis has also increased. In the diagnosis and management of CPA, numerous challenges persist. The Aspergillus IgG antibody test is a highly accurate adjunctive diagnostic method for CPA that has been approved in Japan since 2024. However, the diagnostic accuracy for non-fumigatus species is not as high as that for Aspergillus fumigatus. The development of an auxiliary diagnostic method for non-fumigatus CPA is a pressing concern. Azole-resistant strains, related species, and challenges in long-term therapy are significant issues. Currently, most azole-resistant strains in Japan are patient-route strains that harbor CYP51A mutations. Although the prevalence of azole-resistant strains transmitted via environmental routes remains limited, ongoing surveillance and monitoring are essential. Furthermore, the lack of health insurance coverage for drug susceptibility testing is another critical issue. The recommended treatment duration for CPA is a minimum of 6–12 months; however, maintaining long-term therapy is challenging because of the higher incidence of adverse events associated with antifungal agents than with other antimicrobial medications. Additionally, CPA co-infection in patients with non-tuberculosis mycobacteria has recently become a concern owing to poor prognosis and drug-drug interactions between antifungal and antimycobacterial agents. Therefore, the development of treatment agents with improved safety profiles and fewer drug-drug interactions is highly desirable.

慢性肺曲霉病（CPA）是一种难治性传染病，发生在轻度免疫受损或潜在肺部疾病的患者中。与肺曲霉病有关的死亡率也有所增加。在CPA的诊断和管理中，许多挑战仍然存在。曲霉IgG抗体检测是一种高度准确的CPA辅助诊断方法，于2024年在日本获得批准。然而，对非烟曲霉种的诊断准确率不如对烟曲霉的诊断准确率高。开发一种非烟菌性CPA的辅助诊断方法是一个迫切需要关注的问题。抗唑菌株、相关菌种和长期治疗的挑战是重要的问题。目前，日本大多数抗唑菌株是携带CYP51A突变的患者途径菌株。尽管通过环境途径传播的耐唑菌株的流行率仍然有限，但持续的监测和监测至关重要。此外，缺乏药物敏感性测试的医疗保险是另一个关键问题。CPA的推荐治疗时间至少为6-12个月；然而，维持长期治疗是具有挑战性的，因为与其他抗菌药物相比，抗真菌药物的不良事件发生率更高。此外，由于预后不良以及抗真菌和抗细菌药物之间的药物相互作用，非结核分枝杆菌患者的CPA合并感染最近已成为人们关注的问题。因此，开发具有更高安全性和更少药物-药物相互作用的治疗剂是非常可取的。

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引用次数: 0

Role of bronchoscopic mucus plug removal in the diagnosis and treatment of allergic bronchopulmonary mycosis using the new criteria: A single-centre, retrospective study 支气管镜下粘液塞去除在诊断和治疗过敏性支气管肺真菌病中的作用：一项单中心回顾性研究

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-04-17 DOI: 10.1016/j.resinv.2025.04.003

Yuki Takigawa, Ken Sato, Shoichiro Matsumoto, Takeru Ichikawa, Tomoyoshi Inoue, Suzuka Matsuoka, Hiromi Watanabe, Kenichiro Kudo, Akiko Sato, Keiichi Fujiwara

Background

The allergic bronchopulmonary mycosis (ABPM) diagnostic criteria that were proposed in 2019 have proven useful in clinical practice due to their high sensitivity and specificity for ABPM diagnosis. By these new criteria, bronchoscopy may be required for diagnosis and treatment of ABPM. Here, we retrospectively reviewed our experience at the NHO Okayama Medical Center to determine the effectiveness of bronchoscopic examination in the management of patients with ABPM.

Method

We analyzed the background, laboratory data, computed tomography images, and bronchoscopy results of patients diagnosed with ABPM who were treated at Okayama Medical Center between October 2020 and March 2024.

Result

Five of the 10 patients met the new diagnostic criteria for ABPM before bronchoscopic examination. However, after bronchoscopy findings were analyzed, all patients (10/10) met the new inclusion criteria. Fungi cultured from the mucus plugs obtained in four cases as well as cytology revealed the presence of fungus in the mucus plug in six cases. Three patients showed clinical improvement after bronchoscopic removal of the mucus plug.

Conclusion

Bronchoscopy performed as part of the new ABPM diagnostic criteria were shown to be efficacious for the diagnosis and treatment of ABPM in our institution.

2019年提出的过敏性支气管肺真菌病（ABPM）诊断标准因其对ABPM诊断的高敏感性和特异性而在临床实践中被证明是有用的。根据这些新标准，诊断和治疗ABPM可能需要支气管镜检查。在这里，我们回顾性地回顾了我们在NHO冈山医疗中心的经验，以确定支气管镜检查在治疗ABPM患者中的有效性。方法分析2020年10月至2024年3月在冈山医疗中心接受治疗的诊断为ABPM的患者的背景、实验室数据、计算机断层扫描图像和支气管镜检查结果。结果10例患者中有5例在支气管镜检查前符合新的ABPM诊断标准。然而，在分析支气管镜检查结果后，所有患者（10/10）符合新的纳入标准。4例粘液塞真菌培养及细胞学检查显示6例粘液塞真菌存在。3例患者经支气管镜下清除黏液塞后临床改善。结论支气管镜检查作为ABPM新诊断标准的一部分，对本院ABPM的诊断和治疗是有效的。

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引用次数: 0