Incidence of myeloperoxidase anti-neutrophil cytoplasmic antibody positivity and microscopic polyangitis in the course of idiopathic pulmonary fibrosis
Incidence of myeloperoxidase anti-neutrophil cytoplasmic antibody positivity and microscopic polyangitis in the course of idiopathic pulmonary fibrosis
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DOI：
10.1016/j.rmed.2013.01.006
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发表时间：
2013-04-01
影响因子：
4.3
通讯作者：
Kumamoto, Toshihide
中科院分区：
文献类型：
--
作者：
Ando, Masaru;Miyazaki, Eishi;Kumamoto, Toshihide
背景：肺纤维化是显微镜下多血管炎（MPA）的一种表现，并且通常先于 MPA 的检测。最初诊断为特发性肺纤维化 (IPF) 的患者中髓过氧化物酶抗中性粒细胞胞浆抗体 (MPO-ANCA) 和 MPA 的患病率和序列尚未明确阐明。方法：我们连续招募了 61 名 IPF 患者，并测量了初次就诊时和随访期间的 MPO-ANCA 滴度。检查了 MPO-ANCA 阳性病例的临床、放射学和组织学特征。结果：61 例患者中，3 例 (4.9%) 在 IPF 初次出现时 MPO-ANCA 滴度呈阳性。病程中有6例患者出现MPO-ANCA阳性转化，ANCA患病率增至14.8%。在 MPO-ANCA 阳性的 9 名患者中，有 2 名患者在随访期间出现 MPA。 MPO-ANCA 阳性肺纤维化的组织学特征与常见的间质性肺炎模式一致，其中未观察到肺泡出血和毛细血管炎。与 MPO-ANCA 阴性 IPF 患者相比，MPO-ANCA 阳性转化患者的支气管肺泡灌洗液嗜酸性粒细胞百分比增加，肺气肿并发症更常见。结论：本研究的结果表明，初次诊断为 IPF 的患者偶尔会出现 MPO-ANCA，并在 IPF 病程中发展为 MPA。计算机断层扫描中肺嗜酸性粒细胞增多和低衰减区域的存在可能预示着 MPO-ANCA 阳性转化。 (c) 2013 Elsevier Ltd. 保留所有权利。
Background: Pulmonary fibrosis is a manifestation of microscopic polyangitis (MPA), and often precedes the detection of MPA. The prevalence and sequence of myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) and MPA in patients initially diagnosed with idiopathic pulmonary fibrosis (IPF) have not been precisely elucidated.Methods: We enrolled 61 consecutive patients with IPF and measured the MPO-ANCA titers at initial presentation and during the follow-up period. Clinical, radiologic and histologic features of MPO-ANCA-positive cases were examined.Results: Of 61 patients, 3 (4.9%) had positive MPO-ANCA titers at the initial presentation of IPF. During the disease course, MPO-ANCA-positive conversion occurred in 6 patients and the prevalence of ANCA increased to 14.8%. Among the nine patients positive for MPO-ANCA, two patients developed MPA during follow-up. Histologic features of MPO-ANCA-positive pulmonary fibrosis were compatible with the usual interstitial pneumonia pattern in which alveolar hemorrhage and capillaritis were not observed. The patients with MPO-ANCA-positive conversion showed increased percentages of bronchoalveolar lavage eosinophils and more frequent complication of pulmonary emphysema compared to those with MPO-ANCA-negative IPF.Conclusions: The findings of the present study demonstrated that patients with an initial diagnosis of IPF occasionally acquire MPO-ANCA, which develops to MPA during the disease course of IPF. The presence of pulmonary eosinophilia and low attenuation areas on computed tomography scans might be predictive of MPO-ANCA positive conversion. (c) 2013 Elsevier Ltd. All rights reserved.