Comparative Study of High-Resolution CT Findings Between Autoimmune and Secondary Pulmonary Alveolar Proteinosis
Comparative Study of High-Resolution CT Findings Between Autoimmune and Secondary Pulmonary Alveolar Proteinosis
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DOI：
10.1378/chest.09-0097
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发表时间：
2009-11-01
期刊：
影响因子：
9.6
通讯作者：
Nakata, Koh
中科院分区：
文献类型：
--
作者：
Ishii, Haruyuki;Trapnell, Bruce C.;Nakata, Koh
背景：获得性肺泡蛋白沉积症(PAP)根据血清粒细胞-巨噬细胞集落刺激因子自身抗体的出现情况分为自身免疫性PAP或继发性PAP。大多数患者接受高分辨率CT(HRCT)扫描，以便医生对弥漫性肺疾病作出鉴别诊断，但尚无资料可区分继发性PAP和自身免疫性PAP的HRCT扫描特征。方法：对42例自身免疫性PAP和继发性PAP患者(自身免疫性PAP组和继发性PAP组各21例)的HRCT表现进行集中、盲法评价。结果：自身免疫性PAP组和继发性PAP组均以磨玻璃样阴影(GGO)为主。在继发性PAP组中，GGO典型地表现为弥漫性模式(62%)，而在自身免疫性PAP组中，GGO表现为斑片状的地理模式(71%；p<；0.005)。在自身免疫性PAP组中，所谓的“疯狂铺路”和胸膜下疏松现象最常见(均为71%)，而在继发性PAP组中较少见(分别为14%和33%)。继发性PAP组GGO受累面积均匀分布于颅尾部，而自身免疫性PAP组受累区域以下肺野占优势(p<；0.05)。结论：自身免疫性PAP患者GGO的典型HRCT表现为GGO呈斑片状、胸膜下少见、铺路不清、下肺野占优势。这些发现在继发性PAP患者中相当罕见。(《胸部》2009；136：1348-135-5)
Background: Acquired pulmonary alveolar proteinosis (PAP) has been reclassified into autoimmune or secondary PAP according to the occurrence of serum granulocyte macrophage colony-stimulating factor autoantibody. Most patients undergo high-resolution CT (HRCT) scanning in order for physicians to make a differential diagnosis of diffuse lung diseases, but no information is available to distinguish the HRCT scan features of secondary PAP from those of autoimmune PAP. The objective of this study was to characterize the HRCT scan features of autoimmune and secondary PAP.Methods: HRCT scans of 42 patients (21 patients each in the autoimmune PAP and secondary PAP groups) were centrally collected and evaluated in a blinded manner.Results: Ground-glass opacities (GGO) were a major finding in both the autoimmune PAP and secondary PAP groups. In the secondary PAP group, GGOs typically showed a diffuse pattern (62%), whereas GGOs showed a patchy geographic pattern in the autoimmune PAP group (71%; p < 0.005). The so-called "crazy-paving" appearance and subpleural sparing were frequently seen in the autoimmune PAP group (both 71%), whereas they were less frequently seen in the secondary PAP group (14% and 33%, respectively). The involved area of GGO was even in craniocaudal distribution for the secondary PAP group, whereas it was predominant in the lower lung field compared with the upper lung field in the autoimmune PAP group (p < 0.05).Conclusions: Typical HRCT scan findings for autoimmune PAP patients were GGO with a patchy geographic pattern, subpleural sparing, crazy-paving appearance, and predominance in the lower lung field. These findings were rather infrequent for secondary PAP patients. (CHEST 2009; 136:1348-135-5)