Primary Systemic Vasculitides Clinic, Instituto Nacional de Enfermedades Respiratorias, Calzada de Tlalpan 4502, Col. Sección XVI, Tlalpan, Mexico City, Mexico.
Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
Curr Rheumatol Rep. 2017 Sep;19(9):56. doi: 10.1007/s11926-017-0682-4.
The purpose of this study is to describe the most relevant advances concerning lung involvement in the ANCA-associated vasculitides (excluding eosinophilic granulomatosis with polyangiitis which may have different disease mechanisms). Focus is on pathophysiology, recent important imagenological procedures, treatment, and outcome.
Emerging information exists on potential newly investigated diagnostic procedures (v.g. transbronchial cryobiopsies), detailed tomographic abnormalities, the potential favorable role of rituximab and the still uncertain one of plasma exchange in the treatment, and the increasing description of interstitial lung disease. Survival is reduced in case of both, diffuse alveolar hemorrhage and diffuse parenchymal disease. There is the need to expand the knowledge concerning better long-term treatment options with specific regimes, and to incorporate other measures regarding integral treatment in patients afflicted with lung involvement these maladies, as the outcome seems adverse in this scenario.
本研究旨在描述抗中性粒细胞胞浆抗体相关性血管炎(不包括可能具有不同发病机制的嗜酸性肉芽肿性多血管炎)肺部受累的最新进展。重点是发病机制、最近重要的影像学程序、治疗和预后。
关于潜在的新诊断程序(例如经支气管冷冻活检)、详细的断层成像异常、利妥昔单抗的潜在有利作用以及血浆置换在治疗中的作用仍不确定,以及间质性肺疾病的不断描述。弥漫性肺泡出血和弥漫性实质疾病均降低了生存率。需要扩展有关特定方案的更好的长期治疗选择的知识,并在患有肺部受累的患者中纳入其他综合治疗措施,因为在这种情况下,预后似乎不利。