Hypersensitivity Pneumonitis: Perspectives in Diagnosis and Management
Hypersensitivity Pneumonitis: Perspectives in Diagnosis and Management
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DOI：
10.1164/rccm.201611-2201pp
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发表时间：
2017-09-15
影响因子：
24.7
通讯作者：
Raghu, Ganesh
中科院分区：
文献类型：
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作者：
Vasakova, Martina;Morell, Ferran;Raghu, Ganesh
对过敏性肺炎（HP）作为一种独特疾病实体的认识可追溯到世纪（1）。从那时起，许多激发剂已被归因于诱导HP，现在更好地了解疾病的发病机制（1，2）。HP是一种具有许多方面和表型的疾病，使其与其他间质性肺病（ILD），特别是特发性肺纤维化（IPF）的识别和鉴别具有挑战性。临床医生通常无法区分慢性HP（CHP）与IPF的特征，一些符合2011年IPF诊断标准的患者实际上可能患有CHP伴肺纤维化（3）。参与IPF临床试验的患者的高筛查失败率突出了这一诊断挑战，因为肺病学家可能将CHP患者误诊为IPF，忽略了可能导致疾病的环境因素（4-8）。尽管最近的数据和报告表明了HP诊断、管理和治疗的新方向（9-15），但在流行病学、发病机制、最佳诊断方法以及最终对该疾病的分类方面的知识仍存在很大差距。专家之间缺乏诊断、治疗和管理的共识，显然需要共识指南。在这方面，我们提出了诊断标准和一个新的分类HP的基础上结合国际临床经验和现有的证据。我们相信，这些标准将是有用的肺病学家面对病人怀疑有HP和促进进一步的研究，以增加我们的理解HP应该如何管理。建议的标准需要在进一步的研究中验证，因此不应被解释为指南建议。
Awareness of hypersensitivity pneumonitis (HP) as a unique disease entity dates back to the 18th century (1). Since then, numerous inciting agents have been attributed to inducing HP, and the pathogenesis of the disease is now better understood (1, 2). HP is a disease of many facets and phenotypes, making its recognition and differentiation from other interstitial lung diseases (ILDs) challenging, in particular idiopathic pulmonary fibrosis (IPF). The clinician is often unable to distinguish features of chronic HP (CHP) from those of IPF, and some patients meeting the 2011 criteria for the diagnosis of IPF may in fact have CHP with pulmonary fibrosis (3). The high rate of screen failures in patients participating in IPF clinical trials highlights this diagnostic challenge, as pulmonologists may be misdiagnosing patients with CHP as having IPF, overlooking environmental factors that can contribute to the disease (4–8). Despite recent data and reports suggesting new directions in the diagnosis, management, and treatment of HP (9–15), there remain substantial gaps in knowledge of epidemiology, pathogenesis, optimal diagnostic approach, and, ultimately, classification of this disease. Consensus among experts for diagnosis, treatment, and management are lacking, and the need for consensus guidelines is evident. In thisPerspective, we propose diagnostic criteria and a novel classification of HP based on a combination of international clinical experience and available evidence. We believe that these criteria will be of use to the pulmonologist when confronted with patients suspected of having HP and promote further study to increase our understanding of how HP should be managed. The proposed criteria need to be validated in further studies, and therefore should not be interpreted as a guideline recommendation.