Clinical analysis of anti-neutrophil cytoplasmic antibody associated vasculitis complicated with inter-stitial lung disease

Abstract

Objective To investigate the clinical featuresand related factors of anti-neutrophil cytoplasmic antibody associated vasculitis (AVV) with interstitial lung disease (ILD), and to explore the high-resolution computed tomography (HRCT) of the chest features between different anti-neutrophil cytoplasmic antibody (ANCA) serotypes. Methods Clinical date of 125 patients diagnosed with AAV by Tianjin Medical University General Hospital from January 1, 2010 to April 30, 2017 were analyzed retrospectively. Clinical manifestations between AAV patients with ILD or those without ILD (NILD) were compared. Patients who were complicated with ILD were divided into myeloperoxidase (MPO)-ANCA positive subset and proteimase (PR3)-ANCA positive subset, and the pulmonary computed tomographic mani-festation was compared among the two subsets. The count data was analyzed by t test, chi-square test/Fisher exact probality. Logistic regression model was applied to analyze the related factors. Results Of the 125 AAV patients, 86(68.8%) patients were complicated with inter-stitial lung disease, and the mean age of ILD subgroup was higher than that of the NILD subgroup [(66±11) years vs (56±15) years, t=-3.78, P=0.001]. Com-pared with NILD patients, ILD patients had more symptoms (χ2=4.676, P=0.031). The serum levels of carcinoe-mbryonic antigen (t=-1.908, P=0.012), carbohydrate antigen 19-9 (t=-2.286, P=0.025) and carbohydrate antigen 153 (t=-2.857, P=0.007) were higher than the NILD pa-tients. In addition, MPO-ANCA positivesubgroup was more likely to present with pulmonary fibrosis (χ2=7.736, P=0.005), reticular shadow (χ2=9.762, P=0.002) and honeycombing (χ2=4.278, P=0.039) than PR3-ANCA positive subgroup on CT images of all ILD patients. Multivariate Logistic regressive analysis showed that patients who were older than 65 years [OR(95%CI): 3.305(1.280, 8.531), P=0.013], and Birmin-gham vasculitis activity(BVAS) score higher than or equal to 15 [OR(95%CI): 3.249(1.280, 8.247), P=0.013] were risk factors for AAV patients with ILD, while the probability of PR3-ANCA positive patients complicated with ILD was low [OR(95%CI): 0.063(0.005, 0.851), P=0.037]. Conclusion ILD is a very common clinical feature in AAV, especially for elders. The increase of serum CEA, CA199 and CA153 levels may be an early warning sign of interstitial lung disease. Pulmonary HRCT may more likely to present with pulmonary fibrosis in patients with MPO-ANCA positive. Key words: Antibody, antineutrophil cytoplasmic; Vasculitis; Tomography, X-ray computed; Lung disease, interstitial