目的:在这项涉及伦敦三家医院的多中心研究中,我们比较了ANCA阳性和ANCA阴性可卡因诱导的中线破坏性病变(CIMDL)患者,以评估抗中性粒细胞胞浆抗体(ANCA)的存在与疾病严重程度的相关性.我们的次要目标是更好地对以ANCA阳性为中心的病因进行分类,因此,更好的疾病管理。
方法:对2019年1月至2022年12月期间发现的CIMDL患者进行回顾性审查。人口数据包括年龄,性别,介绍,内镜检查结果,可卡因使用的持续时间和可卡因的积极使用,治疗类型,实验室(包括ANCA血清学),放射学,并收集组织学发现。
结果:FortyCIMDL患者(25名男性,中位年龄42岁)。其中大多数(72.5%)出现间隔穿孔,马鞍鼻畸形(22.5%),和/或腭瘘(20.0%)。71.1%的病例ANCA呈阳性(66.7%p-ANCA)。一般特征无统计学差异,治疗类型,实验室结果,在比较ANCA阳性和ANCA阴性CIMDL患者或比较p-ANCA和c-ANCA患者时观察到放射学或组织学发现.同样,比较两组间病变的分布方式,差异无统计学意义.
结论:大部分CIMDL患者显示ANCA试验阳性(71.1%),在大多数情况下,p-ANCA模式专门针对PR3(p-ANCA,PR3+MPO-)。然而,ANCA阳性或特定ANCA模式的存在与更严重的表现或更具侵袭性的疾病无关。鉴于其与肉芽肿性多血管炎(GPA)的相似性,我们建议使用术语“可卡因诱导的ENT伪GPA”代替CIMDL。
方法:IV喉镜,134:2609-2616,2024.
OBJECTIVE: In this multicentric study involving three London hospitals, we compared ANCA-positive and ANCA-negative cocaine-induced midline destructive lesions (CIMDL) patients to assess how presence of antineutrophil cytoplasmic antibodies (ANCA) may correlate with disease severity. Our secondary aims are to better classify etiology centered around ANCA positivity and, consequently, better disease management.
METHODS: A retrospective review was performed to identify patients with CIMDL seen between January 2019 and December 2022. Population data including age, sex, presentation, endoscopic findings, duration of cocaine use and active use of cocaine, type of treatment, laboratory (including ANCA serology), radiological, and histological findings were collected.
RESULTS: Forty CIMDL patients (25 male, median age of 42 years) were identified. The majority of them (72.5%) presented with either a septal perforation, a saddle nose deformity (22.5%), and/or a palatal fistula (20.0%). ANCA was positive in 71.1% of cases (66.7% p-ANCA). No statistically significant differences in the general characteristics, type of treatment, laboratory results, radiological or histological findings were observed when comparing ANCA-positive and ANCA-negative CIMDL patients or when comparing p-ANCA and c-ANCA patients. Similarly, no statistically significant difference was obtained when comparing the pattern of distribution of lesions between the two groups.
CONCLUSIONS: A large percentage of CIMDL patients showed positive ANCA test (71.1%) and in the majority of the cases a p-ANCA pattern specifically targeting PR3 (p-ANCA, PR3 + MPO-). However, ANCA positivity or presence of a specific ANCA pattern was not associated with more severe presentation or more aggressive disease. Given its similarities to granulomatosis with polyangiitis (GPA), we recommend the use of the term \"cocaine-induced ENT pseudo-GPA\" instead of CIMDL.
METHODS: IV Laryngoscope, 134:2609-2616, 2024.