Respiratory investigation最新文献_第10页

Impact of medications on lung function in fibrotic hypersensitivity pneumonitis 药物对纤维化超敏性肺炎肺功能的影响

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-11-01 Epub Date: 2025-09-10 DOI: 10.1016/j.resinv.2025.09.001

Takemoto Abe , Tsukasa Okamoto , Takashi Shimamura , Masaru Ejima , Shiro Sonoda , Tsuyoshi Shirai , Masahiro Ishizuka , Haruhiko Furusawa , Tomoya Tateishi , Ryoichi Hanazawa , Akihiro Hirakawa , Yasunari Miyazaki

Background

Hypersensitivity pneumonitis (HP) is primarily managed through antigen avoidance. However, symptoms often persist even after avoidance, necessitating systemic therapies such as glucocorticoids, immunosuppressants, and antifibrotic agents. The impact of these medications on pulmonary function remains uncertain. To clarify the effects of these systemic therapies on lung function in fibrotic HP, we conducted a retrospective cohort study analyzing longitudinal pulmonary function data.

Methods

Patients were identified at our center. Changes in lung function before and after treatment initiation were analyzed using linear mixed effects model and interrupted time series analysis. Multivariate analysis adjusted for age, sex, and smoking history.

Results

A total of 388 patients were included. Multivariate regression analysis revealed an annual decline in forced vital capacity (FVC) percent predicted of 3.16 % (95 % confidence interval: 2.73–3.58). Untreated patients had a slower decline (1.68 % per year, 95 % confidence interval: 0.83–2.52), while treated patients showed a reduction in annual decline from 6.96 % (95 % confidence interval: 6.27–7.65) before treatment to 3.03 % thereafter (P < 0.001). Glucocorticoids alone reduced the decline from 6.96 % (95 % confidence interval: 5.57–8.34) to 0.32 % per year (P < 0.001), while antifibrotic agents slowed it from 4.24 % (95 % confidence interval: 3.09–5.40) to 1.24 % per year (P < 0.001).

Conclusion

Systemic therapies, particularly glucocorticoids and antifibrotic agents, significantly slow the decline in FVC percent predicted in patients with fibrotic HP. Prospective trials are needed to confirm these findings.

背景：超敏性肺炎（HP）的主要治疗方法是抗原规避。然而，即使在避免后，症状仍然存在，需要全身治疗，如糖皮质激素、免疫抑制剂和抗纤维化药物。这些药物对肺功能的影响仍不确定。为了阐明这些系统性治疗对纤维化HP患者肺功能的影响，我们进行了一项回顾性队列研究，分析了纵向肺功能数据。方法在本中心对患者进行鉴定。采用线性混合效应模型和中断时间序列分析治疗开始前后肺功能的变化。多变量分析调整了年龄、性别和吸烟史。结果共纳入388例患者。多因素回归分析显示，用力肺活量（FVC）年下降率预测为3.16%（95%置信区间：2.73 ~ 3.58）。未经治疗的患者下降速度较慢（每年1.68%，95%可信区间：0.83-2.52），而接受治疗的患者的年下降速度从治疗前的6.96%（95%可信区间：6.27-7.65）降至治疗后的3.03% （P < 0.001）。单独使用糖皮质激素可将下降速度从每年6.96%（95%可信区间：5.57-8.34）降低到0.32% (P < 0.001)，而抗纤维化药物可将下降速度从每年4.24%（95%可信区间：3.09-5.40）降低到每年1.24% （P < 0.001）。结论：全身治疗，特别是糖皮质激素和抗纤维化药物，可显著减缓纤维化HP患者FVC百分比的下降。需要前瞻性试验来证实这些发现。

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引用次数: 0

Association between pleurodesis before immunotherapy and pneumonitis in non-small cell lung cancer 非小细胞肺癌免疫治疗前胸膜浸润与肺炎的关系

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-11-01 Epub Date: 2025-09-25 DOI: 10.1016/j.resinv.2025.09.016

Megumi Mizutani , Yasutaka Ihara , Kenji Sawa , Akira Sugimoto , Hiroaki Nagamine , Yoshiya Matsumoto , Yoko Tani , Takako Oka , Hiroyasu Kaneda , Tsubasa Bito , Tomoya Kawaguchi , Ayumi Shintani

Background

Immune checkpoint inhibitors are important in the treatment of advanced non-small cell lung cancer, with pneumonitis being a prevalent complication. Pneumonitis is a recognized adverse event of pleurodesis in lung cancer patients with pleural effusion. However, the association between pleurodesis and pneumonitis in patients with immunotherapy remains unclear.

Methods

This retrospective cohort study used nationwide administrative claims data in Japan. Patients aged ≥18 years who underwent immunotherapy for newly diagnosed non-small cell lung cancer between December 2015 and January 2023 were included in the study. Patients who used talc or OK-432 within 60 days prior to immune checkpoint inhibitors treatment were defined as having undergone pleurodesis. The incidence rates of pneumonitis in patients with and without pleurodesis were compared using cumulative incidence functions against time, and by conducting a Fine–Gray analysis to account for death as a competing risk factor for pneumonitis incidence.

Results

Among the 16,538 patients with non-small cell lung cancer who received immune checkpoint inhibitors, 509 underwent pleurodesis. The incidence of pneumonitis was higher in patients who underwent pleurodesis than in those who did not. The sub-distribution hazard ratio quantified by Fine–Gray analysis was 1.168 (95 % confidence intercal, 1.062–1.286).

Conclusions

Pleurodesis before immunotherapy in patients with advanced non-small cell lung cancer was associated with an increased incidence of pneumonitis.

免疫检查点抑制剂在晚期非小细胞肺癌的治疗中很重要，肺炎是一种常见的并发症。肺炎是公认的胸腔积液肺癌患者胸腔积液的不良事件。然而，在接受免疫治疗的患者中，胸膜穿刺术和肺炎之间的关系尚不清楚。方法本回顾性队列研究使用日本全国行政索赔数据。在2015年12月至2023年1月期间接受新诊断的非小细胞肺癌免疫治疗的年龄≥18岁的患者纳入研究。在免疫检查点抑制剂治疗前60天内使用滑石粉或OK-432的患者被定义为经历了胸膜切除术。采用累积发病率随时间变化的函数，并通过细灰分析，将死亡作为肺炎发病率的竞争危险因素，比较有胸膜切除术和无胸膜切除术患者的肺炎发病率。结果在接受免疫检查点抑制剂治疗的16,538例非小细胞肺癌患者中，509例发生了胸膜切除术。胸膜切除术患者的肺炎发病率高于未行胸膜切除术的患者。细灰分析量化的亚分布风险比为1.168（95%可信区间为1.062 ~ 1.286）。结论晚期非小细胞肺癌患者免疫治疗前行脾脏切除术与肺炎发病率增高相关。

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引用次数: 0

Familial fibrotic hypersensitivity pneumonitis: A distinct clinical phenotype with shorter leukocyte telomere length 家族性纤维化超敏性肺炎：白细胞端粒长度较短的独特临床表型。

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-11-01 Epub Date: 2025-11-05 DOI: 10.1016/j.resinv.2025.10.012

Masashi Nishimura , Hideya Kitamura , Yoichi Tagami , Kazushi Fujimoto , Takashi Fukushima , Ryota Otoshi , Takashi Niwa , Jun Aoki , Taiki Fukuda , Tomoe Sawazumi , Tae Iwasawa , Koji Okudela , Tamiko Takemura , Yayoi Natsume-Kitatani , Yu Hara , Takeshi Kaneko , Takashi Ogura

Background

Family history is an important factor in recognizing the prognosis of interstitial lung disease (ILD), however, its significance in fibrotic hypersensitivity pneumonitis (HP), as based on the latest international guidelines, remains unclear. This study aimed to investigate the distinct clinical profile and leukocyte telomere length (LTL) of familial fibrotic HP.

Methods

We retrospectively reviewed 490 patients who underwent leukocyte telomere length (LTL) measurement, and identified 131 patients with fibrotic HP, including 19 familial cases. Chest HRCT images were reviewed using automatic deep learning-based lung analysis.

Results

Familial fibrotic HP patients were younger (age ≥60: 68.4 % vs. 91.9 %, p = 0.02) and had lower diffusing capacity for carbon monoxide (DLco) (mean [SD]: 70.9 [23.6] vs. 82.9 [23.2], p = 0.031) compared to non-familial cases. Despite similar imaging patterns and AI-based CT analysis, pathological features of usual interstitial pneumonia (UIP) were more frequent in familial cases. Age-adjusted LTL was significantly shorter in the familial group (mean [SD]: −0.26 [0.26] vs. −0.06 [0.28], p = 0.004). Furthermore, LTL correlated with serum KL-6 (r = −0.603, p = 0.006), %DLco(r = 0.629, p = 0.007), and fibrotic features according to deep learning-based CT analysis; the consolidation with traction bronchiectasis ratio (r = −0.48, p = 0.038) and the traction bronchiectasis ratio (r = −0.489, p = 0.034).

Conclusion

Familial fibrotic HP may represent a distinct clinical phenotype characterized by shorter telomeres, with LTL emerging as a potential biomarker for disease severity.

背景：家族史是判断间质性肺疾病（ILD）预后的重要因素，然而，根据最新的国际指南，家族史在纤维化超敏性肺炎（HP）中的意义尚不清楚。本研究旨在探讨家族性纤维化HP的独特临床特征和白细胞端粒长度（LTL）。方法：我们回顾性分析了490例接受白细胞端粒长度（LTL）测量的患者，并确定了131例纤维化HP患者，其中包括19例家族病例。使用基于自动深度学习的肺部分析对胸部HRCT图像进行审查。结果：与非家族性患者相比，家族性纤维化HP患者更年轻（年龄≥60岁：67.4% vs. 91.9%, p = 0.02），并且一氧化碳弥散能力（DLco）更低（平均[SD]: 70.9 [23.6] vs. 82.9 [23.2], p = 0.031）。尽管影像学和基于人工智能的CT分析相似，但常见性间质性肺炎（UIP）的病理特征在家族病例中更为常见。家族性组经年龄调整后的LTL显著缩短（平均[SD]: -0.26[0.26]比-0.06 [0.28],p = 0.004）。此外，根据基于深度学习的CT分析，LTL与血清KL-6 （r = -0.603, p = 0.006）、%DLco（r = 0.629, p = 0.007）和纤维化特征相关；实变与牵引支气管扩张的比值（r = -0.48, p = 0.038）和牵引支气管扩张的比值（r = -0.489, p = 0.034）。结论：家族性纤维化HP可能代表了一种独特的临床表型，其特征是端粒较短，LTL正在成为疾病严重程度的潜在生物标志物。

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引用次数: 0

Corrigendum to “Symptom control and medication adherence in Japanese pediatric and adolescent asthma: A large-scale web-based cross-sectional survey” [Respir Invest, Volume 63, Issue 5, September 2025, Pages 1018–1025] “日本儿童和青少年哮喘的症状控制和药物依从性：一项大规模基于网络的横断面调查”的更正[Respir Invest，第63卷，第5期，2025年9月，第1018-1025页]

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-11-01 Epub Date: 2025-09-02 DOI: 10.1016/j.resinv.2025.08.005

Shigemi Yoshihara , Toshiko Itazawa , Taiji Nakano , Daisuke Hayashi , Takumi Takizawa , Arshan Perera , Yoshiyuki Yamada

引用次数: 0

The prognosis of lung transplant candidates with progressive pulmonary fibrosis 进行性肺纤维化肺移植候选者的预后。

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-11-01 Epub Date: 2025-09-19 DOI: 10.1016/j.resinv.2025.09.009

Takafumi Yamaya , Tatsuya Muraoka , Miho Yamaguchi , Mitsuaki Kawashima , Chihiro Konoeda , Masaaki Sato

Background

Interstitial lung disease with progressive fibrosis is now defined as progressive pulmonary fibrosis (PPF), and often requires lung transplantation. However, the prognosis of lung transplant candidates with PPF is unclear.

Methods

We retrospectively investigated fibrotic ILD patients who were candidates for lung transplantation. Based on the clinical data, we classified the patients into idiopathic pulmonary fibrosis (IPF), PPF, and non-PPF groups. We investigated the patient characteristics, transplant-free survival (TFS), and cumulative waiting list mortality in each group.

Results

In total, 194 patients were included in the study: 51 IPF patients, 121 PPF patients, and 22 non-PPF patients, respectively. PPF patients tended to show a lower forced vital capacity (47.0 ± 16.2 %) and a shorter 6-min walk distance than IPF patients [310 (233–400) m]. The TFS of PPF patients was shorter than that of non-PPF patients and comparable to that of IPF patients (p < 0.001, 0.132, respectively). A similar trend was observed for cumulative waiting list mortality (p = 0.001, 0.062, respectively). Pleuroparenchymal fibroelastosis (PPFE) patients exhibited worse waiting list mortality than IPF patients (p = 0.019). Multivariate analysis revealed no statistically significant risk factors for mortality in the PPF group.

Conclusions

Among lung transplant candidates, PPF patients exhibited worse TFS and waiting list mortality than non-PPF patients, and were comparable to IPF patients. In addition, PPFE patients demonstrated significantly higher mortality rates than IPF patients. Early lung transplantation should be considered for PPF patients, especially PPFE patients.

背景：间质性肺疾病伴进行性纤维化现在被定义为进行性肺纤维化（PPF），通常需要肺移植。然而，肺移植候选人PPF的预后尚不清楚。方法：我们回顾性调查了适合肺移植的纤维化ILD患者。根据临床资料，我们将患者分为特发性肺纤维化（IPF）组、PPF组和非PPF组。我们调查了每组患者的特征、无移植生存（TFS）和累积等待名单死亡率。结果：共纳入194例患者：IPF患者51例，PPF患者121例，非PPF患者22例。与IPF患者相比，PPF患者的强迫肺活量（47.0±16.2%）更低，6分钟步行距离更短[310 (233-400)m]。PPF患者的TFS比非PPF患者短，与IPF患者相当(p结论：在肺移植候选者中，PPF患者的TFS和等待名单死亡率比非PPF患者差，与IPF患者相当。此外，PPFE患者的死亡率明显高于IPF患者。对于PPF患者，尤其是PPFE患者应考虑早期肺移植。

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引用次数: 0

Efficacy and feasibility of percutaneous needle biopsy in molecular profiling of thoracic cancers via next-generation sequencing 经皮穿刺活检在胸部肿瘤分子分析中的有效性和可行性

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-11-01 Epub Date: 2025-09-12 DOI: 10.1016/j.resinv.2025.09.004

Yuma Sato , Hiroshi Yokouchi , Keita Tagami , Hiroyuki Nagashima , Noriyuki Yamada , Shinichi Fukumoto , Wataru Sakai , Dai Okuyama , Ken Kuwahara , Shingo Matsumoto , Hiroaki Hiraga , Masao Harada , Satoshi Oizumi

Background

Recent advances in therapeutic strategies for thoracic cancers, particularly non-small cell lung cancer (NSCLC), have been driven by the discovery of various driver genes and the development of companion diagnostics. However, few studies have analyzed in detail the utility of percutaneous needle biopsy (PNB) in successfully performing molecular diagnostic tests using next-generation sequencing (NGS) in patients with thoracic cancer.

Methods

We retrospectively analyzed 285 consecutive patients who underwent 299 PNB procedures for thoracic cancer at our hospital. The primary objective of this study was to evaluate the success rate of at least one NGS test performed using PNB. Secondary objectives included the success rate of singleplex gene or protein expression tests, multiplex gene detection tests using PNB, factors associated with diagnostic success, and the safety profile of the procedure.

Results

The vast majority of patients had lung cancer (n = 261, 87.3 %), followed by thymic tumors (n = 24, 8.0 %). Among the 86 patients who underwent PNB and subsequent multiplex gene detection testing via NGS, the success rate was 89.5 %. The overall success rate for all molecular tests was 93.6 %. The complication rate for all procedures was 12.7 %, including grade 1 or 2 pneumothorax and grade 1 hemorrhage, none of which required emergency intervention or prolonged hospitalization. No significant relationship was observed between success rates and factors such as tumor size or biopsy instrument selection.

Conclusion

These results suggest that PNB is a useful and safe method for performing multiplex gene testing via NGS in patients with thoracic cancer.

近年来，随着各种驱动基因的发现和伴随诊断技术的发展，胸部肿瘤特别是非小细胞肺癌（NSCLC）的治疗策略取得了进展。然而，很少有研究详细分析了经皮穿刺活检（PNB）在使用新一代测序（NGS）成功地对胸部癌症患者进行分子诊断测试中的应用。方法回顾性分析我院连续行299次PNB手术的285例胸部肿瘤患者。本研究的主要目的是评估使用PNB进行的至少一项NGS测试的成功率。次要目标包括单基因或蛋白表达测试的成功率，使用PNB的多基因检测测试，与诊断成功相关的因素，以及手术的安全性。结果绝大多数患者为肺癌（261例，87.3%），其次为胸腺肿瘤（24例，8.0%）。86例患者接受了PNB并随后通过NGS进行多重基因检测，成功率为89.5%。所有分子检测的总成功率为93.6%。所有手术的并发症发生率为12.7%，包括1级或2级气胸和1级出血，均不需要紧急干预或延长住院时间。成功率与肿瘤大小或活检器械选择等因素无显著关系。结论PNB是一种有效且安全的方法，可以通过NGS对胸部肿瘤患者进行多重基因检测。

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引用次数: 0

Anterior rotation of the ribs flattens the thoracic cage in idiopathic pleuroparenchymal fibroelastosis 在特发性胸膜实质纤维弹性病中，肋骨前旋使胸廓变平

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-11-01 Epub Date: 2025-09-12 DOI: 10.1016/j.resinv.2025.09.003

Yoshiaki Kinoshita, Kengo Takata, Kenta Hara, Chiharu Hirai, Shota Takenaka, Takuhide Utsunomiya, Yuji Yoshida, Shota Nakashima, Hisako Kushima, Hiroshi Ishii

Background

Idiopathic pleuroparenchymal fibroelastosis (iPPFE) is a rare but increasingly recognized interstitial lung disease characterized by upper-lobe-predominant elastofibrosis. A flattened thoracic cage is a physical characteristic of iPPFE; however, the underlying anatomical organization remains unexplored.

Methods

We retrospectively reviewed 57 patients with iPPFE, 30 patients with idiopathic pulmonary fibrosis (IPF), and 32 control subjects. To clarify the anatomical factors contributing to thoracic cage flattening in iPPFE, we examined potential determinants, including rib shape, rib angle relative to the vertical plane on sagittal computed tomography images, and standardized lung volumes (lung volumes adjusted for predicted vital capacity).

Results

The rib angle was significantly smaller in the iPPFE group (47.0° ± 60.5°) than in the IPF (58.3° ± 7.30°, p < 0.001) and control groups (57.9° ± 6.32°, p < 0.001). Meanwhile, the ribs themselves were not structurally deformed in iPPFE patients compared to those in the IPF or control groups. Rib angles were correlated with clinical parameters characteristic of iPPFE and progressively decreased over time (−1.346°/year, p < 0.001). A multivariate linear regression analysis identified body mass index and standardized upper-lobe volume as an independent determinant of the rib angle in patients with iPPFE.

Conclusions

Anterior rotation of the ribs may contribute to the characteristic platythorax observed in patients with iPPFE.

背景：didiopathic pleuroparenchymal fibroelastosis （iPPFE）是一种罕见的间质性肺疾病，以上肺叶为主的弹性纤维化为特征。扁平胸廓是iPPFE的物理特征；然而，潜在的解剖组织仍未被探索。方法回顾性分析57例iPPFE患者、30例特发性肺纤维化（IPF）患者和32例对照组。为了阐明导致iPPFE胸廓变平的解剖学因素，我们研究了潜在的决定因素，包括肋骨形状、矢状计算机断层图像上相对于垂直平面的肋骨角度和标准化肺体积（肺体积根据预测肺活量调整）。结果iPPFE组肋角（47.0°±60.5°）明显小于IPF组（58.3°±7.30°，p < 0.001）和对照组（57.9°±6.32°，p < 0.001）。同时，与对照组相比，iPPFE患者的肋骨本身没有结构变形。肋骨角度与iPPFE的临床参数特征相关，并随着时间的推移逐渐降低（- 1.346°/年，p < 0.001）。多变量线性回归分析发现，体重指数和标准化上肺叶容积是iPPFE患者肋骨角度的独立决定因素。结论前向旋转的肋骨可能与iPPFE患者特征性的平胸有关。

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引用次数: 0

Superior performance of three-dimensional to two-dimensional convolutional neural network for predicting airflow limitation in patients with chronic obstructive pulmonary disease 三维与二维卷积神经网络在预测慢性阻塞性肺疾病患者气流限制方面的优越性能

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-11-01 Epub Date: 2025-11-03 DOI: 10.1016/j.resinv.2025.10.008

Kaoruko Shimizu , Hiroyuki Sugimori , Naoya Tanabe , Nobuyasu Wakazono , Yoichi M. Ito , Hironi Makita , Susumu Sato , Masaharu Nishimura , Toyohiro Hirai , Satoshi Konno

Background

Chronic obstructive pulmonary disease (COPD) may be inconsistent with the severity of airflow limitation. This causes COPD underdiagnosis, necessitating approaches that facilitate timely diagnosis and intervention. Combining deep learning models (based on medical imaging) with regression methods improves numerical functional predictions. We aimed to evaluate and compare the prediction performance of two deep learning-based models (two-dimensional [2D]-convolutional neural network (CNN) and three-dimensional [3D]-CNN) for the percentage predicted forced expiratory volume in 1 s (%FEV₁) in patients with COPD.

Methods

ResNet18-based regression prediction models were constructed for %FEV₁ based on 200 computed tomography (CT) datasets. Five-fold cross-validation was performed to develop the predictive models, which were externally validated using 20 data points. In addition, 200 internal CT datasets were assessed using commercial software to develop a regression model for predicting airway (% wall area) and parenchymal indices (% low-attenuation volume).

Results

The 3D-CNN model demonstrated superior performance with an average root mean squared error (RMSE) of 10.73 and a correlation coefficient of 0.88, compared with that of the 2D-CNN model (RMSE: 16.76, correlation coefficient: 0.66) during internal validation. In the external validation approach, the 3D-CNN model maintained a performance (RMSE: 11.48, correlation coefficient: 0.59) better than that of the 2D-CNN model (RMSE: 12.38, correlation coefficient: 0.47), with both models outperforming the commercial software analysis (RMSE: 23.18).

Conclusions

Volumetric analysis using 3D-CNN may sufficiently capture the complex structural features of COPD in CT images. Further studies are required to validate these models with larger datasets and determine their validity for longitudinal applications.

背景：慢性阻塞性肺疾病（COPD）可能与气流受限的严重程度不一致。这导致慢性阻塞性肺病诊断不足，需要能够促进及时诊断和干预的方法。将深度学习模型（基于医学成像）与回归方法相结合可以改进数值函数预测。我们旨在评估和比较两种基于深度学习的模型（二维[2D]-卷积神经网络（CNN）和三维[3D]-CNN）对COPD患者1 s用力呼气量预测百分比（%FEV1）的预测性能。方法：基于200组CT数据，建立基于resnet18的%FEV1回归预测模型。进行五重交叉验证以建立预测模型，并使用20个数据点进行外部验证。此外，使用商业软件评估200个内部CT数据集，开发预测气道（%壁面积）和实质指数（%低衰减体积）的回归模型。结果：3D-CNN模型在内部验证时的平均均方根误差（RMSE）为10.73，相关系数为0.88，优于2D-CNN模型（RMSE: 16.76，相关系数：0.66）。在外部验证方法中，3D-CNN模型的性能（RMSE: 11.48，相关系数：0.59）优于2D-CNN模型（RMSE: 12.38，相关系数：0.47），且两种模型都优于商业软件分析（RMSE: 23.18）。结论：使用3D-CNN的体积分析可以充分捕捉COPD在CT图像中的复杂结构特征。需要进一步的研究来验证这些模型与更大的数据集，并确定其纵向应用的有效性。

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引用次数: 0

Turbidity of whole lung lavage fluid in patients with autoimmune pulmonary alveolar proteinosis: Association between turbidity and pulmonary function 自身免疫性肺泡蛋白沉积症患者全肺灌洗液浊度：浊度与肺功能的关系

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-11-01 Epub Date: 2025-09-18 DOI: 10.1016/j.resinv.2025.09.008

Takuma Katano , Satoru Ito , Masaya Fukami , Hiroyuki Tanaka , Eisuke Fujishiro , Hiroto Murao , Hitomi Amano , Shiori Nishizaki , Tomoyuki Ogisu , Toshiyuki Yonezawa , Etsuro Yamaguchi

Background

Whole lung lavage (WLL) under general anesthesia has been the standard therapeutic strategy for patients with severe autoimmune pulmonary alveolar proteinosis (APAP). However, the criteria for termination of WLL have not yet been standardized.

Methods

We retrospectively examined clinical data of APAP patients who underwent WLL. The turbidity of effluent was measured by nephelometry.

Results

Fourteen patients and totally 26 sets of WLLs were enrolled in the study. The turbidity of the effluent decreased with repeated instillation and drainage as the effluent became visibly clear. In most cases (88.5 % of right lung lavage and 65.4 % of left lung lavage), the turbidity fell below 100 nephelometric turbidity units, the value that has been proposed by the Japanese Respiratory Society Guidelines for pulmonary alveolar proteinosis in 2022 for considering termination of the WLL. The maximum turbidity of the effluent in the first WLL was significantly correlated with % of predicted values of diffusing capacity of the lungs of carbon monoxide before the WLL. The changes in turbidity, differences between the maximum and minimum turbidity, were significantly correlated with changes in % of predicted values of forced vital capacity.

Conclusions

Assessment of turbidity may serve as a supplementary indicator of termination and effectiveness of WLL.

背景：全麻下全肺灌洗（WLL）已成为严重自身免疫性肺泡蛋白沉积症（APAP）患者的标准治疗策略。然而，终止井馀水的标准尚未标准化。方法：回顾性分析APAP患者行WLL的临床资料。用浊度法测定出水浊度。结果：14例患者共26套wll纳入研究。随着反复注入和排水，出水的浊度降低，出水变得明显清澈。在大多数情况下（88.5%的右肺灌洗和65.4%的左肺灌洗），浊度低于100浊度单位，这是日本呼吸学会在2022年提出的肺泡蛋白沉积症指南中提出的考虑终止WLL的值。第一次生化试验出水最大浊度与生化试验前肺一氧化碳扩散能力预测值的%显著相关。浊度的变化，最大浊度和最小浊度之间的差异，与强迫肺活量预测值百分比的变化显著相关。结论：浊度评价可作为WLL终止和有效性的补充指标。

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引用次数: 0

Evaluation of inhalation device prescribing trends: A retrospective database study in Japan 评估吸入装置处方趋势：日本的回顾性数据库研究

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-11-01 Epub Date: 2025-09-23 DOI: 10.1016/j.resinv.2025.09.011

Hiroyuki Ura , Noriko Matsuoka , Hiroyuki Furuya

Background

Inhalation therapy is crucial in treating obstructive lung diseases, including asthma and chronic obstructive pulmonary disease (COPD). Improper inhalation techniques are associated with poor asthma and COPD management, increased exacerbation risk, and overutilization of healthcare resource. However, comprehensive analyses of prescription trends across diverse inhalation devices are limited. Therefore, we aimed to investigate inhalation device prescription trends in Japan from 2016 to 2022 using data from the National Database of Health Insurance Claims and Specific Health Checkups Open Data Japan.

Methods

Temporal changes in prescription patterns were analyzed across different device types, therapeutic categories, and patient demographics.

Results

Our findings revealed major shifts toward combination therapies, particularly triple combination therapy (inhaled corticosteroid [ICS]/long-acting beta2-agonist [LABA]/long-acting muscarinic antagonist [LAMA]), in addition to the preference for newer devices, such as the Ellipta dry powder and Aerosphere pressurized metered-dose inhalers. Age- and sex-specific patterns emerged, with distinct preferences observed across demographic groups. The pediatric population primarily received ICS mono- and ICS/LABA combination therapies, while older adults showed increased use of the triple combination therapy. Sex disparities were particularly pronounced in the older population, with older male patients requiring LABA/LAMA and triple combination therapies more often than older female patients. An economic analysis revealed that while dry powder inhalers had the highest overall cost, the introduction of generic formulations markedly reduced expenditures.

Conclusions

The shift toward combination therapies and newer inhaler devices in Japan highlights the critical need for personalized treatment strategies that balance patient characteristics with economic factors.

背景：在治疗包括哮喘和慢性阻塞性肺疾病（COPD）在内的阻塞性肺疾病中，放射治疗是至关重要的。不恰当的吸入技术与哮喘和慢性阻塞性肺病管理不良、加重风险增加以及医疗资源的过度利用有关。然而，对不同吸入装置的处方趋势的综合分析是有限的。因此，我们的目的是利用日本国家健康保险索赔数据库和特定健康检查开放数据，调查2016年至2022年日本吸入装置处方趋势。方法分析不同器械类型、治疗类别和患者人口统计学中处方模式的变化。结果：除了对Ellipta干粉和Aerosphere加压式定量吸入器等新设备的偏好外，我们的研究结果还揭示了向联合治疗的主要转变，特别是三联治疗（吸入皮质类固醇[ICS]/长效β -受体激动剂[LABA]/长效毒瘤碱拮抗剂[LAMA]）。出现了年龄和性别特定的模式，在人口统计群体中观察到不同的偏好。儿科人群主要接受ICS单一和ICS/LABA联合治疗，而老年人使用三联疗法的情况有所增加。性别差异在老年人群中尤为明显，老年男性患者比老年女性患者更需要LABA/LAMA和三联疗法。一项经济分析显示，虽然干粉吸入器的总成本最高，但采用非专利配方显著减少了支出。结论：日本向联合治疗和新型吸入器设备的转变凸显了对个性化治疗策略的迫切需求，该策略应平衡患者特征和经济因素。

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