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Clinical features and outcome of adult patients with pulmonary Langerhans cell histiocytosis 成人肺朗格汉斯细胞组织细胞增多症的临床特点及预后
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa3683
E. Radzikowska, E. Wiatr, K. Błasińska-Przerwa, M. Jeśkiewicz, R. Langfort, B. Maksymiuk, Katarzyna Modrzewska, I. Bestry, M. Załęska, J. Szopiński, Agnieszka Jerzemska, M. Ochman, W. Naumnik, D. Jastrzębski, W. Piotrowski, K. Roszkowski-Śliż
Pulmonary Langerhans’ cell histiocytosis (PLCH) is a neoplastic disorder with strong inflammatory component. The clinical manifestations, features, and outcome of the PLCH vary widely, and clinical course of the disease is unpredictable. Material and methods: 124 adults (61 women and 63 men in age 15 to 69 years) with LCH, have been presented in our Department for the last 21 years. The median follow-up period was 146 months (range 3 to 338 months). Results: Isolated PLCH was diagnosed in 90(72%) cases, multisystem disease in 30(26%) patients. Two (1.6%) patients had multifocal bone disease, one (0.8%) had isolated mucosal, and one isolated bone lesion. Out of whole group only 6(5%) patients were nonsmokers. Incidentally the disease was diagnosed in 20% of patients. Pneumothorax as a first symptom of the disease was observed in 26% of patients. The most common findings in the pulmonary function tests were obstructive ventilatory defect (57%), and decreasing of transfer factor for carbon monoxide (80%). During the time of observation 70(56%) patients did not require immunosuppressive therapy. Only in 3(14%) patients steroid treatment was sufficient, other 19(86%) patients required chemotherapy. Chemotherapy with vinblastine, prednisone and mercaptopurine was administered in 11 patients, but only in 4 the regression with non-active disease was observed. Sixteen (13%) patients were treated successfully with cladribine, and till now no relapse was noticed. Conclusions: PLCH is a rare, cystic lung disease, affects mainly young adult smokers, without gender predominance; early diagnosis, smoking cessation, and adequate treatment are critical in its management.
肺朗格汉斯细胞组织细胞增多症(PLCH)是一种具有强烈炎症成分的肿瘤疾病。PLCH的临床表现、特征和预后差异很大,其临床病程难以预测。材料和方法:在过去的21年里,我科共收治了124例LCH患者(61例女性,63例男性,年龄15 - 69岁)。中位随访期为146个月(3 - 338个月)。结果:单纯PLCH 90例(72%),多系统病变30例(26%)。2例(1.6%)患者有多灶性骨病,1例(0.8%)患者有孤立性粘膜,1例患者有孤立性骨病变。在整个组中,只有6例(5%)患者不吸烟。顺便说一句,20%的患者被诊断出患有这种疾病。26%的患者以气胸为首发症状。肺功能检查中最常见的发现是阻塞性通气缺陷(57%)和一氧化碳传递因子降低(80%)。在观察期间,70例(56%)患者不需要免疫抑制治疗。只有3例(14%)患者类固醇治疗是足够的,其他19例(86%)患者需要化疗。11例患者给予长春花碱、强的松和巯基嘌呤化疗,但只有4例患者出现非活动性疾病消退。16例(13%)患者经克拉德滨治疗成功,至今未见复发。结论:PLCH是一种罕见的囊性肺疾病,主要累及年轻成年吸烟者,无性别优势;早期诊断、戒烟和适当的治疗对其管理至关重要。
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引用次数: 2
Interstitial lung disease in CVID (GLILD): clinical presentation and comparison to CVID without ILD 间质性肺疾病CVID (GLILD):临床表现和与无ILD的CVID的比较
Pub Date : 2019-09-28 DOI: 10.1183/13993003.congress-2019.pa1409
V. Somogyi, M. Eichinger, F. Lasitschka, J. Kappes, M. Kreuter
Introduction: Common variable immunodeficiency (CVID) patients are susceptible to respiratory diseases including bronchiectasis and granulomatous lymphocytic interstitial lung disease (GLILD). As data on evaluating CVID with and without GLILD are sparse, we aimed to compare these groups. Methods: 21 CVID patients were analyzed retrospectively for characteristics and outcomes and grouped into CVID with (ILD,n=9) and without GLILD (noILD,n=12). CT scoring (CTS) assessed 11 patterns (ground glass opacities, reticulations, traction bronchiectasis, honeycombing, consolidations, air-trapping, nodules, bronchial wall thickening, bronchiectasis, mucus plugging, effusion). Histology scoring (HS) evaluated changes of the bronchial wall and of the interstitium (fibrosis, inflammation, anthracosis, granuloma, tumor, infection, metaplasia, mucoid impactation, microhoneycombing, eosinophilia). Results: Baseline characteristics were similar between groups. Most CVID patients received immunoglobulins (Ig) and all ILD patients were treated immunosuppressive (IS). Under Ig and IS lung function remained stable in ILD. CTS were worse for ILD than noILD (ILD:16.5±8.7 vs. noILD:9.4±4.9, p=0.02) while HS (ILD:5.8±2.7, noILD 6.0±2.6) were similar. CTS deteriorated in ILD but not in noILD with pattern changes in ILD, from initial mainly GGO to fibrosis (p Conclusion: CVID with and without GLILD has similar clinical characteristics but differs mainly in CT scoring. Future work has to assess clinical predictors of GLILD.
简介:常见变异性免疫缺陷(CVID)患者易患呼吸道疾病,包括支气管扩张和肉芽肿性淋巴细胞间质性肺疾病(GLILD)。由于评估有无GLILD的CVID的数据很少,我们的目的是比较这些组。方法:回顾性分析21例CVID患者的特征和结局,并将其分为有ILD (n =9)和无GLILD (n =12)两组。CT评分(CTS)评估了11种征象(磨玻璃混浊、网状、牵引支气管扩张、蜂窝状、实变、气陷、结节、支气管壁增厚、支气管扩张、粘液堵塞、积液)。组织学评分(HS)评估支气管壁和间质的变化(纤维化、炎症、炭疽、肉芽肿、肿瘤、感染、化生、粘液嵌塞、微蜂窝、嗜酸性粒细胞增多)。结果:两组间基线特征相似。大多数CVID患者接受免疫球蛋白(Ig)治疗,所有ILD患者接受免疫抑制剂(IS)治疗。Ig和IS下,ILD患者肺功能保持稳定。CTS对ILD的诊断差于noILD (ILD:16.5±8.7 vs. noILD:9.4±4.9,p=0.02), HS (ILD:5.8±2.7,noILD 6.0±2.6)相似。CTS在ILD中恶化,但在ILD中没有恶化,并且ILD的模式发生了变化,从最初主要是GGO到纤维化(p结论:CVID合并和不合并GLILD的临床特征相似,但主要在CT评分上存在差异。未来的工作必须评估GLILD的临床预测因素。
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引用次数: 2
Transbronchial cryobiopsy in interstitial lung disease 间质性肺疾病的经支气管低温活检
Pub Date : 2018-09-15 DOI: 10.1183/13993003.CONGRESS-2018.PA3029
L. Hagmeyer, D. Theegarten, M. Treml, A. Pietzke-Calcagnile, S. Herkenrath, W. Randerath
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引用次数: 10
Atypical presentation of a rare lung condition: axillary and paraspinal lymphadenopathy in a patient with clinical and radiological features of lymphangioleomatosis (LAM) 罕见肺部疾病的不典型表现:以淋巴血管油瘤病(LAM)为临床和影像学表现的腋窝和棘旁淋巴结病患者
Pub Date : 2018-09-15 DOI: 10.1183/13993003.congress-2018.pa3032
A. Kavidasan, Vicky Taylor, S. Chaudhry, R. Siva, Y. Raste
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引用次数: 0
Eosinophilic Pneumonia Due to Sulphasalazine Use 磺胺嘧啶引起的嗜酸性肺炎
Pub Date : 2018-09-15 DOI: 10.1183/13993003.congress-2018.pa3026
S. Sökücü, C. Özdemir, Özlem Kahya, S. ÖnÜr
Sulfasalazine is a compound of 5-aminosalicylic acid and sulfapyridine joined by an azo bond. There are only case reports in the literature about pulmonary toxicity caused by this drug. A 23-year old man diagnosed as ulcerative colitis 3 months ago admitted to our hospital with a 1 month history of fever, cough, dyspnoea. He didn9t respond to antibiotics. He was a nonsmoker and had been on sulfazalazine and mesalazine treatment for 8 weeks. All of his medications were held on admission. He had fever (38.6 °C) with respiratory rate of 20/min with normal oxygen saturations in room air Physical examination revealed crepitation over right lung on auscultation. Chest radiograph showed multilobar pulmonary infiltrates dominated right lung peripherally. He has peripheral eosinophilia. For differential diagnosis, an autoimmune screen, Ig E level and parasite search in his feces was negative. Sputum culture was negative for pathogenic bacteria and acid-fast bacilli. HRCT revealed patchy consolidations at all zones of the right lung and upper zone of left lung, peribronchial and interlobuler septal thickenings, ground glass opasities. No endobronchial pathology was detected. Bronchoalveolar lavage done from medial segment of right middle lobe was negative for viral, tuberculous and fungal infections. The differential cell count showed 20% eosinophils. After withdrawal of sulfazalazine, pulmonary infiltrates started to regress in the control chest radiograph but respiratory symptoms were not resolved completely so oral prednisone treatment was started. 2 weeks later, his chest radiograph was dramatically improved with near complete resolution of the pulmonary infiltrates. The patient is in our follow up for 6 months without any symptoms.
磺胺吡啶是由5-氨基水杨酸和磺胺吡啶通过偶氮键连接而成的化合物。文献中仅有本品引起肺毒性的病例报道。患者23岁,男,3个月前确诊为溃疡性结肠炎,有1个月发热、咳嗽、呼吸困难病史。他对抗生素没有反应。患者不吸烟,服用磺胺氮嗪和美沙拉嗪治疗8周。他的所有药物在入院时都被搁置了。发热(38.6℃),呼吸频率20次/分,室内空气氧饱和度正常。体格检查听诊示右肺颤音。胸片示右肺周围多叶浸润为主。他周围嗜酸性粒细胞增多。为了鉴别诊断,自身免疫筛查、ige水平和粪便寄生虫检查均为阴性。痰培养病原菌和抗酸杆菌均阴性。HRCT示右肺各区及左肺上区片状实变,支气管周围及小叶间间隔增厚,磨玻璃样病变。未见支气管内病变。右中肺叶内侧段支气管肺泡灌洗对病毒、结核和真菌感染均阴性。差异细胞计数显示20%嗜酸性粒细胞。停用磺胺氮嗪后,对照胸片肺部浸润开始消退,但呼吸道症状未完全缓解,故开始口服强的松治疗。2周后,他的胸片明显改善,肺浸润几乎完全消失。患者随访6个月,无任何症状。
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引用次数: 1
Traction bronchiectasis and platythorax on computed tomography are determinants of progression and mortality in pleuro-parenchymal fibroelastosis 在计算机断层扫描上,牵引性支气管扩张和平胸是胸膜实质纤维弹性增生的进展和死亡率的决定因素
Pub Date : 2018-09-15 DOI: 10.1183/13993003.CONGRESS-2018.PA2232
P. George, D. Armstrong-James, A. Devaraj, E. Renzoni, T. Maher, A. Wells, I. Pulzato, P. Molyneaux, M. Kokosi, V. Kouranos, G. Margaritopoulos, S. Desai, F. Chua
Pleuroparenchymal fibroelastosis (PPFE) is a rare interstitial disease characterised by accumulation of elastin-rich fibrosis and predominant upper lobe shrinkage. The pathogenesis is poorly understood but idiopathic and secondary forms are recognised; an association with Aspergillus infection has been reported. We evaluated computed tomography (CT) and clinical/serological indices to identify factors influencing progression and mortality in patients with PPFE. CT studies in 72 patients, with a multidisciplinary diagnosis of PPFE, were consensus scored by two thoracic radiologists. The presence and severity of traction bronchiectasis in areas of PPFE correlated with the extent, severity and progression of PPFE (all p 40 mgA/L) was seen in 18/72 (25%) patients and was higher than in reference cohorts of idiopathic pulmonary fibrosis (20/105; 19%) and chronic hypersensitivity pneumonitis (12/111; 11%) (p=0.04). These data highlight the importance of platythorax as a clinico-radiological marker of volume loss and, more importantly, an index of poor outcome in PPFE, potentially reflecting inexorable physiological decline. The possibility that fungal sensitisation may form part of a pathogenetic or progressive PPFE profile warrants further investigation.
胸膜实质纤维弹性增生症(PPFE)是一种罕见的间质性疾病,其特征是富含弹性蛋白的纤维化积聚和主要的上肺叶萎缩。发病机制尚不清楚,但特发性和继发性形式是公认的;与曲霉感染有关的报道。我们评估了计算机断层扫描(CT)和临床/血清学指标,以确定影响PPFE患者进展和死亡率的因素。两名胸科放射科医生对72例多学科诊断为PPFE的患者进行了一致评分。在18/72(25%)的患者中,PPFE区域的牵引性支气管扩张的存在和严重程度与PPFE的程度、严重程度和进展相关(均为40mga /L),高于特发性肺纤维化的参考队列(20/105;19%)和慢性超敏性肺炎(12/111;11%) (p = 0.04)。这些数据强调了胸厚作为体积损失的临床放射标志物的重要性,更重要的是,它是PPFE预后不良的指标,潜在地反映了不可避免的生理衰退。真菌致敏可能构成致病性或进行性PPFE概况的一部分的可能性值得进一步研究。
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引用次数: 1
Pneumothorax in pulmonary langerhans cell histiocytosis (PLCH) 肺朗格汉斯细胞组织细胞增多症(PLCH)并发气胸
Pub Date : 2018-09-15 DOI: 10.1183/13993003.CONGRESS-2018.PA2241
P. Guen, S. Chevret, E. Bugnet, C. Margerie-Mellon, F. Jouenne, G. Lorillon, A. Seguin-Givelet, S. Mourah, D. Gossot, R. Vassallo, A. Tazi
Background: Pneumothorax (PNO) is a salient complication of PLCH, which management is not standardized. The factors associated with PNO recurrence are poorly understood. Objectives: To determine PNO outcome after thoracic surgery and search for factors associated with the risk of recurrence. Methods: All PLCH patients ≥18 years with ≥1PNO between 11/2003 and 12/2015 of the database of the National Registry for histiocytoses and followed ≥6 months were retrospectively studied. Kaplan Meier method and univariate Cox models were used for statistical analyses. Results: Among the 43 patients included (39 smokers), 53% presented at least 1 PNO recurrence during a 49 months median time (53 additional episodes, 75% ipsilateral, all within 2 years). Thoracic surgery did not modify the risk of PNO recurrence, as compared to conservative treatment (p=0.96). However, the rate of recurrences was lower after thoracotomy (TCT), as compared to video-assisted thoracoscopy (VATS) (p=0.03). In the univariate analyses, lung function air trapping at diagnosis was associated with increased hazard of PNO recurrence (p=0.03). Patients whose LCH lesion harboured the BRAFV600E mutation had a lower rate of ipsilateral recurrences (p=0.019). When incorporating all ipsilateral recurrences, VATS was associated with increased hazard of subsequent recurrence (p=0.05). Conclusions: Surgery did not decrease the risk of PNO recurrence in PLCH. Thus, no particular treatment can be recommended for the first PNO in PLCH patients. In case of recurrence, TCT which appears more effective than VATS to prevent subsequent recurrence, should be privileged. The reduced risk of PNO recurrence associated with the presence of BRAFV600E mutation needs to be confirmed.
背景:气胸(PNO)是PLCH的一个突出并发症,其处理不规范。与PNO复发相关的因素尚不清楚。目的:确定胸外科手术后PNO的预后,并寻找与复发风险相关的因素。方法:回顾性研究2003年11月至2015年12月期间所有年龄≥18岁、pno≥1PNO的PLCH患者,随访≥6个月。采用Kaplan Meier法和单变量Cox模型进行统计分析。结果:在纳入的43例患者(39例吸烟者)中,53%的患者在49个月的中位时间内出现至少1次PNO复发(53次额外发作,75%同侧,均在2年内)。与保守治疗相比,胸外科手术没有降低PNO复发的风险(p=0.96)。然而,与电视胸腔镜(VATS)相比,开胸手术(TCT)后的复发率较低(p=0.03)。在单变量分析中,诊断时肺功能空气潴留与PNO复发风险增加相关(p=0.03)。LCH病变携带BRAFV600E突变的患者同侧复发率较低(p=0.019)。当合并所有同侧复发时,VATS与随后复发的风险增加相关(p=0.05)。结论:手术并没有降低PLCH患者PNO复发的风险。因此,对于PLCH患者的首次PNO,不推荐特殊的治疗方法。如果复发,TCT似乎比VATS更有效地防止再次复发,应优先考虑。与BRAFV600E突变存在相关的PNO复发风险降低有待证实。
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引用次数: 2
Cytokine profiling in Pulmonary Langerhans Cell Histiocytosis: novel insights into pathogenesis. 肺朗格汉斯细胞组织细胞增多症的细胞因子谱分析:对发病机制的新见解。
Pub Date : 2018-09-15 DOI: 10.1183/13993003.CONGRESS-2018.PA2242
Silvia Barril Farre, S. Hortelano, A. Luque, M. Higueras, C. Rodríguez-Martín, C. Robledo, A. Feliu, P. Millán, O. Sibila, F. J. Alonso, D. Castillo
Introduction: Pulmonary Langerhans Cell Histiocytosis (PLCH) is an uncommon disorder link with tobacco smoking. Although an abnormal inflammatory response to tobacco particles has been consider the hallmark of PLCH pathogenesis, there is limited knowledge about the mediators of inflammation in PLCH. Objectives: To investigate inflammatory serum profile in PLCH patients. Methods: Blood samples and clinical data were obtained from adult patients with PLCH. Cytokine profile in serum of these patients and 5 healthy adult volunteers were analysed using the Cytokine Human Membrane Antibody Array. Results: Twelve patients with PLCH were included. Median age (±SD) was 40±14 years old. All were current smokers and only 1 (8,3%) had multisystemic disease. Mean FVC (% predicted) was 85±20% and DLCO (% predicted) was 65±11%. Regarding the 80 cytokine evaluated, there were significant differences between healthy and PLCH patients in levels of MCP-1 (CCL2), MCP-2 (CCL8), SCF, TARC (CCL17), IGF-I, Oncostatin M, Thrombopoietin, FDF-7, Fractalkine, LIF and TIMP-2 (see figure 1). Conclusions: Cytokine profile in patients with PLCH has a distinctive pattern compare to health subjects. Our data supports that IL-6 family could have a meaningful role in the pathogenesis of PLCH.
肺朗格汉斯细胞组织细胞增多症(PLCH)是一种与吸烟有关的罕见疾病。尽管对烟草颗粒的异常炎症反应被认为是PLCH发病机制的标志,但对PLCH中炎症介质的了解有限。目的:探讨PLCH患者的炎性血清特征。方法:采集成年PLCH患者的血液及临床资料。采用细胞因子人膜抗体阵列分析了这些患者和5名健康成人志愿者的血清细胞因子谱。结果:纳入12例PLCH患者。中位年龄(±SD)为40±14岁。所有患者均为当前吸烟者,仅有1例(8.3%)患有多系统疾病。平均FVC(预测%)为85±20%,DLCO(预测%)为65±11%。在80种细胞因子评估中,健康与PLCH患者在MCP-1 (CCL2)、MCP-2 (CCL8)、SCF、TARC (CCL17)、IGF-I、Oncostatin M、血小板生成素、FDF-7、Fractalkine、LIF和TIMP-2水平上存在显著差异(见图1)。结论:PLCH患者的细胞因子谱与健康受试者相比具有独特的模式。我们的数据支持IL-6家族可能在PLCH的发病机制中起重要作用。
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引用次数: 0
Vascular endothelial growth factors and matrix metalloproteinases serum levels for LAM diagnosis in patients with sporadic LAM and tuberous sclerosis 血管内皮生长因子和基质金属蛋白酶血清水平对散发性LAM和结节性硬化症患者LAM诊断的意义
Pub Date : 2018-09-15 DOI: 10.1183/13993003.CONGRESS-2018.OA3785
S. Terraneo, F. Marco, G. Imeri, L. Giuliani, S. Ancona, P. Cetrangolo, E. Grasso, S. Centanni, E. Lesma
{"title":"Vascular endothelial growth factors and matrix metalloproteinases serum levels for LAM diagnosis in patients with sporadic LAM and tuberous sclerosis","authors":"S. Terraneo, F. Marco, G. Imeri, L. Giuliani, S. Ancona, P. Cetrangolo, E. Grasso, S. Centanni, E. Lesma","doi":"10.1183/13993003.CONGRESS-2018.OA3785","DOIUrl":"https://doi.org/10.1183/13993003.CONGRESS-2018.OA3785","url":null,"abstract":"","PeriodicalId":267660,"journal":{"name":"Rare ILD/DPLD","volume":"2018 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128114878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Disease characteristics and outcomes in a Swedish cohort of patients with pulmonary fibrosis (PF) 瑞典肺纤维化(PF)患者队列的疾病特征和结局
Pub Date : 2018-09-15 DOI: 10.1183/13993003.CONGRESS-2018.PA3028
C. Sköld, K. Bartley, A. Levine, L. Arnheim‐Dahlström, K. Kirchgaessler, R. Linder, C. Janson, G. Ferrara
Disease characteristics and outcomes in a Swedish cohort of patients with pulmonary fibrosis (PF)
瑞典肺纤维化(PF)患者队列的疾病特征和结局
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引用次数: 0
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