Shi Xuhua, Zhang Yongfeng, Lu Yuewu
Department of Rheumatology and Immunology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
J Cardiothorac Surg. 2018 Jan 15;13(1):7. doi: 10.1186/s13019-018-0695-8.
To investigate the risk factors and treatment strategies for pneumothorax secondary to granulomatosis with polyangiitis (GPA).
Retrospective analysis of cases with pneumothorax secondary to GPA from our own practice and published on literature.
A total of 25 patients, 18 males and 7 females, mean age 44 ± 15.7 years, were analyzed. Diagnosis included pneumothorax (11 cases), hydropneumothorax (n = 5), empyema (n = 8) and hemopneumothorax (n = 1). 88% (22/25) patients showed single/multiple pulmonary/ subpleural nodules with/without cavitation on chest imaging. Erythrocyte sedimentation rate and C-reactive protein were both elevated. Corticosteroids and immunosuppressive agents were used in 16 cases. Five cases received steroid pulse therapy, of which 4 patients survived. Pleural drainage was effective in some patients. Seven patients underwent surgical operations. In the 10 fatal cases, infection and respiratory failure were the most common cause. Lung biopsy/ autopsy showed lung/pleural necrotizing granulomatous vasculitis, breaking into the chest cavity, pleural fibrosis, bronchial pleural fistula, etc. The mean age in the death group was greater than the survival group (53 ± 12.9 years vs 40.1 ± 14.7 years, p = 0.05), the ineffective pleural drainage was also higher in the death group (5/5 vs 0/7, p = 0.01).
Pneumothorax was seen in the active GPA, due to a variety of reasons, and gave rise to high fatality rate. Aggressive treatment of GPA can improve the prognosis. Older and lack of response for pleural drainage indicates poor prognosis.
探讨显微镜下多血管炎（GPA）继发气胸的危险因素及治疗策略。
对我院收治的及文献报道的GPA继发气胸病例进行回顾性分析。
共分析25例患者，其中男性18例，女性7例，平均年龄44±15.7岁。诊断包括气胸（11例）、血气胸（n = 5）、脓胸（n = 8）和血气胸（n = 1）。88%（22/25）的患者胸部影像学显示单发/多发肺/胸膜下结节伴/不伴空洞。红细胞沉降率和C反应蛋白均升高。16例患者使用了糖皮质激素和免疫抑制剂。5例患者接受了激素冲击治疗，其中4例存活。部分患者胸腔引流有效。7例患者接受了手术治疗。10例死亡病例中，感染和呼吸衰竭是最常见的原因。肺活检/尸检显示肺/胸膜坏死性肉芽肿性血管炎，破入胸腔、胸膜纤维化、支气管胸膜瘘等。死亡组的平均年龄大于存活组（53±12.9岁 vs 40.1±14.7岁，p = 0.05），死亡组无效胸腔引流的比例也更高（5/5 vs 0/7，p = 0.01）。
GPA活动期可出现气胸，原因多样，病死率高。积极治疗GPA可改善预后。年龄较大及胸腔引流效果不佳提示预后不良。
