Suzuki Aika, Sakamoto Susumu, Kurosaki Atsuko, Kurihara Yasuyuki, Satoh Keita, Usui Yusuke, Nanki Toshihiro, Arimura Yoshihiro, Makino Hirofumi, Okada Yasunori, Harigai Masayoshi, Yamagata Kunihiro, Sugiyama Hitoshi, Dobashi Hiroaki, Ishizu Akihiro, Tsuboi Naotake, Usui Joichi, Sada Ken-Ei, Homma Sakae
Department of Respiratory Medicine, Toho University Omori Medical Center, Ota-ku Omori nisi 6-11-1, Tokyo 143-8541, Japan.
Department of Diagnostic Radiology, Fukujuji Hospital, Tokyo, Japan.
AJR Am J Roentgenol. 2019 Jul;213(1):104-114. doi: 10.2214/AJR.18.20967. Epub 2019 Apr 11.
The lung is one of the organs possibly involved in microscopic polyangiitis (MPA), and myeloperoxidase (MPO) antineutrophil cytoplasmic antibody (ANCA) is commonly found in patients with MPA. The aim of this study was to assess pulmonary lesions in Japanese patients with MPA. This prospective study was based on 144 patients with MPA who were enrolled in the Remission Induction Therapy in Japanese Patients With ANCA-Associated Vasculitis and Rapidly Progressive Glomerulonephritis Study and who underwent chest high-resolution CT (HRCT) imaging at the time of diagnosis during 2011-2014. We reviewed the electronic case report forms of patients with MPA who did and did not have interstitial pneumonia (IP), and the clinical features and laboratory findings of these groups were compared. Abnormal HRCT findings were noted in 134 of the 144 patients (93%). Chest HRCT findings included ground-glass opacity ( = 72; 50%), reticulation ( = 69; 48%), traction bronchiectasis ( = 57; 42%), honeycombing ( = 44; 31%), and emphysema ( = 32; 22%). IP was diagnosed radiologically in 74 patients (51%), 38% of whom had the usual IP (UIP) pattern. Ground-glass opacity, reticulation, traction bronchiectasis, honeycombing, and interlobular septal thickening were frequent in patients with IP ( < 0.05). Patients with MPA with the UIP or possible UIP pattern also had minor findings, such as bronchial wall thickening, consolidation, increased attenuation around honeycombing, and traction bronchiectasis. IP (51%) was most commonly observed in Japanese patients with MPA, and 38% of these patients exhibited a UIP pattern. Increased attenuation around honeycombing or traction bronchiectasis was also found.
肺是可能参与显微镜下多血管炎（MPA）的器官之一，髓过氧化物酶（MPO）抗中性粒细胞胞浆抗体（ANCA）常见于MPA患者。本研究的目的是评估日本MPA患者的肺部病变。这项前瞻性研究基于144例MPA患者，这些患者参加了日本ANCA相关血管炎和快速进展性肾小球肾炎患者缓解诱导治疗研究，并在2011 - 2014年诊断时接受了胸部高分辨率CT（HRCT）成像。我们回顾了有和没有间质性肺炎（IP）的MPA患者的电子病例报告表，并比较了这些组的临床特征和实验室检查结果。144例患者中有134例（93%）HRCT检查结果异常。胸部HRCT表现包括磨玻璃影（n = 72；50%）、网状影（n = 69；48%）、牵拉性支气管扩张（n = 57；42%）、蜂窝状改变（n = 44；31%）和肺气肿（n = 32；22%）。74例患者（51%）经影像学诊断为IP，其中38%具有普通型IP（UIP）模式。磨玻璃影、网状影、牵拉性支气管扩张、蜂窝状改变和小叶间隔增厚在IP患者中很常见（P < 0.05）。具有UIP或可能的UIP模式的MPA患者也有一些轻微表现，如支气管壁增厚、实变、蜂窝状改变周围密度增加和牵拉性支气管扩张。IP（51%）在日本MPA患者中最常见，其中38%的患者表现为UIP模式。还发现了蜂窝状改变周围密度增加或牵拉性支气管扩张。
