元医生智能体/呼吸/知识库
文献速递肺栓塞

南亚过敏性肺炎暴露问卷（HP-SAQE）的开发与验证

Development and validation of the Hypersensitivity Pneumonitis South Asian Questionnaire for Exposure (HP-SAQE): a novel, qualitative and quantitative tool
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本研究旨在开发和验证一种用于间质性肺病（ILD）患者环境暴露评估的定性与定量工具。通过系统文献检索、两轮德尔菲调查（39名南亚肺病专家）及多中心前瞻性验证，最终形成HP-SAQE问卷。验证结果显示，HP患者与非HP ILD患者的得分存在显著差异，且ROC曲线显示良好诊断效能。

要点

  • HP-SAQE是首个针对ILD患者的定性与定量暴露评估工具。
  • 问卷经39名南亚专家德尔菲共识及多中心队列验证。
  • 验证队列AUC为0.858，区分HP与非HP ILD性能良好。

核心结论

  • HP-SAQE是首个针对ILD患者的定性与定量暴露评估工具，具有良好诊断性能。

研究设计与样本

  • 系统文献检索筛选5170条记录，纳入407项研究，识别24种暴露因素。
  • 两轮德尔菲调查涉及印度、斯里兰卡、巴基斯坦、尼泊尔39名肺病专家。
  • 问卷在印度和斯里兰卡五个中心进行前瞻性验证，以多学科讨论诊断为金标准。

主要发现

  • 德尔菲调查达成专家共识（>70%），最终包含17个定性条目和4个定量条目（6个问题）。
  • 推导队列（n=40）中HP患者得分显著高于非HP（10.2±1.6 vs 6.7±4.2；p=0.001）。
  • 验证队列（n=163）得分差异同样显著（9.4±2.2 vs 4.13±4.28；p<0.001）。
  • ROC分析显示推导队列AUC为0.791，验证队列为0.858，中心间AUC范围0.705-0.967。

关键数值与推荐

  • HP-SAQE得分范围为0至14分。
  • 德尔菲共识阈值为专家同意率>70%。
  • 问卷已翻译为印地语、泰米尔语和僧伽罗语。

临床怎么用

  • 临床上可用于南亚地区ILD患者的环境暴露评估，辅助区分HP与非HP ILD。
  • 建议结合多学科讨论诊断，作为标准化暴露评估的补充工具。

局限性

  • 验证主要在南亚地区进行，可能限制在其他人群的适用性。
  • 研究未报告敏感度、特异度等具体阈值。

以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。

原文

Introduction There is an unmet need for a validated qualitative and quantitative tool to assess environmental exposures in patients with interstitial lung disease (ILD). This study aimed to develop and validate a comprehensive tool to systematically identify exposures in patients with ILD. Methods A systematic literature search was completed to identify exposures associated with more than five documented hypersensitivity pneumonitis (HP) cases. These exposures were evaluated through a two-round Delphi survey involving 39 pulmonologists from India, Sri Lanka, Pakistan and Nepal. The questionnaire was prospectively derived at one centre and validated across five centres in India and Sri Lanka. The HP South Asian Questionnaire for Exposure (HP-SAQE) was validated against the gold standard multidisciplinary discussion diagnosis, distinguishing HP from non-HP ILD. Results The literature search screened 5170 records and included 407 studies, identifying 24 exposures. A 50-item Delphi survey achieved expert consensus (>70%) on 17 qualitative and 4 quantitative items (six questions) by 39 pulmonologists. HP-SAQE score ranged from 0 to 14. After pilot testing, the questionnaire was translated into Hindi, Tamil and Sinhala. In the derivation cohort (n=40), the HP-SAQE score was significantly higher in patients with HP versus non-HP (mean: 10.2&plusmn;1.6 vs 6.7&plusmn;4.2; p=0.001). This finding was validated in a separate cohort (n=163; mean: 9.4&plusmn;2.2 vs 4.13&plusmn;4.28; p<0.001). Receiver operating characteristic curve analysis showed good diagnostic performance (area under the receiver operating characteristic curve, AUC: 0.791 derivation; 0.858 validation, centre-wise AUCs 0.705&ndash;0.967). Conclusion The HP-SAQE is the first qualitative and quantitative exposure assessment tool for patients with ILD that has a good diagnostic performance.

来源：Thorax，查看原文。版权归原作者所有。

引用

  1. Thorax：Development and validation of the Hypersensitivity Pneumonitis South Asian Questionnaire for Exposure (HP-SAQE): a novel, qualitative and quantitative tool
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供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。