Saraya Takeshi, Ogawa Yukari, Nakamoto Keitaro, Fujiwara Masachika, Ishii Haruyuki
Respiratory Medicine, Kyorin University School of Medicine, Mitaka, JPN.
Pathology, Kyorin University School of Medicine, Mitaka, JPN.
Cureus. 2022 Jan 16;14(1):e21285. doi: 10.7759/cureus.21285. eCollection 2022 Jan.
Background and objective Pulmonary involvement is seen in up to 30% of microscopic polyangiitis (MPA) patients. Pulmonary radiological findings for MPA have been scarcely reported to date. This study was conducted to evaluate computed tomography (CT) and clinical findings at the time of MPA diagnosis as predictors for systemic or lung recurrence. Methods We retrospectively reviewed the medical records and radiological data of 55 MPA patients with pulmonary involvement who were admitted to our hospital between April 2008 and December 2016. Results Aside from pulmonary lesions, lesions were found in the kidneys (52.7%), skin (7.3 %), and peripheral nerves (3.6%). Biopsies were performed for 29.1% of the patients, with an overall diagnostic accuracy of 78.9%. Parenchymal opacities (74.5%, mainly ground-glass opacities and reticular shadowing) were more commonly seen than airway abnormalities were (40.0%, mainly bronchiectasis). Systemic recurrence in the first year after diagnosis was found in 10.9% of the patients, and it mainly involved the kidneys or lungs. A serum WBC count ≥ 10,900/μL was a risk factor for predicting systemic recurrence within the first year after diagnosis according to the Cox regression analysis (HR 11.1, 95%CI: 1.3-95.9, p=0.028). Lung recurrence within five years after the diagnosis was observed in 9.1% of the patients. The incidences of reticular shadowing and honeycombing in thoracic CT at diagnosis were significantly higher in recurrence-positive patients than in recurrence-negative patients, but these differences could not be used to predict lung recurrence. Conclusions Ground glass opacities, reticular shadowing, and bronchiectasis are prominent thoracic CT findings for MPA. There are no radiological patterns capable of predicting recurrence. However, a serum WBC count ≥ 10,900/μL at diagnosis might be a predictive factor for systemic recurrence within the year.
在高达30%的显微镜下多血管炎（MPA）患者中可见肺部受累。迄今为止，MPA的肺部放射学表现鲜有报道。本研究旨在评估MPA诊断时的计算机断层扫描（CT）及临床 findings，作为全身或肺部复发的预测指标。方法：我们回顾性分析了2008年4月至2016年12月期间我院收治的55例有肺部受累的MPA患者的病历和放射学数据。结果：除肺部病变外，还在肾脏（52.7%）、皮肤（7.3%）和周围神经（3.6%）发现病变。29.1%的患者进行了活检，总体诊断准确率为78.9%。实质密度增高影（74.5%，主要为磨玻璃影和网状阴影）比气道异常（40.0%，主要为支气管扩张）更常见。诊断后第一年有10.9%的患者出现全身复发，主要累及肾脏或肺部。根据Cox回归分析，血清白细胞计数≥10,900/μL是诊断后第一年内预测全身复发的危险因素（HR 11.1，95%CI：1.3 - 95.9，p = 0.028）。诊断后五年内9.1%的患者出现肺部复发。复发阳性患者诊断时胸部CT上网状阴影和蜂窝状改变的发生率显著高于复发阴性患者，但这些差异不能用于预测肺部复发。结论：磨玻璃影、网状阴影和支气管扩张是MPA突出的胸部CT表现。没有能够预测复发的放射学模式。然而，诊断时血清白细胞计数≥10,900/μL可能是一年内全身复发的预测因素。 （注：原文中“clinical findings”未翻译完整，推测是遗漏了部分内容，但按照要求未添加其他解释或说明）
