Background: Hypersensitivity pneumonitis (HP) is an immune-mediated disorder that causes inflammation of interstitial lung, bronchioles, and alveoli. Although corticosteroids have been used as first line treatment for HP for many years, it does not provide satisfactory results in all patients. The aim of this study is to compare the effect of oral methylprednisolone on different radiological patterns of HP to identify the most adequate candidates for corticosteroids.
Patients and Methods: Fifty-three patients with confirmed diagnosis of HP were divided into two groups according to their radiological patterns based on high resolution computed tomography (HRCT) findings. The first group included 21 patients with fibrotic HP (fHP), the second group included 32 patients without fibrosis; non-fibrotic HP patients (nfHP). The second group is divided into 3 subgroups: mosaic, attenuation, centrilobular nodules and finally, ground-glass opacities. All patients were administered methylprednisolone by dose 0.5mg/kg/day for eight consecutive weeks. HRCT was performed at the beginning of the study. Spirometry, six-minute walk and oximetry were performed periodically to assess the patients’ progress.
Results: Upon finalizing the treatment process, a significant improvement was noticed in FEV1 (p < 0.001), FVC (p < 0.001), six-minute walk test (p =0.001) and oximetry (p < 0.05) in nfHP compared to the fHP patients. However, there was a significant improvement in (p < 0.01), FVC (p < 0.01), oximetry (p < 0.01) and six-minute walk test (p < 0.01) in fibrotic patients after receiving the treatment. There was no significant difference in the response of FEV1 (p =0.82), FVC (p =0.15), six-minute walk test (p =0.36) and oximetry (p =0.27) among the subgroups of nfHP patients.
Conclusion: It was accordingly concluded that corticosteroid treatment is more effective in treatment of nfHP than fHP patients but still has effect on fibrotic patients. There is no significant difference in the response to corticosteroids among nfHP patients’ subgroups.



中文翻译：

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口服甲基泼尼松龙对超敏性肺炎不同影像学表现的影响

背景：过敏性肺炎（HP）是一种免疫介导的疾病，可引起间质性肺，细支气管和肺泡发炎。尽管皮质类固醇已被用作HP的一线治疗已有多年，但它并不能在所有患者中提供令人满意的结果。这项研究的目的是比较口服甲基泼尼松龙对HP放射线不同模式的影响，从而确定最合适的皮质类固醇激素候选药物。
患者和方法：根据高分辨率CT扫描（HRCT）的影像学表现，将53例确诊为HP的患者分为两组。第一组包括21例纤维化HP（fHP）患者，第二组包括32例无纤维化的患者。非纤维化HP患者（nfHP）。第二组分为3个子组：镶嵌，衰减，小叶小结节，最后是磨玻璃混浊。所有患者连续八周以0.5mg / kg /天的剂量服用甲基泼尼松龙。在研究开始时进行了HRCT。定期进行肺活量测定，六分钟步行和血氧定量以评估患者的病情。
结果：在完成治疗过程后，FEV1明显改善（与fHP患者相比，nfHP中的p <0.001），FVC（p <0.001），六分钟步行测试（p = 0.001）和血氧测定法（p <0.05）。然而，接受纤维化治疗的纤维化患者在（p <0.01），FVC（p <0.01），血氧测定法（p <0.01）和六分钟步行测试（p <0.01）方面有显着改善。在nfHP患者亚组中，FEV1（p = 0.82），FVC（p = 0.15），六分钟步行测试（p = 0.36）和血氧测定法（p = 0.27）的反应无显着差异。
结论：因此得出的结论是，皮质类固醇激素治疗对nfHP的治疗比对fHP的患者更有效，但对纤维化患者仍然有效。nfHP患者的亚组对皮质类固醇的反应没有显着差异。