Navegando por Palavras-chave "Pneumonite De Hipersensibilidade"

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    Biópsia transbrônquica em pneumonite de hipersensibilidade crônica
    (Universidade Federal de São Paulo (UNIFESP), 2019-06-27) Botelho, Andre Bezerra [UNIFESP]; Pereira, Carlos Alberto De Castro [UNIFESP]; http://lattes.cnpq.br/5439717016826243; Universidade Federal de São Paulo (UNIFESP)
    Introduction: The diagnosis of chronic hypersensitivity pneumonitis (cHP) is based on clinical data, tomographic patterns and, in several cases, on pathologic findings. There are some proposed diagnostic criteria, but none is widely accepted. The role of transbronchial biopsy (TBB) in HP is still uncertain. Aim: To analyze the yield of the TBB in patients with cHP according tomographic findings and to evaluate the importance of the bronchoalveolar lavage (BAL) in the diagnosis approach. Methods: Retrospective study of patients with cHP submitted to TBB in two specialized centers in interstitial lung diseases in São Paulo - Brazil, between 1999 and 2017. Diagnostic criteria according Salisbury et al were applied to diagnosis. The disease was classified as non-fibrotic or fibrotic according findings of fibrosis on HRCT. Findings in TBB were classified as definitive (granulomas and/or multinucleated giant’s cells, associated or not with peribronchiolar infiltration of lymphocytes and plasma cells and bronchiolocentric distribution) and compatible (indicative of small airway injury, such as peribronchiolar metaplasia, organizing pneumonia and intra-alveolar xanthomatous macrophages). Results: One hundred and nine patients were included, with female predominance (70.6%), mean age 61.4 years and mean FVC 72.1%. The main symptom was dyspnea, in 95 cases (87.1%). The tomographic finding more common was ground-glass, in 90 cases (82.6%), followed by any indicative findings of fibrosis, in 76 (69.7%) and mosaic attenuation/air trapping, in 67 (61.5%). The main identified exposures were to molds (60.6%) and birds (48.6%). The presence of definitive findings of HP were seen in 15 cases (13.8%) and compatible findings in 33 (30.2%), with total yield of 44%. Pathologic definite findings were more common in cases without fibrosis on HRCT (24,2% vs. 9,2%, p= 0.036), whereas the presence compatible findings were more common in fibrotic HP (38.1% vs. 12.1%, p= 0.007). The number of samples obtained in the TBB did not influences the results. 52 patients had differential cytology of the BAL. Lymphocytosis (> 20%) was present in 51.9% of the patients. The median of the percentage of lymphocytes in the BAL was 20,0% (interquartile interval: 11,5% to 29,5%). There wasn’t difference in the median of the lymphocytes according tomographic patterns. Conclusion: The TBB has a considerable yield to the diagnosis of HP and in association with BAL should be used as the initial option in the investigation of the disease.
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    CA 15-3 como marcador de atividade e gravidade na pneumonite de hipersensibilidade crônica
    (Universidade Federal de São Paulo (UNIFESP), 2019-03-28) Gomes, Paula Silva [UNIFESP]; Pereira, Carlos Alberto De Castro [UNIFESP]; http://lattes.cnpq.br/9232295231546605; http://lattes.cnpq.br/3792784925350536; Universidade Federal de São Paulo (UNIFESP)
    Objective: Assess CA 15-3 as severity and activity marker in chronic hypersensitivity pneumonitis (cHP). Methods: Forty-one adults diagnosed according Salisbury’s criteria were evaluated in a cross-sectional study. Patients with other causes that could lead to high serum levels of CA 15-3 or dyspnea were excluded. Serum levels of CA 15-3 were: 1) Compared between patients with and without disease activity (based on progressive worsening of the dyspnea or significant worsening of lung function in the last 6-12 months before the study enrollment); 2) Correlated with functional severity indicators; 3) Compared between CT semi-quantitative scores set by two expert radiologists and; 4) Compared between patients removed from antigen exposure and others. Results: median age was 70.2 ± 17.34 years; Mean FVC% was 60.9±11.5. Environmental exposure was presented in all cases. Serum levels of CA 15-3 were higher in patients with active disease (Md= 73,2, Q1=34,7-Q3=141,6 vs Md= 38,8, Q1=25,7-Q3=60,9, p=0,02) in those out of activity. The cut-off point of CA 15-3 obtained using ROC curve was 51 U/mL (t=6,16, p=0,01). CA 15-3 were negatively correlated with: FVC% (r =-0,30, p=0,05), DLCO% (r =-0,52, p<0,01) e Exercise SpO2 (r =-0,59, p<0,01). There was a direct correlation between CA 15-3 and semiquantitative score of ground-glass opacities extension (F=3,03, p=0,04). There was no correlation with score fibrosis. Patients improved after withdrawal of exposure had lower values of CA 15-3 than those maintained it and worsened and the best point of cut-off was 55 U/mL (AUC=0,73, p=0,01). Conclusion: CA 15-3 is a promising biomarker in HP chronic disclosing direct correlation with disease severity, particularly with gas exchange and activity.