AAV-ILD的CT影像学特征与ANCA浓度的相关性分析研究

王红梅; 李俊林; 董宇清; 张月阳; 姚韧寰

doi:10.15953/j.ctta.2025.081

AAV-ILD的CT影像学特征与ANCA浓度的相关性分析研究

王红梅^1a,,
李俊林^1a,
董宇清^1a,
张月阳²,
姚韧寰^1b, ,

11a.
内蒙古自治区人民医院影像医学科；
11b.
内蒙古自治区人民医院核医学科，呼和浩特 010017
2.
内蒙古医科大学赤峰临床医学院，内蒙古赤峰 024020

基金项目:

内蒙古医学科学院公立医院科研联合基金科技项目（2024GLLH0033；2023GLLH0030）。

详细信息

作者简介:
王红梅，博士，副主任医师，擅长中枢、胸部及腹部疾病影像诊断，E-mail：xjtuwhm@163.com

通讯作者:
姚韧寰✉，硕士，副主任医师，擅长核医学诊断及治疗，E-mail：493769809@qq.com。

中图分类号: R 537；R 814
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出版历程
- 收稿日期: 2025-03-05
- 修回日期: 2025-04-11
- 录用日期: 2025-05-06
- 网络出版日期: 2025-05-27
- 刊出日期: 2025-07-04

Computer Tomography Features of Antineutrophil Cytoplasm Antibody-associated Vasculitis-interstitial Lung Disease and Its Correlation with Antineutrophil Cytoplasmic Antibody Concentration

11a.
Inner Mongolia People’s Hospital, Hohhot 010017, China Department of Medical Imaging
11b.
Inner Mongolia People’s Hospital, Hohhot 010017, China Department of Nuclear Medicine
2.
Inner Mongolia Medical University, Chifeng Clinical Medical College, Chifeng 024020, China

摘要

摘要:
本研究旨在系统分析抗中性粒细胞胞浆抗体相关性血管炎（AAV）−间质性肺病（ILD）患者首次诊断时的CT影像学特征，探讨病变类型、分布特点及其与实验室检查结果的相关性。回顾性纳入92例首次确诊为AAV-ILD的患者，收集患者的临床及CT影像数据，对CT影像资料进行主观定量分析，评估病变类型（如磨玻璃影、网格影、蜂窝样改变、实变影及牵拉性支气管扩张）及其分布特征。采用肺纤维化评分系统量化病变严重程度，分析影像学特征ANCA浓度之间的相关性。结果发现AAV-ILD在老年男性中更为常见，蜂窝样改变和网格影是最常见的影像学表现，病变主要分布于双肺下叶及外周区域，主要表现为寻常型间质性肺炎（UIP）模式。另外还发现肺纤维化评分与髓过氧化物酶（MPO）浓度呈显著正相关，蜂窝样改变评分与MPO浓度也存在正相关。AAV-ILD的CT表现具有独特的特点，而且MPO-ANCA与肺纤维化的相关性提示MPO可能成为肺纤维化进展的潜在生物标志物，这为深入理解AAV-ILD的影像学特征及其病理机制提供了重要依据。
- 抗中性粒细胞胞浆抗体 /
- 间质性肺病 /
- 高分辨率CT /
- 磨玻璃影 /
- 蜂窝样改变
Abstract:
This study systematically analyzed the CT imaging features of patients diagnosed with ANCA-associated vasculitis (AAV)-related interstitial lung disease (ILD) at the time of their first diagnosis. The types and distribution characteristics of the lesions and their correlation with laboratory findings were investigated. A retrospective study was conducted on 92 patients with newly diagnosed AAV-ILD. Clinical and CT imaging data were collected. CT imaging data were analyzed qualitatively and quantitatively to evaluate lesion types (e.g., ground-glass opacities, reticulations, honeycombing, consolidation, and traction bronchiectasis) and their distribution patterns. The severity of the lesions was quantified using a pulmonary fibrosis scoring system, and the correlation between imaging features and laboratory indices was analyzed. AAV-ILD was more commonly observed in elderly male patients. Honeycombing and reticulations were the most common CT-imaging findings, with lesions primarily distributed in the bilateral lower lungs and peripheral regions. AAV-ILD predominantly exhibited a usual interstitial pneumonia (UIP) pattern. A significant positive correlation was also observed between the pulmonary fibrosis score and myeloperoxidase (MPO) concentration and between honeycombing scores and MPO concentration. The CT features of AAV-ILD are unique. The correlation between MPO and pulmonary fibrosis suggests that MPO may serve as a potential biomarker for the progression of pulmonary fibrosis. These findings provide important insights into the imaging characteristics and pathological mechanisms of AAV-ILD.
- antineutrophil cytoplasmic antibodies /
- interstitial lung disease /
- high-resolution CT /
- ground-glass opacities /
- honeycomb lung

HTML全文

图 1 AAV-ILD患者肺部UIP和NSIP模式

注：（a）男，57岁，临床确诊AAV，双肺多发蜂窝样改变伴牵拉性支气管扩张，符合典型UIP模式。（b）女，65岁，临床确诊AAV，双肺胸膜下磨玻璃密度影及小叶间隔增厚，胸膜下不受累，符合NSIP模式。

Figure 1. Pulmonary UIP and NSIP patterns in patients with AAV-ILD

下载: 全尺寸图片幻灯片

图 2 纤维化评分与MPO-ANCA相关性分析结果

Figure 2. Correlation analysis between AAV-ILD pulmonary fibrosis score and MPO-ANCA

下载: 全尺寸图片幻灯片

表 1 AAV-ILD患者临床特征

Table 1 Clinical characteristics of patients with AAV-ILD

项目	临床特征	例数	占比/%
总例数		92	100

性别	男	54	58.7
性别	女	38	41.3

吸烟史	有长期吸烟者≥10年12例	30	32.6
吸烟史	无	62	67.4

症状	咳嗽（干咳）	50	54.4
	气促（劳力性呼吸困难）	40	43.5
	胸痛	8	8.7
	咯血	5	5.4

下载: 导出CSV

表 2 AAV-ILD患者肺部HRCT特征

Table 2 HRCT characteristics of lungs in patients with AAV-ILD

项目	HRCT特征	例数	占比/%
总例数		92	100

影像学表现	蜂窝样改变（下叶分布为主）	78	84.8
	磨玻璃密度影	72	78.3
	实变影	6	6.5
	网格影	85	92.4
	牵拉性支气管扩张	72	78.3

分布特点	外周分布	70	76.1
分布特点	弥漫性分布	22	23.9

分布模式	UIP	62	67.4
	NSIP	15	16.3
	OP	10	10.9
	DAD	4	4.4
	NSIP叠加DAD	1	1.1

下载: 导出CSV

参考文献(24)

[1]	SEBASTIANI M, MANFREDI A, VACCHI C, et al. Epidemiology and management of interstitial lung disease in ANCA-associated vasculitis[J]. Clinical and Experimental Rheumatology, 2020, 124(2): 221-231.
[2]	SACOTO G, BOUKHLAL S, SPECKS U, et al. Lung involvement in ANCA-associated vasculitis[J]. Presse Médicale, 2020, 49(3): 104039. DOI: 10.1016/j.lpm.2020.104039.
[3]	刘泠钰, 田新平. 原发性系统性血管炎的肺部表现[J]. 中华医学杂志, 2021, 101(24): 1938-1941. LIU L Y, TIAN X P. Pulmonary manifestations of primary systemic vasculitis. Chinese Medical Journal, 2021, 101(24): 1938-1941. (in Chinese).
[4]	DOLINER B, RODRIGUEZ K, MONTESI S B, et al. Interstitial lung disease in ANCA-associated vasculitis: Associated factors, radiographic features and mortality[J]. Rheumatology (Oxford), 2023, 62(2): 716-725. DOI: 10.1093/rheumatology/keac339.
[5]	马震忠, 盛亚丹, 杨凯, 等. 皮肌炎/多发性肌炎相关间质性肺病高分辨率CT特征[J]. CT理论与应用研究(中英文), 2024, 33(4): 497-502. DOI: 10.15953/j.ctta.2023.131. MA Z Z, SHENG Y D, YANG K, et al. HRCT features of dermatomyositis-/polymyositis- associated interstitial lung disease[J]. CT Theory and Applications, 2024, 33(4): 497-502. DOI: 10.15953/j.ctta.2023.131. (in Chinese).
[6]	HINO T, LEE KS, YOO H, et al. Interstitial lung abnormality (ILA) and nonspecific interstitial pneumonia (NSIP)[J]. European Journal of Radiology Open, 2021, 8: 100336. DOI: 10.1016/j.ejro.2021.100336.
[7]	DELANEY L, ALABED S, MAITER A, et al. Meta-analysis of interobserver agreement in assessment of interstitial lung disease using high-resolution CT[J]. Radiology, 2024, 313(1): e240016. DOI: 10.1148/radiol.240016.
[8]	TURGEON D, BALTER M S, PAGNOUX C. Interstitial lung disease in patients with anti-neutrophil cytoplasm antibody-associated vasculitis: An update on pathogenesis and treatment[J]. Current Opinion in Pulmonary Medicine, 2023, 29(5): 436-442. DOI: 10.1097/mcp.0000000000000979.
[9]	ALBA M A, FLORES-SUÁREZ L F, HENDERSON A G, et al. Interstitial lung disease in ANCA vasculitis[J]. Autoimmunity Reviews, 2017, 16(7): 722-729. DOI: 10.1016/j.autrev.2017.05.008.
[10]	MCDERMOTT G, FU X, STONE J H, et al. Association of cigarette smoking with antineutrophil cytoplasmic antibody-associated vasculitis[J]. JAMA Internal Medicine, 2020, 180(6): 870-876. DOI: 10.1001/jamainternmed.2020.0675.
[11]	CERRO-CHIANG G, AYRES M, RIVAS A, et al. An exploratory analysis of differences in serum protein expression by sex in patients with systemic sclerosis associated interstitial lung disease[J]. BMC Pulmonary Medicine, 2025, 25(1): 16. DOI: 10.1186/s12890-024-03474-z.
[12]	HUNNINGHAKE G M, HATABU H, OKAJIMA Y, et al. MUC5B promoter polymorphism and interstitial lung abnormalities[J]. New England Journal of Medicine, 2013, 368(23): 2192-2200. DOI: 10.1056/NEJMoa1216076.
[13]	CHOI W I, DAUTI S, KIM H J, et al. Risk factors for interstitial lung disease: A 9-year nationwide population-based study[J]. BMC Pulmonary Medicine, 2018, 18(1): 96. DOI: 10.1186/s12890-018-0660-2.
[14]	KADURA S, RAGHU G. Antineutrophil cytoplasmic antibody-associated interstitial lung disease: A review[J]. European Respiratory Review, 2021, 30(162). DOI: 10.1183/16000617.0123-2021.
[15]	OIWA H, OOI K, OYAMA T, et al. Idiopathic interstitial pneumonia as a possible cause of antineutrophil cytoplasmic antibody-associated vasculitis: A case report[J]. Archives of Rheumatology, 2018, 33(1): 89-92. DOI: 10.5606/ArchRheumatol.2018.6532.
[16]	NEGREROS M, FLORES-SUÁREZ L F. A proposed role of neutrophil extracellular traps and their interplay with fibroblasts in ANCA-associated vasculitis lung fibrosis[J]. Autoimmunity Reviews, 2021, 20(4): 102781. DOI: 10.1016/j.autrev.2021.102781.
[17]	LEE KS, HAN J, WADA N, et al. Imaging of pulmonary fibrosis: An update, from the AJR special series on imaging of fibrosis[J]. American Journal of Roentgenology, 2024, 222(2): e2329119. DOI: 10.2214/ajr.23.29119.
[18]	WIJSENBEEK M, SUZUKI A, MAHER T M. Interstitial lung diseases[J]. Lancet, 2022, 400(10354): 769-786. DOI: 10.1016/s0140-6736(22)01052-2.
[19]	BANKIER A A, MACMAHON H, COLBY T, et al. Fleischner society: Glossary of terms for thoracic imaging[J]. Radiology, 2024, 310(2): e232558. DOI: 10.1148/radiol.232558.
[20]	HATA A, HINO T, PUTMAN R K, et al. Traction bronchiectasis/bronchiolectasis on CT scans in relationship to clinical outcomes and mortality: The COPD Gene study[J]. Radiology, 2022, 304(3): 694-701. DOI: 10.1148/radiol.212584.
[21]	SMITH M L. The histologic diagnosis of usual interstitial pneumonia of idiopathic pulmonary fibrosis: Where we are and where we need to go[J]. Modern Pathology, 2022, 35(S1): 8-14. DOI: 10.1038/s41379-021-00889-5.
[22]	张笑雨, 于文成, 冯爱然, 等. ANCA血管炎相关间质性肺病的研究进展[J]. 青岛大学学报(医学版), 2018, 54(1): 115-118,126. ZHANG X Y, YU W C, FENG A R, et al. Research progress of ANCA vasculitis-related interstitial lung disease[J]. Journal of Qingdao University (Med Edition), 2018, 54(1): 115-118,126. (in Chinese).
[23]	SALVATI L, PALTERER B, LAZZERI E, et al. Presentation and progression of MPO-ANCA interstitial lung disease[J]. Journal of Translational Autoimmunity, 2024, 8: 100235. DOI: 10.1016/j.jtauto.2024.100235.
[24]	HOSODA C, BABA T, HAGIWARA E, et al. Clinical features of usual interstitial pneumonia with anti-neutrophil cytoplasmic antibody in comparison with idiopathic pulmonary fibrosis[J]. Respirology, 2016, 21(5): 920-926. DOI: 10.1111/resp.12763.