Inflammatory activity is still present in the advanced stages of idiopathic pulmonary fibrosis.
OBJECTIVE
The role of active inflammation in idiopathic pulmonary fibrosis (IPF) is controversial. A gallium-67 citrate (Ga(67) scan) is a sensitive indicator of inflammatory activity. The aim of this study was to assess the Ga(67) uptake and other markers of inflammation at different stages of IPF and to investigate its prognostic role.


METHODS
Twenty-two patients (aged 66 +/- 11 years, 18 males) with IPF were monitored for a period of 6-20 months (mean 13 months). At presentation (T0), high resolution CT (HRCT) scans showed reticular opacities and traction bronchiectasis with bi-basilar and peripheral distribution in all cases. At both T0 and follow-up (T1), we measured pulmonary function (PaO(2), FVC, DLco), overall radiographic extent of fibrosis (HRCT visual score), Ga(67) uptake, serum concentrations of lactate dehydrogenase (LDH) and C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR).


RESULTS
All parameters showed a significant deterioration during the T0-T1 interval, though the increase in Ga(67) uptake and serum markers was not significant. Patients with Ga(67) uptake indices graded as normal or mildly increased (group I), and graded as considerably or severely increased (group II) at presentation, were compared. There was no significant difference with respect to lung function or HRCT score between the two groups at T1. Ga(67) uptake, LDH, CRP and ESR at presentation did not correlate significantly with the interval change in pulmonary function and disease extent.


CONCLUSIONS
Our findings indicate that inflammatory activity in the advanced stage of IPF is still relevant, although a Ga(67) scan is not predictive of the clinical course.
Mura
Marco
M
UO Fisiopatologia Respiratoria, Policlinico Sant'Orsola-Malpighi, Bologna, Italy. marcomura@hotmail.com
Belmonte
Gelorma
G
Fanti
Stefano
S
Contini
Paola
P
Pacilli
Angela Maria Grazia
AM
Fasano
Luca
L
Zompatori
Maurizio
M
Schiavina
Mario
M
Fabbri
Mario
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D002951:Citrates; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005708:Gallium; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011658:Pulmonary Fibrosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000276:immunology; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals
D015415:Biomarkers; D002951:Citrates; D019275:Radiopharmaceuticals; D005708:Gallium; C103850:gallium citrate