Pulmonary alveolar proteinosis-like change: A fairly common reaction associated with the severity of idiopathic pulmonary fibrosis

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• 作者：Sayuri Nunomura^a ; ¹ ; ^{bb55313028@cc.nagasaki-u.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Tomonori Tanaka^a ; ¹ ; ^{tanaka.t.tomonori@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Toshiyuki Nakayama^b ; ² ; ^{toshi-n@med.uoeh-u.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Kyoko Otani^a ; ³ ; ^{o.kyoko303@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Haruyuki Ishii^c ; ^{h141@ks.kyorin-u.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Kazuhiro Tabata^a ; ¹ ; ^{t-kaz@nagasaki-u.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Yasuhiro Kondoh^d ; ^{konyasu2003@yahoo.co.jp" class="auth_mail" title="E-mail the corresponding author} ; Kensuke Kataoka^d ; ^{kataoka@tosei.or.jp" class="auth_mail" title="E-mail the corresponding author} ; Takeshi Johkoh^e ; ^{Johkoht@aol.com" class="auth_mail" title="E-mail the corresponding author} ; Hiroyuki Taniguchi^d ; ^{hiro-tosei-lung@kkd.biglobe.ne.jp" class="auth_mail" title="E-mail the corresponding author} ; Junya Fukuoka^b ; ^{fukuokaj@nagasaki-u.ac.jp" class="auth_mail" title="E-mail the corresponding author}
• 关键词：IP ; Interstitial pneumonia ; PAP ; Pulmonary alveolar proteinosis ; IPF ; I ; diopathic pulmonary fibrosis ; %FVC ; Percent-predicted forced vital capacity ; %DLco ; Percent-predicted diffusion capacity of carbon monoxide ; BAL ; Bronchoalveolar lavage ; KL-6 ; Krebs von den Lungen-6 ; SP-D ; Surfactant protein-D ; LDH ; Lactate dehydrogenase ; SP-A ; Surfactant protein-A ; ATS/ERS ; American Thoracic Society/European Respiratory Society ; UIP ; Usual interstitial pneumonia ; NSIP ; Nonspecific interstitial pneumonia ; G
• 刊名：Respiratory Investigation
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：54
• 期：4
• 页码：272-279
• 全文大小：1590 K

文摘

We have seen cases of chronic interstitial pneumonia (IP) with pulmonary alveolar proteinosis (PAP)-like changes that are focal histological features similar to PAP. To our knowledge, the association between PAP-like changes and chronic IP has not been investigated. We aimed to evaluate the incidence of PAP-like changes in chronic IP cases, and the association between the existence of PAP-like changes and the clinical features seen in patients with idiopathic pulmonary fibrosis (IPF).

Methods

We selected 144 cases of chronic IP that had a video-assisted thoracoscopic surgery biopsy between 2008 and 2011. Clinical records and hematoxylin and eosin-stained slides were reviewed, and clinicopathological findings, including the cumulative survival probability, were compared between IPF cases with and without a PAP-like change.

Results

A PAP-like change was identified in 20 of 144 cases (13.9%) of chronic IP and 14 of 61 IPF cases (23.0%). When comparing IPF cases with and without a PAP-like change, histological findings of honeycomb cysts and fibroblastic foci were associated with PAP-like changes (p=0.022 and 0.036, respectively). The percent-predicted values for forced vital capacity and diffusion capacity of carbon monoxide were lower (p=0.006 and 0.015, respectively), and concentrations of serum Krebs von den Lungen-6 and lactate dehydrogenase were higher (p=0.007 and 0.037, respectively) in cases of IPF with a PAP-like change than in those without one.

Conclusions

The presence of a PAP-like change in IPF cases was fairly common in our study, and may be a secondary reaction associated with IPF severity.