Clinical Analysis on Interstitial Pneumonia with Positive Myeloperoxidase_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

PENGShouchun ,  LIXueren

Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Logistics University of Chinese People’s Armed Police Force, Tianjin 300162, P.R.China;

Corresponding?author：

LIXueren, Email: 13820931847@163.com

Keywords：

Idiopathic interstitial pneumonia; Myeloperoxidase; Idiopathic lung fibrosis

DOI：

10.7507/1671-6205.201607006

Video：

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Objective To summarize the clinical characteristics of patients with interstitial pneumonia with positive myeloperoxidase (MPO-IP). Methods The clinical data of 15 patients hospitalized with MPO-IP from June 2013 to January 2016 were analyzed retrospectively, including clinical manifestations, laboratory test, lung function test, chest high resolution computed tomography (HRCT) and management. Simultaneously, 11 patients with IPF were recruited as control. Results The onset age of MPO-IP was older than that in IPF patients (74.07±6.31 yearsvs. 66.73±6.80 years,P＜0.01). There was no manifestation of vasculitis in kidney in all included patients, and the differences were not significant in gender, smoking, cough and expectoration, wheezing, shortness of breath, HRCT manifestations, FVC%pred, T_LCO%pred, PaO₂ or PaCO₂ between the two groups. In 15 MPO-IP patients, HRCT revealed 12 cases of usual interstitial pneumonitis (UIP), 2 cases of nonspecific interstitial pneumonia (NSIP), 1 case of organizing pneumonia (OP), and 5 patients with overlapped emphysema. Eleven IPF patients were all in UIP pattern and 4 with overlapped emphysema. One MPO-IP patients and 5 IPF patients had clubbed-fingers. The differences in clubbed-finger and treatment were significantly different between the two groups. Nine IPF patients received symptomatic treatment and7 MPO-IP patients were administered with glucocorticoids and immunosuppressants. In addition 2 MPO-IP patients were treated with pirfenidone. Conclusions MPO-IP patients have older onset age of disease and lower incidence of clubbed-finger than IPF patients. UIP is the main HRCT change both in MPO-IP and IPF. Beside glucocorticoid and immunosuppressants, pirfenidone is a choice and worthy of further research in management of MPO-IP.

Citation： PENGShouchun, LIXueren. Clinical Analysis on Interstitial Pneumonia with Positive Myeloperoxidase. Chinese Journal of Respiratory and Critical Care Medicine, 2017, 16(1): 46-49. doi: 10.7507/1671-6205.201607006 Copy

1.	?靳建軍, 施舉紅, 陸慰萱, 等. 顯微鏡下多血管炎肺部病變的臨床特點. 中華結核和呼吸雜志, 2011, 34(5): 339-343.
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4.	Raghu G, Collard HR, Egan JJ, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med, 2011, 183(6): 788-824.
5.	Lynch DA, Godwin JD, Safrin S, et al. High-resolution computed tomography in idiopathic pulmonary fibrosis: diagnosis and prognosis. Am J Respir Crit Care Med, 2005, 172(4): 488-493.
6.	Fischer A, Antoniou KM, Brown KK, et al. An official European Respiratory Society/American Thoracic Society research statement: interstitial pneumonia with autoimmune features. Eur Respir J, 2015, 46(4): 976-987.
7.	李學任, 彭守春. 伴有自身免疫特征的間質性肺疾病單中心研究. 中國呼吸與危重監護雜志, 2016, 15(2): 153-157.
8.	陳露露, 張德平, 苗立云. 合并肺部損害的顯微鏡下多血管炎的臨床特征及與特發性肺纖維化的比較分析. 中國呼吸與危重監護雜志, 2011, 10(5): 437-441.
9.	Tanaka T, Otani K, Egashira R, et al. Interstitial pneumonia associated with MPO-ANCA: clinicopathological features of nine patients. Respir Med, 2012, 106(12): 1765-1770.
10.	蔡后榮. 2011 年特發性肺纖維化診斷和治療循證新指南解讀. 中國呼吸與危重監護雜志, 2011, 10(4): 313-316.
11.	Raghu G, Rochwerg B, Zhang Y, et al. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline: Treatment of Idiopathic Pulmonary Fibrosis. An Update of the 2011 Clinical Practice Guideline. Am J Respir Crit Care Med, 2015, 192(2): e3-e19.
12.	曹孟淑, 蔡后榮, 代華平. 2015ATS/ERS/JRS/ALAT 官方的臨床實踐指南: 特發性肺纖維化的治療 (執行摘要)—對2011年臨床指南的更新. 中國呼吸與危重監護雜志, 2016, 15(2): 189-197.
13.	中華醫學會呼吸病學分會間質性肺疾病學組. 特發性肺纖維化診斷和治療中國專家共識. 中華結核和呼吸雜志, 2016, 39(6): 427-432.
14.	Miura Y, Saito T, Fujita K, et al. Clinical experience with pirfenidone in five patients with scleroderma-related interstitial lung disease. Sarcoidosis Vasc Diffuse Lung Dis, 2014, 31(3): 235-238.
15.	Udwadia ZF, Mullerpattan JB, Balakrishnan C, et al. Improved pulmonary function following pirfenidone treatment in a patient with progressive interstitial lung disease associated with systemic sclerosis. Lung India, 2015, 32(1): 50-52.

1. ?靳建軍, 施舉紅, 陸慰萱, 等. 顯微鏡下多血管炎肺部病變的臨床特點. 中華結核和呼吸雜志, 2011, 34(5): 339-343.
2. Ando Y, Okada F, Matsumoto S, et al. Thoracic manifestation of myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA)-related disease. CT findings in 51 patients. J Comput Assist Tomogr, 2004, 28(5): 710-716.
3. Bradley B, Branley HM, Egan JJ, et al. Interstitial lung disease guideline: the British Thoracic Society in collaboration with the Thoracic Society of Australia and New Zealand and the Irish Thoracic Society. Thorax, 2008, 63 Suppl 5: v1-58.
4. Raghu G, Collard HR, Egan JJ, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med, 2011, 183(6): 788-824.
5. Lynch DA, Godwin JD, Safrin S, et al. High-resolution computed tomography in idiopathic pulmonary fibrosis: diagnosis and prognosis. Am J Respir Crit Care Med, 2005, 172(4): 488-493.
6. Fischer A, Antoniou KM, Brown KK, et al. An official European Respiratory Society/American Thoracic Society research statement: interstitial pneumonia with autoimmune features. Eur Respir J, 2015, 46(4): 976-987.
7. 李學任, 彭守春. 伴有自身免疫特征的間質性肺疾病單中心研究. 中國呼吸與危重監護雜志, 2016, 15(2): 153-157.
8. 陳露露, 張德平, 苗立云. 合并肺部損害的顯微鏡下多血管炎的臨床特征及與特發性肺纖維化的比較分析. 中國呼吸與危重監護雜志, 2011, 10(5): 437-441.
9. Tanaka T, Otani K, Egashira R, et al. Interstitial pneumonia associated with MPO-ANCA: clinicopathological features of nine patients. Respir Med, 2012, 106(12): 1765-1770.
10. 蔡后榮. 2011 年特發性肺纖維化診斷和治療循證新指南解讀. 中國呼吸與危重監護雜志, 2011, 10(4): 313-316.
11. Raghu G, Rochwerg B, Zhang Y, et al. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline: Treatment of Idiopathic Pulmonary Fibrosis. An Update of the 2011 Clinical Practice Guideline. Am J Respir Crit Care Med, 2015, 192(2): e3-e19.
12. 曹孟淑, 蔡后榮, 代華平. 2015ATS/ERS/JRS/ALAT 官方的臨床實踐指南: 特發性肺纖維化的治療 (執行摘要)—對2011年臨床指南的更新. 中國呼吸與危重監護雜志, 2016, 15(2): 189-197.
13. 中華醫學會呼吸病學分會間質性肺疾病學組. 特發性肺纖維化診斷和治療中國專家共識. 中華結核和呼吸雜志, 2016, 39(6): 427-432.
14. Miura Y, Saito T, Fujita K, et al. Clinical experience with pirfenidone in five patients with scleroderma-related interstitial lung disease. Sarcoidosis Vasc Diffuse Lung Dis, 2014, 31(3): 235-238.
15. Udwadia ZF, Mullerpattan JB, Balakrishnan C, et al. Improved pulmonary function following pirfenidone treatment in a patient with progressive interstitial lung disease associated with systemic sclerosis. Lung India, 2015, 32(1): 50-52.

Chinese Journal of Respiratory and Critical Care Medicine

Clinical Analysis on Interstitial Pneumonia with Positive Myeloperoxidase

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