title: Occupational inhalational exposure and serum GM-CSF autoantibody in pulmonary alveolar proteinosis.
abstract: OBJECTIVE
  Although the serum granulocyte-macrophage colony stimulating factor autoantibody (GMAb) levels have been recognised as a diagnostic marker in primary pulmonary alveolar proteinosis (PAP), their role in PAP with occupational inhalational exposure (PAPo) remains unclear.
  
  
  METHODS
  Forty-five consecutive patients with PAP were enrolled. Each patient with PAP was assessed for baseline clinical characteristics, chest high-resolution CT (HRCT), serum GMAb and occupational exposure. Fifty healthy controls were included to define normal ranges for GMAb levels. Ninety-seven hospital controls with other respiratory diseases were included to establish prevalence of a history of occupational inhalation exposure.
  
  
  RESULTS
  According to the serum GMAb cut-off value of 2.39 μg/mL, 84.4% of the recruited patients with PAP had positive serum GMAb with a median level of 28.7 μg/mL, defined as autoimmune PAP, and the remaining 15.6% had negative serum GMAb with a median level of 0.16 μg/mL, defined as non-autoimmune PAP. Also, 34.2% of patients with autoimmune PAP had a history of occupational inhalational exposure, which was not significantly higher than that of hospital controls (34.2% vs 19.6%, p=0.072). Four patients with PAPo showed negative GMAb. Their arterial oxygen tension, pulmonary function parameters and chest HRCT features were significantly different when compared with patients with autoimmune PAP (p<0.05). These four non-autoimmune occupational lung disease cases culminated in 3 deaths and a lung transplant.
  
  
  CONCLUSIONS
  A number of patients with PAP who may have occupational inhalational exposure and negative serum GMAb represent a high possibility of silicoproteinosis and very poor survival.
authors.affiliation: Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China Department of Respiratory Medicine, Suqian People's Hospital of Nanjing Drum Tower Hospital Group, Suqian, Jiangsu, China.
authors.forename: Yong-Long
authors.initials: YL
authors.lastname: Xiao
authors.affiliation: Department of Respiratory Medicine, Peking Union Medical College Hospital, Beijing, China.
authors.forename: Kai-Feng
authors.initials: KF
authors.lastname: Xu
authors.affiliation: Department of Respiratory Medicine, Peking Union Medical College Hospital, Beijing, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Respiratory Medicine, Suqian People's Hospital of Nanjing Drum Tower Hospital Group, Suqian, Jiangsu, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Shi
authors.affiliation: Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
authors.forename: Ke-Feng
authors.initials: KF
authors.lastname: Zhou
authors.affiliation: Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
authors.forename: Zheng-Yang
authors.initials: ZY
authors.lastname: Zhou
authors.affiliation: Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
authors.forename: Hou-Rong
authors.initials: HR
authors.lastname: Cai
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D000395:Air Pollutants, Occupational / Q000009:adverse effects*; D001323:Autoantibodies / Q000097:blood*; D001327:Autoimmune Diseases / Q000097:blood / Q000209:etiology* / Q000276:immunology; D001992:Bronchoalveolar Lavage Fluid; D004391:Dust; D005260:Female; D005740:Gases; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000097:blood / Q000276:immunology*; D006801:Humans; D019570:Inhalation Exposure / Q000009:adverse effects*; D008168:Lung / Q000276:immunology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000097:blood / Q000209:etiology / Q000276:immunology; D016273:Occupational Exposure / Q000009:adverse effects*; D011649:Pulmonary Alveolar Proteinosis / Q000097:blood / Q000209:etiology* / Q000276:immunology
chemical_list: D000395:Air Pollutants, Occupational; D001323:Autoantibodies; D004391:Dust; D005740:Gases; D016178:Granulocyte-Macrophage Colony-Stimulating Factor