支气管检查在多炎和微观多炎的粒状瘤中呼吸道参与的作用
Thomas Villeneuve1, Grégoire Prévot1, Grégory Pugnet2
1Pulmonology Department, University Hospital Center (CHU) of Toulouse, Toulouse, France.
支气管镜有助于诊断抗中性粒细胞质抗体相关的血管炎 (AAV) 与呼吸系统症状. 诸如多管炎 (GPA) 及扩散性膜出血 (DAH) 的粒状瘤病变中的内支气管病变等发现是关键的诊断指标.
科学领域:
- 肺部病理学 肺部病理学
- 类风湿病学 类风湿病学
- 内部医学 内部医学
背景情况:
- 抗中性粒细胞质抗体 (ANCA) 相关的血管炎 (AAV) 包含了微观多炎 (MPA) 和多炎的粒状炎 (GPA) 等疾病.
- 在AAV中,呼吸道表现很常见,因此在疾病发作时需要准确的诊断工具.
研究的目的:
- 评估在被诊断患有ANCA相关血管炎 (AAV) 的患者中支气管镜的诊断效用.
- 分析MPA和GPA诊断时进行的支气管支气管洗 (BAL) 和支气管支气管镜检查的组织学发现.
主要方法:
- 在2004年至2019年期间被诊断患有MPA或GPA的18岁以上患者的回顾性研究,他们在疾病发作时接受了支气管镜检查.
- 收集和分析支气管支气管洗液 (BAL) 和支气管镜手术中的组织学数据.
主要成果:
- 在274名AAV患者中,分析了58例诊断时的支气管镜. 与GPA和蛋白酶3-ANCA相关的内支气管病变在24.1%的病例中存在.
- 对可见病变的支气管活检产生了66.6%的诊断率. 通过BAL在53.4%的患者中检测到扩散膜出血 (DAH),在MPA中更频繁.
- 在没有其他临床或生物证据的情况下,BAL在16.1%的病例中证实了DAH. 在38%的BAL样本中发现了微生物感染,MPA和GPA的发病率相似.
结论:
- 支气管镜对于诊断呼吸系统症状的患者的AAV非常有价值,在疾病发作时提供了关键的见解.
- 胸内膜病变,在GPA中更常见,需要进行活检. BAL对于确认DAH和识别叠加感染是有效的.
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