ABSTRACT
Objective To evaluate the roles of high-resolution computer tomography (HRCT) and bron- choalveolar lavage (BALF) in the diagnosis of connective tissue diseases associated with interstitial lung disease (CTD-ILD). Methods Clinical data of chest HRCT and BALF of patients with CTD-ILD from January 1997 to December 2007 in in-patient department of Peking University First Hospital, were retrospectively analyzed. Results ①Among 46 cases with the picture of chest HRCT, 19 (41.3%)showed usual interstitial pneumonia(UIP) -like pattern and 18 (39.1%) showed lobular and interlobular septa thickening. 8 (8/17) of ANCA vasculitis (AASV) and 5 (5/9) of rheumatoid arthritis (RA) manifested as UIP-like patterns respectively. In polymyositis/dermatomyositis(PM/DM) and Sjogren's syndrome (KS) patients, the organizing pneumonia(OP)-like pattern and lymphocytic interstitial pneumonia(LIP)-like pattern were 2/4 and 2/4 respectively. ②Among 32 cases undergoing BAL, 10/10 patients with AASV-ILD all showed that neutrophils were dominant in BALF, while, the other 22 patients showed that the ratio of neutrophils elevation (14/22, 63.6%) and the ratio of lymphocytes elevation (18/22, 81.8%) were comparable, and there were 12/22(54.5%)patients with both types of cell elevation. Among 13 cases with iymphocytes elevation in BALF who performed analysis of sub-type lymphocytes, 10/13 cases showed decreased CD4/CD8 ratio, 3/13 cases showed increased CD4/CD8 ratio which were all related with SS. ③Among 15 patients undertaken HRCT and BALF detection together, 7/7 UIP-like cases showed the ratio of neutrephils elevation in BALK While in non-UIP-like cases, 5/8 showed the ratio of lymphocytes elevation. Conclusion ①UIP-like patterns and patterns of lobular and interlobular septa thickening are the most common imaging features of HRCT in CTD-ILD, the former are mostly seen in AASV and RA. OP-like patterns and LIP-like patterns are commonly seen in PM/DM and SS respectively. ②Tbe increased neutrophil percentage is dominant in BAL fluid of patients with AASV-ILD, while the others show that the ratio of neutrophil and lymphocyte elevation are comparable, lymphocytes subtype analysis shows decreased CD4/CD8 ratio is dominant in CTD-ILD patients with lymphocytes increased. There is a significant relationship between increased CD4/CD8 ratio and SS-LIP. ③All of the cases with UIP-like patterns show the ratio of neutrophils elevation in BALF. While the ratio of lymphocytes elevation is dominant in non-UIP-like cases.
ABSTRACT
Introducción: La fibrosis pulmonar idiopática (FPI) es una neumopatía crónica de difícil diagnóstico que puede confundirse con otras enfermedades pulmonares intersticiales difusas (EPID), por lo que es importante buscar nuevos métodos auxiliares para su diagnóstico. La osteopontina (OPN) es una glicoproteína multifuncional con efecto estimulante sobre los fibroblastos y la síntesis de matriz extracelular. Dado su posible papel profibrosante, consideramos de interés evaluar su concentración en el lavado bronquioalveolar (LBA) de pacientes con FPI y compararla con otras EPID. Material y métodos: La OPN se cuantificó por ELISA en 25 pacientes con FPI, 10 con neumonía intersticial no específica (NINE), 16 con neumonitis por hipersensibilidad (NH) y 10 controles sanos. Resultados: La concentración de OPN en pacientes con FPI fue significativamente mayor que en pacientes con NH y sanos (p < 0.0001) así como en pacientes con NINE (p < 0.05). Esta prueba mostró una sensibilidad de 80% y especificidad de 75% para el diagnóstico de FPI cuando el logaritmo de la concentración de OPN es de > 2.0. No hubo correlación entre los niveles de OPN con las pruebas de función pulmonar. Es interesante observar una asociación significativa entre los niveles de OPN y la presencia de hipocratismo digital (RM: 6.69; IC 1.25-10.76; p < 0.05). Conclusiones: La OPN se encuentra elevada en el LBA de pacientes con FPI por lo que podría considerarse como una prueba auxiliar en el diagnóstico diferencial de las EPID. Adicionalmente, nuestros hallazgos sugieren que la OPN puede estar implicada en la patogénesis del hipocratismo digital.
Background: Idiopathic pulmonary fibrosis (IPF) is a chronic pulmonary disease of difficult diagnosis that could be confused with other interstitial lung diseases (ILD). In this context, it is important to seek new methods which can be helpful in the diagnosis of this disease. Osteopontin (OPN) is a multifunctional glycopro-tein that has a stimulating effect over fibroblasts and extracellular matrix accumulation. Because it has a possible pro-fibrosing role, we decided to measure its concentration in bronchioalveolar lavage (BAL) from patients with IPF and to compare it with other ILDs. Methods: OPN concentration was measured by ELISA method in 25 IPF patients, 10 patients with non-specific interstitial pneumonia (NSIP), 16 patients with hypersensitivity pneumonitis (HP) and 10 healthy controls. Results: OPN levels in IPF patients were significantly increased compared with patients with HP and healthy controls (p < 0.0001) as with NSIP patients (p< 0.05). This test showed an 80% sensitivity and 75% specificity when the OPN concentration logarithm is > 2.0. There was no correlation between OPN levels and pulmonary function tests. Interestingly, we observed a significant association between OPN levels and finger clubbing (OR: 6.69; Cl: 1.25-10.76; p < 0.05). Conclusions: IPF patients showed increased OPN levels; this test might be considered as an ancillary tool in the differential diagnosis of ILD. Additionally, our findings suggest that OPN could be implicated in the pathogenesis of clubbing.