anca阳性特发性间质性肺炎不同亚型影像学和病理表现的差异

IF 2.3 4区医学 Q3 RESPIRATORY SYSTEM

Clinical Respiratory Journal Pub Date : 2025-03-12 DOI:10.1111/crj.70061

Tetsuro Sawata, Susumu Sakamoto, Yusuke Usui, Aika Suzuki, Hideya Kitamura, Tae Iwasawa, Shoichiro Matsushita, Yasuhiro Terasaki, Shinobu Kunugi, Kazuma Kishi, Tomoyuki Fujisawa, Takafumi Suda, Sakae Homma

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引用次数: 0

摘要

抗中性粒细胞胞浆抗体（Anti-neutrophil cytoplasmic antibody， ANCA）血清阳性与ANCA相关性血管炎密切相关。无系统性血管炎的特发性间质性肺炎（IIPs）患者有时是anca阳性。髓过氧化物酶(MPO)- anca阳性和蛋白酶3 (PR3)- anca阳性IIPs患者的放射学和病理学差异尚不清楚。确定国家数据库中ANCA阳性IIP患者的高分辨率计算机断层扫描（HRCT）特征和病理表现是否因ANCA亚型而异。临床、放射学和病理数据与基于网络的多学科讨论一起进行了检查。方法回顾2009年4月至2014年3月期间，10例mpo - anca阳性和9例pr3 - anca阳性IIP患者行HRCT和手术肺活检的记录。肺科医生、胸部放射科医生和病理学家独立评估HRCT扫描和病理结果。根据ATS/ERS/JRS/ALAT 2011特发性肺纤维化指南进行分类。结果HRCT表现明确为常规间质性肺炎（UIP） (n = 8；42.1%)，可能的UIP (n = 6；31.6%)，与UIP不一致(n = 5；26.3%)。病理模式明确UIP (n = 5；26.3%)，可能的UIP (n = 8；42.1%)，可能的UIP (n = 4；21.1%)，而非UIP (n = 2；10.5%)。mpo - anca阳性和pr3 - anca阳性IIPs的HRCT和病理模式无差异。影像学表现为网状(n = 13；68.4%)，结节(n = 12；63.1%)，蜂窝式(n = 10；52.6%)，蜂窝周围衰减增大(n = 7；36.8%)。病理表现为囊肿(n = 12；63.1%)，有生发中心的淋巴样卵泡(n = 11；57.9%)，细支气管周围壁淋巴细胞浸润(n = 11；57.9%)。结论mpo - anca阳性与pr3 - anca阳性IIPs的HRCT及病理表现无明显差异。这两种类型间质性肺炎的发病机制相似。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Differences in Radiological and Pathological Findings by ANCA-Subtype in ANCA-Positive Idiopathic Interstitial Pneumonias

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Differences in Radiological and Pathological Findings by ANCA-Subtype in ANCA-Positive Idiopathic Interstitial Pneumonias

Introduction

Anti-neutrophil cytoplasmic antibody (ANCA) seropositivity strongly correlates to ANCA-associated vasculitis. Patients with idiopathic interstitial pneumonias (IIPs) without systemic vasculitis are sometimes ANCA-positive. Radiological and pathological differences between patients with myeloperoxidase (MPO)-ANCA-positive and those with proteinase 3 (PR3)-ANCA-positive IIPs remain unclear. To determine whether high-resolution computed tomography (HRCT) features and pathology findings differ by ANCA subtype in ANCA-positive IIP patients in a national database. Clinical, radiological, and pathological data were examined along with a web-based multidisciplinary discussion.

Methods

We reviewed records of 10 MPO-ANCA-positive and 9 PR3-ANCA-positive IIP patients who underwent HRCT and surgical lung biopsy between April 2009 and March 2014. Pulmonologists, chest radiologists, and pathologists evaluated HRCT scans and pathological findings independently. Patterns were classified using ATS/ERS/JRS/ALAT 2011 guidelines for idiopathic pulmonary fibrosis.

Results

HRCT patterns were definite usual interstitial pneumonia (UIP) (n = 8; 42.1%), possible UIP (n = 6; 31.6%), and inconsistent with UIP (n = 5; 26.3%). Pathological patterns were definite UIP (n = 5; 26.3%), probable UIP (n = 8; 42.1%), possible UIP (n = 4; 21.1%), and not UIP (n = 2; 10.5%). HRCT and pathological patterns did not differ between MPO-ANCA-positive and PR3-ANCA-positive IIPs. Radiological features were reticulation (n = 13; 68.4%), nodules (n = 12; 63.1%), honeycombing (n = 10; 52.6%), and increased attenuation around honeycombing (n = 7; 36.8%). Pathological findings were cysts (n = 12; 63.1%), lymphoid follicles with germinal centers (n = 11; 57.9%), and peribronchiolar wall lymphocytic infiltration (n = 11; 57.9%).

Conclusion

HRCT and pathological patterns did not differ between MPO-ANCA-positive and PR3-ANCA-positive IIPs. This absence of significant differences suggests a similar mechanism underlying both types of interstitial pneumonia.

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来源期刊

Clinical Respiratory Journal 医学-呼吸系统

CiteScore

3.70

自引率

0.00%

发文量

104

审稿时长

>12 weeks

期刊介绍： Overview Effective with the 2016 volume, this journal will be published in an online-only format. Aims and Scope The Clinical Respiratory Journal (CRJ) provides a forum for clinical research in all areas of respiratory medicine from clinical lung disease to basic research relevant to the clinic. We publish original research, review articles, case studies, editorials and book reviews in all areas of clinical lung disease including: Asthma Allergy COPD Non-invasive ventilation Sleep related breathing disorders Interstitial lung diseases Lung cancer Clinical genetics Rhinitis Airway and lung infection Epidemiology Pediatrics CRJ provides a fast-track service for selected Phase II and Phase III trial studies. Keywords Clinical Respiratory Journal, respiratory, pulmonary, medicine, clinical, lung disease, Abstracting and Indexing Information Academic Search (EBSCO Publishing) Academic Search Alumni Edition (EBSCO Publishing) Embase (Elsevier) Health & Medical Collection (ProQuest) Health Research Premium Collection (ProQuest) HEED: Health Economic Evaluations Database (Wiley-Blackwell) Hospital Premium Collection (ProQuest) Journal Citation Reports/Science Edition (Clarivate Analytics) MEDLINE/PubMed (NLM) ProQuest Central (ProQuest) Science Citation Index Expanded (Clarivate Analytics) SCOPUS (Elsevier)