Respiratory investigation最新文献_第9页

Survival and functional outcomes of single lung transplantation in secondary pulmonary hypertension 继发性肺动脉高压患者单肺移植的生存和功能结局。

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-10-07 DOI: 10.1016/j.resinv.2025.09.022

Dai Shimizu , Kentaroh Miyoshi , Haruchika Yamamoto , Shin Tanaka , Seiichiro Sugimoto , Mikio Okazaki , Shinichi Toyooka

Background

The role of single lung transplantation (SLT) in secondary pulmonary hypertension (SPH) remains controversial. This study evaluated the feasibility and long-term outcomes of SLT in patients with SPH—defined as mean pulmonary artery pressure ≥25 mmHg measured by right heart catheterization immediately before transplantation—within Japan's allocation system, characterized by protracted waiting periods.

Methods

We retrospectively reviewed 83 deceased-donor lung transplantations, categorized into four groups: SLT without SPH (n = 14), SLT with SPH (n = 19), bilateral lung transplantation (BLT) without SPH (n = 12), and BLT with SPH (n = 38). Outcomes analyzed included 5-year survival, CLAD-free survival, and exercise tolerance.

Results

At transplantation, 68.6 % of recipients exhibited SPH, a significant increase compared to registration. Among SLT recipients, the SPH group demonstrated 5-year survival (83.2 %) and CLAD-free survival (65.9 %) not inferior to those of the non-SPH group (50.0 % and 56.8 %, respectively). Perfusion ratios and 6-min walk distances remained comparable between SPH and non-SPH groups for up to five years. Additionally, 5-year survival (83.2 % vs. 81.1 %) and CLAD-free survival (65.9 % vs. 64.5 %) were similar between SLT and BLT. High preoperative oxygen requirements were associated with poorer early graft function in SPH patients receiving SLT. No definitive predictors of CLAD or long-term survival were identified.

Conclusions

SLT is a viable option for patients with mild-to-moderate SPH, providing survival and functional outcomes comparable to BLT. Careful recipient and donor selection remains essential, particularly given the risk of SPH progression during extended waiting periods.

背景：单肺移植（SLT）在继发性肺动脉高压（SPH）中的作用仍有争议。本研究评估了sph患者SLT的可行性和长期结果，sph的定义是在移植前立即通过右心导管测量平均肺动脉压≥25 mmHg，在日本的分配系统中，其特点是等待时间长。方法：回顾性分析83例死亡供体肺移植病例，将其分为4组：无SPH的SLT （n = 14）、无SPH的SLT （n = 19）、无SPH的双侧肺移植（BLT）（n = 12）和双侧肺移植合并SPH （n = 38）。结果分析包括5年生存率、无clad生存率和运动耐量。结果：移植时，68.6%的受者表现出SPH，与登记时相比显著增加。在SLT接受者中，SPH组的5年生存率（83.2%）和无clad生存率（65.9%）不低于非SPH组（分别为50.0%和56.8%）。灌注比和6分钟步行距离在SPH组和非SPH组之间保持可比性长达5年。此外，SLT和BLT的5年生存率（83.2% vs. 81.1%）和无clad生存率（65.9% vs. 64.5%）相似。接受SLT的SPH患者术前高氧需要量与较差的早期移植物功能相关。没有确定明确的预测因子或长期生存。结论：SLT是轻度至中度SPH患者的可行选择，提供与BLT相当的生存和功能结果。仔细选择受体和供体仍然是必要的，特别是考虑到延长等待期SPH进展的风险。

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引用次数: 0

Prognostic comparison of acute exacerbations across idiopathic interstitial pneumonia subtypes: A nationwide observational study 特发性间质性肺炎亚型急性加重的预后比较：一项全国性的观察性研究。

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-10-06 DOI: 10.1016/j.resinv.2025.10.001

Nobuyasu Awano , Shotaro Aso , Takehiro Izumo , Hiroki Matsui , Kiyohide Fushimi , Hideo Yasunaga

Background

Acute exacerbations of idiopathic interstitial pneumonias (AE-IIPs) are life-threatening events. However, comparative prognostic data across IIP subtypes during AE are limited. This study aimed to evaluate in-hospital mortality differences among major AE-IIP subtypes using a nationwide database in Japan.

Methods

We retrospectively analysed patients with AE of idiopathic pulmonary fibrosis (IPF), nonspecific interstitial pneumonia (NSIP), cryptogenic organising pneumonia (COP), or acute interstitial pneumonia (AIP) who received high-dose methylprednisolone between 1 July, 2010 and 31 March, 2023. Data were extracted from the Japanese Diagnosis Procedure Combination database. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included 14- and 28-day mortality. Multivariable logistic regression analysis with generalised estimating equations was employed to adjust for potential confounders, incorporating multiple imputation to address missing data.

Results

A total of 6645 patients were included (IPF, n = 2092; NSIP, n = 581; COP, n = 871; AIP, n = 3101). Unadjusted in-hospital mortality rates were 53.9 % for IPF, 40.1 % for NSIP, 17.6 % for COP, and 49.3 % for AIP. After adjustment, in-hospital mortality was significantly higher for IPF (odds ratio [OR], 3.92; 95 % confidence interval [95 % CI], 3.05–5.04; p < 0.001), NSIP (OR, 2.80; 95 % CI, 2.10–3.73; p < 0.001), and AIP (OR, 3.07; 95 % CI, 2.43–3.89; p < 0.001), compared with COP. Similar trends were observed for both secondary outcomes.

Conclusions

Among patients with AE-IIPs, those with IPF, NSIP, and AIP exhibited significantly higher in-hospital mortality compared with COP. These findings underscore the inferior prognosis associated with AE-IPF and AIP.

背景：特发性间质性肺炎（AE-IIPs）急性加重是危及生命的事件。然而，AE期间IIP亚型预后的比较数据有限。本研究旨在利用日本全国数据库评估AE-IIP主要亚型的住院死亡率差异。方法：回顾性分析2010年7月1日至2023年3月31日期间接受大剂量甲基强的松龙治疗的特发性肺纤维化（IPF）、非特异性间质性肺炎（NSIP）、隐源性组织性肺炎（COP）或急性间质性肺炎（AIP） AE患者。数据取自日本诊断程序组合数据库。主要结局为全因住院死亡率。次要结局包括14天和28天死亡率。采用广义估计方程的多变量逻辑回归分析来调整潜在的混杂因素，并结合多重输入来解决缺失数据。结果：共纳入6645例患者（IPF, n = 2092； NSIP, n = 581； COP, n = 871； AIP, n = 3101）。未经调整的住院死亡率为：IPF 53.9%, NSIP 40.1%, COP 17.6%, AIP 49.3%。调整后，IPF的住院死亡率显著高于COP（优势比[OR]， 3.92； 95%可信区间[95% CI]， 3.05-5.04; p）结论：在ae - iip患者中，IPF、NSIP和AIP患者的住院死亡率显著高于COP。这些发现强调AE-IPF和AIP的预后较差。

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引用次数: 0

The LIAISON® Legionella Urinary Ag assay: A novel high-throughput, fully automated dual-antigen detection method with improved sensitivity and expanded Legionella species and serogroup coverage 联络®军团菌尿银测定：一种新型的高通量、全自动双抗原检测方法，具有更高的灵敏度和扩大的军团菌种类和血清组覆盖范围

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-10-03 DOI: 10.1016/j.resinv.2025.09.006

Serena Ferraiuolo , Farah Bou Nasser Eddine , Deborah Ferrante , Andrea Dal Corso , Lorenzo Querin , Marco Rigamonti , PierNatale Brusasca , Alfredo Mento , Antonio Savinelli , Karolina Zytko , Massimo Panizzo , Elisa Ghezzi , Clara Rossini , Chiara Mauro , Andrea Pighini , Claudia Zierold , Fabrizio Bonelli , Paolo Ingallinella

Background

Legionella pneumophila is a leading cause of Legionnaires’ disease, with Legionella pneumophila serogroup 1 (Lp1) being the most commonly detected strain. Current urinary antigen tests (UAT) primarily target Lp1, leading to underdiagnosis of non-Lp1 and other Legionella species. A broad-spectrum, fully automated UAT is needed to improve diagnostic accuracy and patient outcomes.

Methods

A novel chemiluminescence immunoassay-based UAT was developed targeting both Legionella peptidoglycan-associated lipoprotein (PAL) and soluble lipopolysaccharide antigen to enable broader detection. Monoclonal antibodies were generated against PAL and integrated into an automated immunoassay platform. The assay's analytical performance was evaluated using recombinant PAL antigens, urine samples spiked with Legionella strains, and clinical specimens. Sensitivity, specificity, cross-reactivity, interference, and precision were assessed.

Results

The LIAISON® Legionella Urinary Ag assay demonstrated a 97.5 % positive agreement and 100 % negative agreement with the Binax™ UAT in detecting Legionella infections. Importantly, the new test also identified multiple non-Lp1 Legionella species, which the comparator assay failed to detect. The assay showed low imprecision, no cross-reactivity or interference.

Conclusions

The LIAISON® Legionella Urinary Ag Assay, a fully automated chemiluminescence-based UAT, provides highly sensitive and specific detection of Legionella infections, including non-Lp1 strains, addressing a major limitation of existing diagnostics. This assay has the potential to improve early detection, guide targeted antibiotic therapy, and enhance public health surveillance of Legionnaires’ disease.

背景：嗜肺军团菌是军团病的主要病因，其中嗜肺军团菌血清1组（Lp1）是最常检测到的菌株。目前的尿抗原检测（UAT）主要针对Lp1，导致非Lp1和其他军团菌种类的诊断不足。需要一种广谱、全自动的UAT来提高诊断准确性和患者预后。方法建立了一种新的基于化学发光免疫分析的UAT，同时靶向军团菌肽聚糖相关脂蛋白（PAL）和可溶性脂多糖抗原，以扩大检测范围。生成针对PAL的单克隆抗体并整合到自动免疫分析平台中。利用重组PAL抗原、加入军团菌菌株的尿液样本和临床标本对该方法的分析性能进行了评估。评估了灵敏度、特异性、交叉反应性、干扰性和精密度。结果LIAISON®军团菌尿银检测与Binax™UAT检测军团菌感染的阳性率为97.5%，阴性率为100%。重要的是，新的测试还发现了多种非lp1军团菌，这是比较试验未能检测到的。该方法不精密度低，无交叉反应或干扰。结论：LIAISON®军团菌尿银测定是一种全自动的基于化学发光的UAT，可提供高灵敏度和特异性的军团菌感染检测，包括非lp1菌株，解决了现有诊断的主要限制。这种检测方法有可能改善军团病的早期发现，指导靶向抗生素治疗，并加强对军团病的公共卫生监测。

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引用次数: 0

Extent of pulmonary involvement on admission predicts long-term pulmonary and muscular sequelae of COVID-19: A longitudinal computed tomography study 入院时肺部受累程度可预测COVID-19的长期肺部和肌肉后遗症：一项纵向计算机断层扫描研究

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-09-30 DOI: 10.1016/j.resinv.2025.09.014

Takashi Shimada , Naoya Tanabe , Shotaro Chubachi , Takanori Asakura , Ho Namkoong , Hiromu Tanaka , Shuhei Azekawa , Shiro Otake , Kensuke Nakagawara , Takahiro Fukushima , Mayuko Watase , Tomoki Maetani , Yusuke Shiraishi , Hideki Terai , Mamoru Sasaki , Soichiro Ueda , Yukari Kato , Norihiro Harada , Shoji Suzuki , Shuichi Yoshida , Koichi Fukunaga

Background

Studies on the association between chest computed tomography (CT) findings of extensive pulmonary involvement and long-term pulmonary and extrapulmonary coronavirus disease 2019 (COVID-19) sequelae are lacking. This study aimed to investigate the relationship between the severity of pneumonia on admission and residual pulmonary and extrapulmonary complications at three months post-hospitalization.

Methods

Using data from the Japan COVID-19 Task Force database, we conducted quantitative analysis of CT scans of 164 patients obtained at admission and three months later. The parameters included pneumonia volume, total lung volume, and area and density of the pectoralis muscle (PM), subcutaneous and epicardial adipose tissue, and vertebral bone density.

Results

Patients with extensive pneumonia on admission had high residual pneumonia volumes, reduced lung volumes, and decreased area and density of PM at three months. No significant differences were observed in the adipose tissue or bone parameters. The severity of pneumonia at admission was independently associated with PM atrophy.

Conclusions

CT-based quantification of pneumonia extent during the acute phase of COVID-19 may be useful in predicting long-term pulmonary sequelae and muscle wasting. This approach may allow the objective evaluation of Long COVID and facilitate the identification of potential therapeutic targets.

背景：广泛肺部受累的胸部计算机断层扫描（CT）表现与长期肺部和肺外冠状病毒病2019 （COVID-19）后遗症之间的关系尚缺乏研究。本研究旨在探讨入院时肺炎严重程度与住院后3个月残留肺及肺外并发症的关系。方法：利用日本COVID-19工作队数据库的数据，对入院时和3个月后获得的164例患者的CT扫描进行定量分析。参数包括肺炎体积、肺总体积、胸肌（PM）面积和密度、皮下和心外膜脂肪组织、椎体骨密度。结果：入院时广泛肺炎患者肺炎残留体积高，肺体积减小，3个月PM面积和密度降低。在脂肪组织和骨骼参数方面没有观察到显著差异。入院时肺炎严重程度与PM萎缩独立相关。结论：基于ct的COVID-19急性期肺炎程度量化可能有助于预测长期肺部后遗症和肌肉萎缩。该方法可实现对Long COVID的客观评价，并有助于确定潜在的治疗靶点。

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引用次数: 0

Differences between influenza and COVID-19 patients who required hospitalization: A study of the 2024–2025 season 需要住院治疗的流感和COVID-19患者之间的差异：2024-2025年季节的研究

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-09-30 DOI: 10.1016/j.resinv.2025.09.012

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

Background

During the winter and spring of 2024–2025, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) XEC subvariant became the main cause of the epidemic, and at the same time, major influenza epidemics were also observed. To clarify the differences between COVID-19 and influenza, we conducted a comparative study of patients who required hospitalization during the same period.

Methods

We compared 193 patients with COVID-19 Omicron XEC subvariant and 98 patients with influenza H1N1 pdm09 who required hospitalization.

Results

The following characteristics were significantly more common in the COVID-19 group than in the influenza group: 1) males, 2) patients with chronic kidney disease, malignant tumors, autoimmune diseases, and patients using immunosuppressants, 3) patients with multiple underlying diseases, 4) healthcare-associated pneumonia, 5) pure viral pneumonia, 6) aspiration pneumonia, 7) cases in which antivirals had not been used since the diagnosis of infection, 8) patients who required invasive mechanical ventilation management or intensive care unit admission, and 9) deaths. On the other hand, the following characteristics were significantly more frequently observed in the influenza group than in the COVID-19 group: 1) patients without underlying diseases, 2) patients who had been vaccinated within the past year, 3) community-acquired pneumonia, and 4) mixed bacterial pneumonia.

Conclusions

There were many differences between the COVID-19 group and the influenza group that required hospitalization. The rates of severe illness and mortality in the elderly remain high in the COVID-19 group.

背景：2024-2025年冬季和春季，SARS-CoV-2 (SARS-CoV-2) XEC亚型成为疫情的主要病原，同时也出现了重大流感流行。为了弄清COVID-19和流感之间的差异，我们对同一时期需要住院治疗的患者进行了比较研究。方法：我们比较了193例COVID-19 Omicron XEC亚变体患者和98例需要住院治疗的H1N1流感pdm09患者。结果：以下特征在COVID-19组中比在流感组中更常见：1)男性，2)慢性肾脏疾病、恶性肿瘤、自身免疫性疾病和使用免疫抑制剂的患者，3)多重基础疾病患者，4)卫生保健相关肺炎，5)纯病毒性肺炎，6)吸入性肺炎，7)诊断感染后未使用抗病毒药物的病例，8)需要有创机械通气管理或入住重症监护病房的患者，9)死亡。另一方面，流感组的以下特征明显高于COVID-19组：1)无基础疾病患者，2)近一年内接种过疫苗的患者，3)社区获得性肺炎，4)混合细菌性肺炎。结论：COVID-19组与需要住院治疗的流感组存在许多差异。在COVID-19组中，老年人的重症发病率和死亡率仍然很高。

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引用次数: 0

Nutritional assessments as predictors of prognosis after long-term oxygen therapy in patients with idiopathic pulmonary fibrosis 营养评估作为特发性肺纤维化患者长期氧疗后预后的预测因素

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-09-27 DOI: 10.1016/j.resinv.2025.09.019

Mayuko Ishiwari, Yuta Kono, Yuki Togashi, Kenichi Kobayashi, Ryota Kikuchi, Mariko Kogami, Shinji Abe

Background

Idiopathic pulmonary fibrosis (IPF), a chronic and progressive interstitial lung disease, frequently leads to chronic respiratory failure, necessitating long-term oxygen therapy (LTOT). Although the prognosis of patients with IPF receiving LTOT is generally poor, limited data are available on clinical factors associated with post-LTOT survival. This study aimed to investigate whether baseline nutritional status at the time of initiation of LTOT is associated with survival outcomes in patients with IPF.

Methods

We retrospectively reviewed 55 patients with IPF and chronic respiratory failure who initiated LTOT. Patients were stratified into two groups based on 1-year survival following LTOT initiation: long-term survivors (≥1 year) and short-term survivors (<1 year). Nutritional status at baseline was assessed using the Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNI), body mass index (BMI), and fat-free mass index (FFMI).

Results

Significant differences were identified between the two groups in BMI, GNRI scores, and the proportion of patients receiving antifibrotic agents. In multivariable analyses adjusted for age, sex and the use of antifibrotic agents, both a GNRI score <92 and a low FFMI were independently associated with increased mortality risk (p = 0.033 and p = 0.007, respectively). Kaplan–Meier analysis demonstrated significantly poorer 1-year survival in patients with GNRI <92 and low FFMI (p = 0.037 and p = 0.006, respectively).

Conclusion

GNRI and FFMI independently predicted 1-year survival in IPF patients on LTOT. These findings underscore the importance of nutritional evaluation at LTOT initiation and suggest that low GNRI and FFMI warrant closer monitoring and targeted nutritional interventions.

背景：特发性肺纤维化（IPF）是一种慢性进行性间质性肺疾病，常导致慢性呼吸衰竭，需要长期氧疗（LTOT）。虽然IPF患者接受LTOT的预后通常较差，但与LTOT后生存相关的临床因素的数据有限。本研究旨在探讨开始LTOT时的基线营养状况是否与IPF患者的生存结果相关。方法回顾性分析55例IPF合并慢性呼吸衰竭患者行LTOT治疗。根据LTOT开始后的1年生存率将患者分为两组：长期幸存者（≥1年）和短期幸存者（<；1年）。采用老年营养风险指数（GNRI）、预后营养指数（PNI）、体重指数（BMI）和无脂体重指数（FFMI）评估基线时的营养状况。结果两组在BMI、GNRI评分和接受抗纤维化药物治疗的患者比例方面存在显著差异。在调整了年龄、性别和抗纤维化药物使用的多变量分析中，GNRI评分为92分和低FFMI均与死亡风险增加独立相关（分别为p = 0.033和p = 0.007）。Kaplan-Meier分析显示，GNRI <；92和FFMI较低的患者1年生存率明显较低（p = 0.037和p = 0.006）。结论nri和FFMI独立预测IPF患者LTOT 1年生存率。这些发现强调了在LTOT开始时营养评估的重要性，并表明低GNRI和FFMI需要更密切的监测和有针对性的营养干预。

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引用次数: 0

The true history of COPD-bronchiectasis overlap syndrome copd -支气管扩张重叠综合征的真实病史

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-09-26 DOI: 10.1016/j.resinv.2025.09.021

Grace Oscullo , Miguel Angel Martinez-Garcia

引用次数: 0

Impact of physical activity on respiratory disease: Current status and therapeutic implications 身体活动对呼吸系统疾病的影响：现状和治疗意义

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-09-25 DOI: 10.1016/j.resinv.2025.09.020

Kazuhisa Asai

Regular physical activity (PA) modulates key pathophysiological mechanisms underlying the onset, progression, and symptoms of major respiratory diseases. Notably, low daily PA and high sedentary time independently predict faster lung function decline, poorer quality of life, and premature mortality in asthma, chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILDs), and post-coronavirus disease lung sequelae. Conversely, structured exercise training—and the increasingly popular, lifestyle-integrated “move-more–sit-less” programs—improve dyspnea, exercise capacity, airway and systemic inflammation, and healthcare utilization. Large cohort analyses corroborate a clear dose-response relationship: attaining ≥7500 steps/day or ≥150 min/week of moderate-to-vigorous activity yields the greatest clinical benefit, even in individuals with impaired pulmonary function. Mechanistic studies also revealed that exercise dampens type-2 airway inflammation in asthma, enhances the skeletal muscle oxidative phenotype in COPD, and counteracts ILD-related deconditioning. Recent randomized trials have shown that pulmonary rehabilitation can improve 5-year survival in fibrotic ILD, while telerehabilitation and gamified smartphone coaching can close access gaps without compromising efficacy. Additionally, major international guidelines such as the Global Initiative for Asthma 2024 and Global Initiative for Chronic Obstructive Lung Disease 2025 now explicitly recognize PA as a “treatable trait.” Nevertheless, PA uptake in routine care remains limited by behavioral, environmental, and policy barriers. Future work must refine personalized PA prescriptions, integrate wearable-derived metrics into decision-support algorithms, and test the synergistic effects with emerging biologics and anti-fibrotic agents. This review synthesizes contemporary evidence, highlights unanswered questions, and offers pragmatic recommendations for clinicians aiming to embed PA promotion in comprehensive respiratory care pathways.

规律的身体活动（PA）调节了主要呼吸系统疾病发生、进展和症状的关键病理生理机制。值得注意的是，低每日PA和高久坐时间独立预测哮喘、慢性阻塞性肺疾病（COPD）、间质性肺疾病（ILDs）和冠状病毒后肺部后遗症的肺功能下降更快、生活质量更差和过早死亡。相反，有组织的运动训练——以及日益流行的、与生活方式相结合的“多动少坐”项目——可以改善呼吸困难、运动能力、气道和全身炎症以及医疗保健利用。大型队列分析证实了明确的剂量-反应关系：达到≥7500步/天或≥150分钟/周的中等至高强度活动产生最大的临床益处，即使对肺功能受损的个体也是如此。机制研究还表明，运动可以抑制哮喘患者的2型气道炎症，增强COPD患者的骨骼肌氧化表型，并抵消ild相关的降糖作用。最近的随机试验表明，肺康复可以提高纤维化ILD患者的5年生存率，而远程康复和游戏化智能手机指导可以在不影响疗效的情况下缩小治疗差距。此外，主要的国际指南，如2024年全球哮喘倡议和2025年全球慢性阻塞性肺疾病倡议，现在明确承认PA是一种“可治疗的特征”。然而，PA在常规护理中的应用仍然受到行为、环境和政策障碍的限制。未来的工作必须完善个性化PA处方，将可穿戴衍生指标整合到决策支持算法中，并测试与新兴生物制剂和抗纤维化药物的协同效应。本综述综合了当代证据，突出了未解决的问题，并为临床医生提供了实用的建议，旨在将PA推广纳入全面的呼吸护理途径。

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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 : 2025-09-25 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

Artificial intelligence for diagnosis in interstitial lung disease and digital ontology for unclassified interstitial lung disease 间质性肺疾病的人工智能诊断与未分类间质性肺疾病的数字本体

IF 2 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2025-09-24 DOI: 10.1016/j.resinv.2025.09.007

Tomohisa Baba , Tsubasa Goto , Yoshiro Kitamura , Tae Iwasawa , Koji Okudela , Tamiko Takemura , Akira Osawa , Takashi Ogura

Background

Multidisciplinary discussion (MDD) is the gold standard for diagnosis in interstitial lung disease (ILD). However, its inter-rater agreement is not satisfactory, and access to the MDD is limited due to a shortage of ILD experts. Therefore, artificial intelligence would be helpful for diagnosing ILD.

Methods

We retrospectively analyzed data from 630 patients with ILD, including clinical information, CT images, and pathological results. The ILD classification into four clinicopathologic entities (i.e., idiopathic pulmonary fibrosis, non-specific interstitial pneumonia, hypersensitivity pneumonitis, connective tissue disease) consists of two stages: first, pneumonia pattern classification of CT images using a convolutional neural network (CNN) model; second, multimodal (clinical, radiological, and pathological) classification using a support vector machine (SVM). The performance of the classification algorithm was evaluated using 5-fold cross-validation.

Results

The mean accuracies of the CNN model and SVM were 62.4 % and 85.4 %, respectively. For multimodal classification using SVM, the overall accuracy was very high, especially with sensitivities for idiopathic pulmonary fibrosis and hypersensitivity pneumonitis exceeding 90 %. When pneumonia patterns from CT images, pathological results, or clinical information were not used, the SVM accuracy was 84.3 %, 70.3 % and 79.8 %, respectively, suggesting that pathological results contributed most to MDD diagnosis. When an unclassifiable interstitial pneumonia was input, the SVM output tended to align with the most likely diagnosis by the expert MDD team.

Conclusions

The algorithm based on multimodal information can assist in diagnosing interstitial lung disease and is suitable for ontology diagnosis. (242 words)

多学科讨论（MDD）是诊断间质性肺疾病（ILD）的金标准。然而，其内部协议并不令人满意，并且由于缺乏ILD专家，对MDD的访问受到限制。因此，人工智能将有助于诊断ILD。方法回顾性分析630例ILD患者的临床资料、CT图像和病理结果。将ILD分为四种临床病理实体（特发性肺纤维化、非特异性间质性肺炎、超敏性肺炎、结缔组织病）分为两个阶段：首先，使用卷积神经网络（CNN）模型对CT图像进行肺炎模式分类；第二，使用支持向量机（SVM）进行多模式（临床、放射和病理）分类。使用5倍交叉验证对分类算法的性能进行评估。结果CNN模型和SVM的平均准确率分别为62.4%和85.4%。对于SVM多模态分类，总体准确率非常高，特别是对特发性肺纤维化和超敏性肺炎的敏感性超过90%。在不使用CT图像、病理结果和临床信息的情况下，SVM的准确率分别为84.3%、70.3%和79.8%，表明病理结果对MDD的诊断贡献最大。当输入无法分类的间质性肺炎时，支持向量机的输出倾向于与MDD专家团队最可能的诊断一致。结论基于多模态信息的诊断算法能够辅助诊断间质性肺疾病，适合本体论诊断。(242字)

{"title":"Artificial intelligence for diagnosis in interstitial lung disease and digital ontology for unclassified interstitial lung disease","authors":"Tomohisa Baba , Tsubasa Goto , Yoshiro Kitamura , Tae Iwasawa , Koji Okudela , Tamiko Takemura , Akira Osawa , Takashi Ogura","doi":"10.1016/j.resinv.2025.09.007","DOIUrl":"10.1016/j.resinv.2025.09.007","url":null,"abstract":"<div><h3>Background</h3><div>Multidisciplinary discussion (MDD) is the gold standard for diagnosis in interstitial lung disease (ILD). However, its inter-rater agreement is not satisfactory, and access to the MDD is limited due to a shortage of ILD experts. Therefore, artificial intelligence would be helpful for diagnosing ILD.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed data from 630 patients with ILD, including clinical information, CT images, and pathological results. The ILD classification into four clinicopathologic entities (i.e., idiopathic pulmonary fibrosis, non-specific interstitial pneumonia, hypersensitivity pneumonitis, connective tissue disease) consists of two stages: first, pneumonia pattern classification of CT images using a convolutional neural network (CNN) model; second, multimodal (clinical, radiological, and pathological) classification using a support vector machine (SVM). The performance of the classification algorithm was evaluated using 5-fold cross-validation.</div></div><div><h3>Results</h3><div>The mean accuracies of the CNN model and SVM were 62.4 % and 85.4 %, respectively. For multimodal classification using SVM, the overall accuracy was very high, especially with sensitivities for idiopathic pulmonary fibrosis and hypersensitivity pneumonitis exceeding 90 %. When pneumonia patterns from CT images, pathological results, or clinical information were not used, the SVM accuracy was 84.3 %, 70.3 % and 79.8 %, respectively, suggesting that pathological results contributed most to MDD diagnosis. When an unclassifiable interstitial pneumonia was input, the SVM output tended to align with the most likely diagnosis by the expert MDD team.</div></div><div><h3>Conclusions</h3><div>The algorithm based on multimodal information can assist in diagnosing interstitial lung disease and is suitable for ontology diagnosis. (242 words)</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 6","pages":"Pages 1179-1186"},"PeriodicalIF":2.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145118670","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}

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