A CASE OF AUTOIMMUNE PULMONARY ALVEOLAR PROTEINOSIS WITH FLUCTUATING LUNG SHADOWS IN PARALLEL WITH CIGARETTE SMOKE BURDEN
A CASE OF AUTOIMMUNE PULMONARY ALVEOLAR PROTEINOSIS WITH FLUCTUATING LUNG SHADOWS IN PARALLEL WITH CIGARETTE SMOKE BURDEN
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DOI：
10.36141/svdld.v34i3.5815
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发表时间：
2017-01-01
影响因子：
1.6
通讯作者：
Kubo, Akihito
中科院分区：
文献类型：
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作者：
Takahashi, Ayumu;Yamaguchi, Etsuro;Kubo, Akihito
肺泡蛋白沉积症(PAP)的发生与吸入粉尘之间的关系已经确定；然而，PAP与吸烟之间的联系尚不清楚。1例46岁男性，轻度支气管哮喘，有52年吸烟史，根据CT影像、肺部病理和血清抗粒细胞巨噬细胞集落刺激因子(GM-CSF)自身抗体水平升高，诊断为自身免疫性PAP(APAP)。戒烟后，他接受了三次单侧全肺灌洗(WLL)。然而，他的呼吸衰竭并没有改善，因为由于支气管痉挛而导致的不完全的WLL，以及在WLL期间呼吸机的顺应性降低。第四次WLL是计划的，但被取消了，因为他的呼吸状况和CT扫描的肺部阴影在WLL之前出人意料地改善了。在不吸烟的随访期内，肺部阴影几乎完全消失。然而，在他恢复吸烟后，异常情况复发，然后在改用焦油含量较低的香烟后略有改善。血清抗GM-CSFIg水平与肺部阴影不相容。这位患者的这些观察表明吸烟和APAP之间存在联系。由于APAP患者的不同吸烟率在流行病学研究中已有报道，因此未来需要进行精确的病例对照研究才能得出明确的结论。
The association between the development of pulmonary alveolar proteinosis (PAP) and dust inhalation has been established; however, the link between PAP and smoking is less clear. A 46-year-old man with mild bronchial asthma and a 52-pack-year smoking history was diagnosed with autoimmune PAP (APAP) based on computed tomography (CT) shadows, pathologic findings of the lung, and a high serum level of antigranulocyte macrophage colony-stimulating factor (GM-CSF) IgG autoantibody. Smoking was stopped and he was treated three times with unilateral whole lung lavage (WLL). However, his respiratory failure did not improve because of incomplete WLL due to bronchospasm and decreased compliance of the ventilated lung during WLL. A fourth WLL was planned, but was cancelled because his respiratory status and lung shadows on CT scan unexpectedly improved immediately before WLL. During the follow-up period without smoking, the lung shadows resolved almost completely. However, the abnormalities relapsed after he resumed smoking and then modestly improved after changing to cigarettes containing less tar. Serum levels of anti-GM-CSF IgG were not compatible with the lung shadows. These observations in this patient suggested a link between smoking and APAP. Since variable smoking rates in patients with APAP have been reported in epidemiologic studies, a definite conclusion requires precise case-control studies in the future.