Chest High-Resolution CT Findings of Microscopic Polyangiitis: A Japanese First Nationwide Prospective Cohort Study
Chest High-Resolution CT Findings of Microscopic Polyangiitis: A Japanese First Nationwide Prospective Cohort Study
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DOI：
10.2214/ajr.18.20967
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发表时间：
2019-07-01
影响因子：
5
通讯作者：
Homma, Sakae
中科院分区：
文献类型：
--
作者：
Suzuki, Aika;Sakamoto, Susumu;Homma, Sakae
OBJECTIVE.肺是显微镜下多血管炎（MPA）可能累及的器官之一，髓过氧化物酶（MPO）抗神经细胞胞浆抗体（ANCA）在MPA患者中较常见。本研究的目的是评估日本MPA患者的肺部病变。这项前瞻性研究基于144例MPA患者，这些患者入组了日本ANCA相关血管炎和快速进展性肾小球肾炎患者缓解诱导治疗研究，并在2011-2014年诊断时接受了胸部高分辨率CT（HRCT）成像。我们回顾了有和没有间质性肺炎（IP）的MPA患者的电子病例报告表，并比较了这些组的临床特征和实验室检查结果。144例患者中有134例（93%）观察到异常HRCT结果。胸部HRCT表现包括毛玻璃样阴影（n = 72; 50%）、网状影（n = 69; 48%）、牵拉性支气管扩张（n = 57; 42%）、蜂窝样改变（n = 44; 31%）和肺气肿（n = 32; 22%）。74例患者（51%）的影像学诊断为IP，其中38%具有通常的IP（UIP）模式。毛玻璃样阴影、网状影、牵拉性支气管扩张、蜂窝样改变和小叶间隔增厚在IP患者中常见（p < 0.05）。具有UIP或可能的UIP模式的MPA患者也有轻微的发现，如支气管壁增厚、实变、蜂窝周围密度增加和牵拉性支气管扩张。IP（51%）在日本MPA患者中最常见，其中38%的患者表现出UIP模式。蜂窝样或牵拉性支气管扩张周围的衰减也增加。
OBJECTIVE. The lung is one of the organs possibly involved in microscopic polyangiitis (MPA), and myeloperoxidase (MPO) antineutrophil cytoplasmic antibody (ANCA) is commonly found in patients with MPA. The aim of this study was to assess pulmonary lesions in Japanese patients with MPA.SUBJECTS AND METHODS. This prospective study was based on 144 patients with MPA who were enrolled in the Remission Induction Therapy in Japanese Patients With ANCA-Associated Vasculitis and Rapidly Progressive Glomerulonephritis Study and who underwent chest high-resolution CT (HRCT) imaging at the time of diagnosis during 2011-2014. We reviewed the electronic case report forms of patients with MPA who did and did not have interstitial pneumonia (IP), and the clinical features and laboratory findings of these groups were compared.RESULTS. Abnormal HRCT findings were noted in 134 of the 144 patients (93%). Chest HRCT findings included ground-glass opacity (n = 72; 50%), reticulation (n = 69; 48%), traction bronchiectasis (n = 57; 42%), honeycombing (n = 44; 31%), and emphysema (n = 32; 22%). IP was diagnosed radiologically in 74 patients (51%), 38% of whom had the usual IP (UIP) pattern. Ground-glass opacity, reticulation, traction bronchiectasis, honeycombing, and interlobular septal thickening were frequent in patients with IP (p < 0.05). Patients with MPA with the UIP or possible UIP pattern also had minor findings, such as bronchial wall thickening, consolidation, increased attenuation around honeycombing, and traction bronchiectasis.CONCLUSION. IP (51%) was most commonly observed in Japanese patients with MPA, and 38% of these patients exhibited a UIP pattern. Increased attenuation around honeycombing or traction bronchiectasis was also found.