Clinical characteristics of patients with anti-aminoacyl-tRNA synthetase antibody positive idiopathic interstitial pneumonia
Clinical characteristics of patients with anti-aminoacyl-tRNA synthetase antibody positive idiopathic interstitial pneumonia
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DOI：
10.1016/j.rmed.2017.10.020
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发表时间：
2017-11-01
影响因子：
4.3
通讯作者：
Mukae, Hiroshi
中科院分区：
文献类型：
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作者：
Yura, Hirokazu;Sakamoto, Noriho;Mukae, Hiroshi
工作背景：抗氨酰-tRNA合成酶（ARS）抗体已在多发性肌炎/皮肌炎（PM/DM）患者中检测到，尤其与间质性肺病（ILD）相关。目的：探讨抗ARS抗体阳性的特发性间质性肺炎（IIP）患者的临床特点。方法：将患者分为3组：1）抗ARS抗体阳性的IIP（ARS（+）IIP）; 2）无抗ARS抗体的IIP（ARS（-）IIP）; 3）抗ARS抗体阳性的PM/DM相关ILD（ARS（+）PM/DMILD）。结果：共纳入18例ARS（+）IIP、284例ARS（-）IIP和20例ARS（+）PM/DM-ILD患者。与ARS（+）PM/DM-ILD组相比，ARS（+）IIP组的年龄明显较大，男性占主导地位，结缔组织病体征的患病率较低，HRCT结果和模式存在差异，KL-6水平较高。支气管肺泡灌洗液（BALF）中的结果显示淋巴细胞增多和较低的CD 4/CD 8比值在两组之间相似。与ARS（-）IIP组相比，ARS（+）IIP组痰液百分比明显降低，机械手患病率明显升高，KL-6水平明显升高，肺功能肺活量百分比明显降低，BALF中CD 4/CD 8比值明显降低。然而，包括HRCT结果和较高KL-6水平在内的一些差异表明，与ARS（+）PM/DM-ILD相比，ARS（+）IIP具有严重的ILD。更多患者的进一步前瞻性研究将阐明抗ARS抗体在IIP中的确切作用。
Background: Anti-aminoacyl-tRNA synthetase (ARS)antibodies have been detected in patients with polymyositis/ dermatomyositis (PM/DM)and are especially correlated with interstitial lung disease (ILD). The aim of this study was to clarify the clinical features of patients with anti-ARS antibody positive idiopathic interstitial pneumonias (IIPs).Methods: Patients were classified into three groups: 1) IIP with anti-ARS antibodies (ARS(+)IIP), 2)IIP without anti-ARS antibodies (ARS(-)IIP), and 3) PM/DM-associated ILD with anti-ARS antibodies (ARS(+)PM/DMILD). Clinical characteristics were compared retrospectively between the ARS(+)IIP group and the ARS(-)IIP group or ARS(+)PM/DM-ILD group.Results: Eighteen ARS(+)IIP, 284 ARS(-)IIP, and 20 ARS(+)PM/DM-ILD patients were enrolled. The ARS(+) IIP group was significantly older and the male sex was predominant, had a lower prevalence of signs of connective tissue disease, differences in HRCT findings and patterns, and higher KL-6 levels compared to the ARS (+)PM/DM-ILD group. The findings in the bronchoalveolar lavage fluid (BALF)showing lymphocytosis and a lower CD4/CD8 ratio were similar between the two groups. However, the ARS(+)IIP group had significantly lower percentage of sputum, higher prevalence of mechanic's hand, higher KL-6 levels, lower percentage of vital capacity in the pulmonary function test, and lower CD4/CD8 ratio in BALF, compared to the ARS(-)IIP group.Conclusions: The present study demonstrated that features of pulmonary involvement were similar to those in the ARS(+)PM/DM-ILD group; however, some differences including HRCT findings and higher KL-6 levels suggest that ARS(+)IIP has severe ILD compared with ARS(+)PM/DM-ILD. Further prospective studies with a larger number of patients will elucidate the exact role of anti-ARS antibodies in IIPs.