支气管扩张合并显微镜下血管炎一例并文献复习_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

黄燕 ¹ , 黄志芳 ² , 张静瑜 ¹ ,  刘一 ¹

1. ;
2. ;

Corresponding author：

刘一, Email: liuyikz@163.com

Keywords：

支气管扩张; 显微镜下血管炎; 弥漫性肺泡出血

DOI：

10.7507/1671-6205.202005136

Video：

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目的报道一例支气管扩张合并显微镜下血管炎的诊治经过并进行文献复习，提高临床医生对此类疾病的认识及诊治水平。方法报道 1 例支气管扩张合并显微镜下血管炎的病史、临床表现及诊治经过，并复习国内外相关文献报道。结果患者女性，68 岁，因“间断咯血 10 余年，乏力 1 个月，发热 3 d”入院，胸部 CT 示支气管扩张合并感染，ANCA 过筛试验阳性（1∶320），抗髓过氧化物酶抗体阳性（++），肾穿刺病理符合显微镜下血管炎。入院后病情进展，出现严重的弥漫性肺泡出血，经气管插管机械通气、糖皮质激素冲击联合环磷酰胺、血浆置换、丙种球蛋白及抗感染等治疗，病情好转出院，随访 1 年病情稳定。国内外文献显示，支气管扩张是显微镜下血管炎患者肺部累及的常见表现，部分患者在血管炎发病之前存在多年的支气管扩张病史，慢性气道感染可能与血管炎的发病有关，合并支气管扩张的血管炎患者出现弥漫性肺出血风险较高。结论支气管扩张与显微镜下血管炎可能存在一定的内在关系。

Citation： 黄燕, 黄志芳, 张静瑜, 刘一. 支气管扩张合并显微镜下血管炎一例并文献复习. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(1): 54-57. doi: 10.7507/1671-6205.202005136 Copy

1.	Jennette JC, Falk RJ, Bacon PA, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum, 2013, 65(1): 1-11.
2.	Furuta S, Chaudhry AN, Arimura Y, et al. Comparison of the phenotype and outcome of granulomatosis with polyangiitis between UK and Japanese cohorts. J Rheumatol, 2017, 44(2): 216-222.
3.	Comarmond C, Crestani B, Tazi A, et al. Pulmonary fibrosis in antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis: a series of 49 patients and review of the literature. Medicine (Baltimore), 2014, 93(24): 340-349.
4.	张宏英, 钟艳芬, 陈力舟, 等. 表现为支气管扩张症的显微镜下多血管炎一例. 中华结核和呼吸杂志, 2018, 41(1): 70-72.
5.	谢亚荣, 余晓萍, 高凤云, 等. 表现为支气管扩张症的显微镜下多血管炎一例——疑点分析. 中华结核和呼吸杂志, 2019, 42(4): 318-319.
6.	何权瀛. 对于"表现为支气管扩张症的显微镜下多血管炎一例"一文的一点不同意见. 中华结核和呼吸杂志, 2018, 41(5): 369.
7.	沈维, 才旭, 霍建民. 表现为支气管扩张症的肺血管炎 3 例并文献复习. 中国校医杂志, 2012, 26(5): 879-880.
8.	Yamagata M, Ikeda K, Tsushima K, et al. Prevalence and responsiveness to treatment of lung abnormalities on chest computed tomography in patients with microscopic polyangiitis: a multicenter, longitudinal, retrospective study of one hundred fifty consecutive hospital-based Japanese patients. Arthritis Rheumatol, 2016, 68(3): 713-723.
9.	Mohammad AJ, Mortensen KH, Babar J, et al. Pulmonary involvement in anti neutrophilcyto plasmicantibodies (ANCA)-associated vasculitis: the influence of ANCA subtype. J Rheumatol, 2017, 44(10): 1458-1467.
10.	Takahashi K, Hayashi S, Ushiyama O, et al. Development of microscopic polyangiits in patients with chronic airway disease. Lung, 2005, 183(4): 273-281.
11.	Néel A, Espitia-Thibault A, Arrigoni PP, et al. Bronchiectasis is highly prevalent in anti-MPO ANCA-associated vasculitis and is associated with a distinct disease presentation. Semin Arthritis Rheum, 2018, 48(1): 70-76.
12.	Pasteur MC, Bilton D, Hill AT; British Thoracic Society Bronchiectasis non-CF Guideline Group. British Thoracic Society guideline for non-CF bronchiectasis. Thorax, 2010, 65(Suppl 1): i1-i58.
13.	林志谦, 许建荣, 程杰军, 等. ANCA 阳性小血管炎的胸部高分辨率 CT 表现. 医学影像学杂志, 2010, 20(6): 816-819.
14.	戴启春, 胡粟, 刘运练, 等. 显微镜下多血管炎肺损害的 CT 表现. 临床放射学杂志, 2013, 32(11): 1576-1579.
15.	Lhote R, Theodore C, Issoufaly T, et al. Successful treatment of antineutrophil cytoplasmic antibody-associated bronchiectasis with immunosuppressive therapy. Eur Respir J, 2015, 46(2): 554-557.
16.	Pinching AJ, Lockwood CM, Pussell BA, et al. Wegener's granulomatosis: observations on 18 patients with severe renal disease. Q J Med, 1983, 52(208): 435-460.
17.	Sitara D, Hoffbrand BI. Chronic bronchial suppuration and antineutrophil cytoplasmic antibody (ANCA) positive systemic vasculitis. Postgrad Med J, 1990, 66(778): 669-671.
18.	Matsuyama W, Wakimoto J, Watanabe A, et al. Bronchiectasis with myeloperoxidase antineutrophil cytoplasmic antibody and bactericidal/permeability-increasing protein antineutrophil cytoplasmic antibody. Intern Med, 1999, 38(10): 813-816.
19.	Nakazawa D, Tomaru U, Suzuki A, et al. Abnormal conformation and impaired degradation of propylthiouracil-induced neutrophil extracellular traps: implications of disordered neutrophil extracellular traps in a rat model of myeloperoxidase antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Rheum, 2012, 64(11): 3779-3787.
20.	Lhote R, Chilles M, Groh M, et al. Spectrum and prognosis of ANCA-associated vasculitis-related bronchiectasis: data from 61 patients. J Rheumatol, 2020, 47(10): 1522-1531.
21.	Cartin-Ceba R, Diaz-Caballero L, Al-Qadi MO, et al. Diffuse alveolar hemorrhagesecondary to antineutrophil cytoplasmic antibody-associated vasculitis: predictors of respiratory failure and clinical outcomes. Arthritis Rheumatol, 2016, 68(6): 1467-1476.
22.	Kida T, Tanaka T, Yokota I, et al. Association between preexisting lung involvements and the risk of diffuse alveolar hemorrhage in patients with microscopic polyangiitis: a multi-center retrospective cohort study. Mod Rheumatol, 2020, 30(2): 338-344.

1. Jennette JC, Falk RJ, Bacon PA, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum, 2013, 65(1): 1-11.
2. Furuta S, Chaudhry AN, Arimura Y, et al. Comparison of the phenotype and outcome of granulomatosis with polyangiitis between UK and Japanese cohorts. J Rheumatol, 2017, 44(2): 216-222.
3. Comarmond C, Crestani B, Tazi A, et al. Pulmonary fibrosis in antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis: a series of 49 patients and review of the literature. Medicine (Baltimore), 2014, 93(24): 340-349.
4. 张宏英, 钟艳芬, 陈力舟, 等. 表现为支气管扩张症的显微镜下多血管炎一例. 中华结核和呼吸杂志, 2018, 41(1): 70-72.
5. 谢亚荣, 余晓萍, 高凤云, 等. 表现为支气管扩张症的显微镜下多血管炎一例——疑点分析. 中华结核和呼吸杂志, 2019, 42(4): 318-319.
6. 何权瀛. 对于"表现为支气管扩张症的显微镜下多血管炎一例"一文的一点不同意见. 中华结核和呼吸杂志, 2018, 41(5): 369.
7. 沈维, 才旭, 霍建民. 表现为支气管扩张症的肺血管炎 3 例并文献复习. 中国校医杂志, 2012, 26(5): 879-880.
8. Yamagata M, Ikeda K, Tsushima K, et al. Prevalence and responsiveness to treatment of lung abnormalities on chest computed tomography in patients with microscopic polyangiitis: a multicenter, longitudinal, retrospective study of one hundred fifty consecutive hospital-based Japanese patients. Arthritis Rheumatol, 2016, 68(3): 713-723.
9. Mohammad AJ, Mortensen KH, Babar J, et al. Pulmonary involvement in anti neutrophilcyto plasmicantibodies (ANCA)-associated vasculitis: the influence of ANCA subtype. J Rheumatol, 2017, 44(10): 1458-1467.
10. Takahashi K, Hayashi S, Ushiyama O, et al. Development of microscopic polyangiits in patients with chronic airway disease. Lung, 2005, 183(4): 273-281.
11. Néel A, Espitia-Thibault A, Arrigoni PP, et al. Bronchiectasis is highly prevalent in anti-MPO ANCA-associated vasculitis and is associated with a distinct disease presentation. Semin Arthritis Rheum, 2018, 48(1): 70-76.
12. Pasteur MC, Bilton D, Hill AT; British Thoracic Society Bronchiectasis non-CF Guideline Group. British Thoracic Society guideline for non-CF bronchiectasis. Thorax, 2010, 65(Suppl 1): i1-i58.
13. 林志谦, 许建荣, 程杰军, 等. ANCA 阳性小血管炎的胸部高分辨率 CT 表现. 医学影像学杂志, 2010, 20(6): 816-819.
14. 戴启春, 胡粟, 刘运练, 等. 显微镜下多血管炎肺损害的 CT 表现. 临床放射学杂志, 2013, 32(11): 1576-1579.
15. Lhote R, Theodore C, Issoufaly T, et al. Successful treatment of antineutrophil cytoplasmic antibody-associated bronchiectasis with immunosuppressive therapy. Eur Respir J, 2015, 46(2): 554-557.
16. Pinching AJ, Lockwood CM, Pussell BA, et al. Wegener's granulomatosis: observations on 18 patients with severe renal disease. Q J Med, 1983, 52(208): 435-460.
17. Sitara D, Hoffbrand BI. Chronic bronchial suppuration and antineutrophil cytoplasmic antibody (ANCA) positive systemic vasculitis. Postgrad Med J, 1990, 66(778): 669-671.
18. Matsuyama W, Wakimoto J, Watanabe A, et al. Bronchiectasis with myeloperoxidase antineutrophil cytoplasmic antibody and bactericidal/permeability-increasing protein antineutrophil cytoplasmic antibody. Intern Med, 1999, 38(10): 813-816.
19. Nakazawa D, Tomaru U, Suzuki A, et al. Abnormal conformation and impaired degradation of propylthiouracil-induced neutrophil extracellular traps: implications of disordered neutrophil extracellular traps in a rat model of myeloperoxidase antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Rheum, 2012, 64(11): 3779-3787.
20. Lhote R, Chilles M, Groh M, et al. Spectrum and prognosis of ANCA-associated vasculitis-related bronchiectasis: data from 61 patients. J Rheumatol, 2020, 47(10): 1522-1531.
21. Cartin-Ceba R, Diaz-Caballero L, Al-Qadi MO, et al. Diffuse alveolar hemorrhagesecondary to antineutrophil cytoplasmic antibody-associated vasculitis: predictors of respiratory failure and clinical outcomes. Arthritis Rheumatol, 2016, 68(6): 1467-1476.
22. Kida T, Tanaka T, Yokota I, et al. Association between preexisting lung involvements and the risk of diffuse alveolar hemorrhage in patients with microscopic polyangiitis: a multi-center retrospective cohort study. Mod Rheumatol, 2020, 30(2): 338-344.

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支气管扩张合并显微镜下血管炎一例并文献复习

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