Villeneuve Thomas, Prévot Grégoire, Pugnet Grégory, Plat Gavin, Héluain Valentin, Faguer Stanislas, Guibert Nicolas
Pulmonology Department, University Hospital Center (CHU) of Toulouse, Toulouse, France.
Internal Medicine Department, University Hospital Center (CHU) of Toulouse, Toulouse, France.
ERJ Open Res. 2023 Sep 11;9(5). doi: 10.1183/23120541.00141-2023. eCollection 2023 Sep.
This study describes data from bronchoscopy performed at the diagnosis of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).
We conducted a retrospective study between 2004 and 2019 in patients aged >18 years with a diagnosis of microscopic polyangiitis (MPA) or granulomatosis with polyangiitis (GPA) who underwent bronchoscopy at onset of the disease. We collected bronchoalveolar lavage (BAL) and histological findings obtained during bronchoscopy.
274 patients with AAV were identified. Among 92 bronchoscopies, 62 were performed at diagnosis, and 58 procedures were finally analysed. Cough was more frequent in patients with MPA than GPA (p=0.02). The presence of endobronchial lesions (24.1%) was found to be significantly associated with GPA (p<0.0001) and proteinase 3-ANCA (p=0.01). The most frequent endobronchial lesions were inflammation and hyperaemia of the bronchial mucosa (50%), followed by stenoses (28%), ulcerations (21%) and mass-like granulomatosis (7%). The diagnostic yield of bronchial biopsies was useful for visible lesions (66.6% 0%; p=0.006). On BAL, diffuse alveolar haemorrhage (DAH) was detected in 31 (53.4%) patients and was more frequent in MPA patients (70.4% 38.7%; p=0.016). In 16.1% of DAH cases, BAL confirmed the diagnosis despite the absence of clinical or biological arguments. The incidence of microbial infections on BAL (38%) was similar between MPA and GPA (p=0.54).
Bronchoscopy is an informative procedure at the onset of AAV disease in patients with respiratory manifestations. Endobronchial lesions are more frequently found in GPA and should be biopsied. BAL can be used to confirm DAH or diagnose superadded infection.
本研究描述了在抗中性粒细胞胞浆抗体（ANCA）相关性血管炎（AAV）诊断时进行支气管镜检查所获得的数据。
我们在2004年至2019年间对年龄大于18岁、诊断为显微镜下多血管炎（MPA）或肉芽肿性多血管炎（GPA）且在疾病发作时接受支气管镜检查的患者进行了一项回顾性研究。我们收集了支气管镜检查期间获得的支气管肺泡灌洗（BAL）和组织学检查结果。
共识别出274例AAV患者。在92例支气管镜检查中，62例在诊断时进行，最终分析了58例检查。MPA患者咳嗽比GPA患者更常见（p=0.02）。发现支气管内病变的存在（24.1%）与GPA（p<0.0001）和蛋白酶3-ANCA（p=0.01）显著相关。最常见的支气管内病变是支气管黏膜炎症和充血（50%），其次是狭窄（28%）、溃疡（21%）和肿块样肉芽肿（7%）。支气管活检的诊断率对可见病变有用（66.6%对0%；p=0.006）。在BAL检查中，31例（53.4%）患者检测到弥漫性肺泡出血（DAH），在MPA患者中更常见（70.4%对38.7%；p=0.016）。在16.1%的DAH病例中，尽管缺乏临床或生物学依据，BAL检查仍可确诊。MPA和GPA患者BAL检查时微生物感染的发生率相似（38%，p=0.54）。
对于有呼吸道表现的AAV患者，支气管镜检查在疾病发作时是一种提供信息的检查方法。支气管内病变在GPA中更常见，应进行活检。BAL可用于确诊DAH或诊断并发感染。
