Ho Huei-Huang, Lin Meng-Chih, Yu Kuang-Hui, Wang Chin-Man, Wu Yeong-Jian Jan, Chen Ji-Yih
Department of Medicine, Division of Allergy, Immunology and Rheumatology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 5, Fu-Shin St. Kuei-Shan, Tao-Yuan, Taiwan, Republic of China.
J Rheumatol. 2009 Feb;36(2):355-60. doi: 10.3899/jrheum.080569. Epub 2009 Jan 22.
We investigated the etiological association and clinical characteristics of apical pulmonary fibrosis in ankylosing spondylitis (AS).
We reviewed medical records of 2136 consecutive patients diagnosed with AS at a tertiary medical center. Clinical and radiographic characteristics were analyzed for evidence of apical lung fibrosis on chest radiographs.
Of 2136 patients with AS, 63 (2.9%) developed apical lung fibrosis, of which chronic infections were the cause in 41 and AS inflammation predisposed the fibrosis in 22 patients. Tuberculosis (TB) infection was considered to be the cause of apical lung fibrosis in 40 patients (63.5%) including 19 with bacteriologically-proven TB and 21 with chest radiographs suggestive of TB. Two were identified as having non-TB mycobacterial infection and one as Aspergillus infection. Lung cavity lesion appeared to be a crucial differentiator (p = 0.009, odds ratio 7.4, 95% CI 1.5-36.0) between TB infection and AS inflammation-induced apical fibrosis.
Our study suggests that TB, instead of Aspergillus, is the most common pulmonary infection in patients with AS presenting with apical lung fibrosis. AS-associated apical lung fibrosis may mimic pulmonary TB infection. Thus, bacteriological survey and serial radiological followup of lung fibrocavitary lesions are critical for accurate diagnosis and treatment.
我们研究了强直性脊柱炎（AS）患者肺尖纤维化的病因及临床特征。
我们回顾了一家三级医疗中心连续诊断为AS的2136例患者的病历。分析临床和影像学特征，以寻找胸部X线片上肺尖纤维化的证据。
在2136例AS患者中，63例（2.9%）发生了肺尖纤维化，其中41例病因是慢性感染，22例是AS炎症导致纤维化。40例（63.5%）患者的肺尖纤维化被认为是由结核（TB）感染引起，其中19例经细菌学证实为TB，21例胸部X线片提示为TB。2例被确定为非结核分枝杆菌感染，1例为曲霉菌感染。肺空洞病变似乎是TB感染与AS炎症诱导的肺尖纤维化之间的关键鉴别点（p = 0.009，比值比7.4，95%可信区间1.5 - 36.0）。
我们的研究表明，在出现肺尖纤维化的AS患者中，TB而非曲霉菌是最常见的肺部感染。AS相关的肺尖纤维化可能类似肺结核感染。因此，对肺纤维空洞性病变进行细菌学检查和系列影像学随访对于准确诊断和治疗至关重要。
