Publication: Hipersensitivite Pnömonisi Tanısı Konmuş Hastalarımızın Retrospektif Olarak İncelenmesi
Abstract
Amaç: Hipersensitivite Pnömonisi (HP) immun aracılı çeşitli antijenlerin inhalasyonuna bağlı olarak ortaya çıkan interstisyel bir akciğer hastalığıdır. HP oldukça karmaşık bir hastalık olup klinik özellikleri ve sonuçları aydınlatılamamıştır. HP birçok interstisyel ve interstisyel olmayan hastalıklarla karışabilmektedir. Dünyada ve ülkemizde HP ile ilgili yeterince çalışma yoktur. Bu çalışmanın amacı; HP tanılı hastaların klinik, radyolojik ve histopatolojik özelliklerini ortaya koymak, neden olan antijenleri belirlemek ve gerekli önlemlerin alınmasını sağlamak, tedavi sonuçlarını ortaya koymak ve HP'nin tanınırlığını arttırmaktır. Gereç ve Yöntem: Tanımlayıcı bu çalışmaya Ocak 2007 ve Ocak 2023 tarihleri arasında Samsun Ondokuz Mayıs Üniversitesi Tıp Fakültesi Hastanesi göğüs hastalıkları polikliniklerine başvuran HP ile takipli hastalar dahil edildi. Klinikleri, görüntülemeleri, histopatolojleri ve tedavileri retrospektif olarak incelenerek güncel rehberlere göre sınıflandırıldı. Hastalar nonfibrotik ve fibrotik olarak ayrılarak SPSS 20.0 yazılımı ile istatiksel analizi yapıldı. Bulgular: Çalışmamıza 217 hasta dahil edildi ve en sık başvuru şikayeti nefes darlığı idi(%90). Çalışmamızdaki hastaların %88'inde neden olan maruziyet tespit edildi ve en sık nedenin 'ahır' olduğu görüldü. Eski sınıflandırmaya göre %14 akut HP, %35 subakut HP ve %51 kronik HP grubunda olan hastalar, yeni rehberlere göre %56 nonfibrotik ve %44 fibrotik olarak sınıflandırıldı. Fibrotik HP hastaların daha yaşlı olmakla birlikte (p<0.001), daha fazla sigara öyküleri (p=0.014) olduğu saptandı. Fizik muayenede çomak parmak (p=0.005) ve oskültasyonda ral (p<0.001) fibrotik HP'de nonfibrotik HP'ye göre daha yaygındı. HP için tipik HRCT bulguları nonfibrotik HP'de daha sık görülmekteydi (p<0,001). Sigara içen hastaların bronkoalveolar lavajlarında lenfositoz daha az tespit edildi (p<0,05). Sedimentasyonun yüksek olması nonfibrotik HP'de daha anlamlı idi (p=0,004). Tedavide kortikosteroid kullanımı semptomların düzelmesini (p=0.00) ve radyolojinin düzelmesi ya da stabil seyretmesini (p=0,006) sağladı. Fibrotik HP'de antifibrotik ilaç kullanımı radyolojik ilerlemeyi engellemede (p=0,016) ve klinik iyileşmede (p=0,022) yardımcı oldu. 5 Sonuç: Bu çalışma ülkemizde ve dünyadaki HP ile ilgili en büyük vaka serilerinden biridir. HP'nin İAH içerisinde ülkemizde de önemli bir yere sahip olduğunu göstermektedir. Diğer ülkelerde yapılan çalışmalardan farklı olarak HP'ye yol açan antijenin kırsal bölgede yaşayanlarda 'ahır', şehirde yaşayanlarda ise 'küflü ev' olduğu tespit edildi. Fibrotik HP, nonfibrotik HP'e göre yüksek oranda olması (%44) ülkemizde HP'nin erken dönemde tanınmadığının göstergesi olduğunu düşünüyoruz. HP'nin önlenebilmesi ve erken dönemde tanı ve tedavi edilebilmesi için hem hekimlerin bu konuda bilinçlendirilmesi hem de kamu otoritesinin HP'ye yol açan bu nedenler (ahır ve küflü ortamda yaşamak) hakkında halkı bilinçlendirilerek gerekli önemlerin alınmasının önemli olduğunu düşünüyoruz. Anahtar Kelimeler: Hipersensitivite Pnömonisi; interstisyel akciğer hastalığı; nonfibrotik; fibrotik
Objective: Hypersensitivity Pneumonitis (HP) is an interstitial lung disease caused by immune-mediated inhalation of various antigens. HP is a highly complex disease and its clinical features and outcomes have not been elucidated. HP can be confused with many interstitial and non-interstitial diseases. There are not enough studies on HP in the world and in our country. The aim of this study was to reveal the clinical, radiologic and histopathologic features of patients diagnosed with HP, to determine the causative antigens and to ensure that necessary precautions are taken, to reveal the treatment results and to increase the recognition of HP. Materials and Methods: This descriptive study included patients with HP who presented to the chest diseases outpatient clinics of Samsun Ondokuz Mayıs University Medical Faculty Hospital between January 2007 and January 2023. Their clinics, imaging, histopathology and treatment were retrospectively analyzed and classified according to current guidelines. Patients were divided into nonfibrotic and fibrotic and statistical analysis was performed with SPSS 20.0 software. Results: 217 patients were included in our study and the most common presenting complaint was dyspnea (90%). Causal exposure was identified in 88% of the patients in our study and the most common cause was 'barn'. According to the old classification, 14% of the patients were classified as acute HP, 35% as subacute HP and 51% as chronic HP. According to the new guidelines, 56% were classified as nonfibrotic and 44% as fibrotic. Fibrotic HP patients were older (p<0.001) and had more smoking history (p=0.014). On physical examination, clubbing (p=0.005) and auscultatory rales (p<0.001) were more common in fibrotic HP than in nonfibrotic HP. HRCT findings typical for HP were more common in nonfibrotic HP (p<0.001). Lymphocytosis was less common in bronchoalveolar lavage of smokers (p<0.05). Elevated sedimentation was more significant in nonfibrotic HP (p=0.004). Corticosteroid treatment resulted in improvement of symptoms (p=0.00) and improvement or stability of radiology (p=0.006). In fibrotic HP, the use of antifibrotic drugs helped to prevent radiologic progression (p=0.016) and clinical improvement (p=0.022). 7 Conclusion: This study is one of the largest case series on HP in our country and in the world. It shows that HP has an important place in ILD in our country. Unlike the studies conducted in other countries, the antigen causing HP was found to be 'barn' in rural areas and 'moldy house' in urban areas. We think that the high rate of fibrotic HP compared to nonfibrotic HP (44%) is an indication that HP is not recognized at an early stage in our country. In order to prevent HP and to diagnose and treat it at an early stage, we think that it is important for both physicians to raise awareness of this issue and the public authority to take the necessary measures by raising public awareness about these causes of HP (living in a barn and moldy environment). Keywords: Hypersensitivity Pneumonitis; interstitial lung disease; nonfibrotic; fibrotic
Objective: Hypersensitivity Pneumonitis (HP) is an interstitial lung disease caused by immune-mediated inhalation of various antigens. HP is a highly complex disease and its clinical features and outcomes have not been elucidated. HP can be confused with many interstitial and non-interstitial diseases. There are not enough studies on HP in the world and in our country. The aim of this study was to reveal the clinical, radiologic and histopathologic features of patients diagnosed with HP, to determine the causative antigens and to ensure that necessary precautions are taken, to reveal the treatment results and to increase the recognition of HP. Materials and Methods: This descriptive study included patients with HP who presented to the chest diseases outpatient clinics of Samsun Ondokuz Mayıs University Medical Faculty Hospital between January 2007 and January 2023. Their clinics, imaging, histopathology and treatment were retrospectively analyzed and classified according to current guidelines. Patients were divided into nonfibrotic and fibrotic and statistical analysis was performed with SPSS 20.0 software. Results: 217 patients were included in our study and the most common presenting complaint was dyspnea (90%). Causal exposure was identified in 88% of the patients in our study and the most common cause was 'barn'. According to the old classification, 14% of the patients were classified as acute HP, 35% as subacute HP and 51% as chronic HP. According to the new guidelines, 56% were classified as nonfibrotic and 44% as fibrotic. Fibrotic HP patients were older (p<0.001) and had more smoking history (p=0.014). On physical examination, clubbing (p=0.005) and auscultatory rales (p<0.001) were more common in fibrotic HP than in nonfibrotic HP. HRCT findings typical for HP were more common in nonfibrotic HP (p<0.001). Lymphocytosis was less common in bronchoalveolar lavage of smokers (p<0.05). Elevated sedimentation was more significant in nonfibrotic HP (p=0.004). Corticosteroid treatment resulted in improvement of symptoms (p=0.00) and improvement or stability of radiology (p=0.006). In fibrotic HP, the use of antifibrotic drugs helped to prevent radiologic progression (p=0.016) and clinical improvement (p=0.022). 7 Conclusion: This study is one of the largest case series on HP in our country and in the world. It shows that HP has an important place in ILD in our country. Unlike the studies conducted in other countries, the antigen causing HP was found to be 'barn' in rural areas and 'moldy house' in urban areas. We think that the high rate of fibrotic HP compared to nonfibrotic HP (44%) is an indication that HP is not recognized at an early stage in our country. In order to prevent HP and to diagnose and treat it at an early stage, we think that it is important for both physicians to raise awareness of this issue and the public authority to take the necessary measures by raising public awareness about these causes of HP (living in a barn and moldy environment). Keywords: Hypersensitivity Pneumonitis; interstitial lung disease; nonfibrotic; fibrotic
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