Hypersensitivity pneumonitis: current concepts.
Hypersensitivity pneumonitis: current concepts.
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发表时间：
2001-07
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通讯作者：
S. Bourke;J. Dalphin;G. Boyd;C. McSharry;C. I. Baldwin;J. E. Calvert
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作者：
S. Bourke;J. Dalphin;G. Boyd;C. McSharry;C. I. Baldwin;J. E. Calvert
过敏性肺炎(HP)，或称外源性过敏性肺泡炎，是由于反复吸入细小分散的抗原(主要是有机颗粒或低分子化学物质)而引起的过敏反应。这种疾病的本质是宿主的免疫系统和外部抗原之间的相互作用，受到遗传和环境因素的影响。在易感人群中，它会导致Gell和Coombs的III型过敏反应(形成沉淀物)和IV型淋巴细胞反应(在远端细支气管和肺泡出现肉芽肿性炎症)。本文就幽门螺杆菌的流行病学、抗原、发病机制、宿主易感性、环境因素、临床特点、诊断和治疗等方面的研究进展作一综述。病原学的清单很长，新的抗原源也在不断被发现。宿主风险因素的特征很差，但与暴露因素有关的因素除外。环境因素和辅助因素可能在该病的发病机制中起关键作用。幽门螺杆菌不是一个统一的疾病实体，而是一个复杂的动态临床综合征，随着时间的推移会出现不同的疾病模式。诊断是结合临床特征、放射学异常、肺功能测试和免疫学测试做出的。由于缺乏标准化，吸入性挑战试验用于诊断一直受到阻碍。抗原回避是治疗中的关键因素。皮质类固醇通常有明显的有益反应，但可能很难区分治疗的效果、疾病的自然病程和抗原回避的效果。
Hypersensitivity pneumonitis (HP), or extrinsic allergic alveolitis, is due to a hypersensitivity reaction after repeated inhalation of finely dispersed antigens, mainly organic particles or low molecular weight chemicals. The essence of this disease is an interaction between the host's immune system and external antigen, influenced by both genetic and environmental factors. In susceptible subjects, it leads to a combined type III allergic reaction of Gell and Coombs (with formation of precipitines) and a type IV lymphocytic reaction (with a granulomatous inflammation in the distal bronchioles and alveoli). This review gives an update on epidemiology, antigens, pathogenesis, host susceptibility, environmental factors, clinical features, diagnosis and treatment in HP. The list of aetiological agents is long and new sources of antigens are constantly being identified. Host risk factors are poorly characterized, with the exception of those linked to exposure factors. Environmental factors and cofactors may be critical for the pathogenesis of the disease. HP is not a uniform disease entity, but a complex dynamic clinical syndrome such that different patterns of disease emerge over time. The diagnosis is made from a combination of clinical features, radiographic abnormalities, lung function tests and immunological tests. The use of inhalation challenge tests for the diagnosis has been hampered by the lack of standardization. Antigen avoidance is the key element in the treatment. There is often an apparent beneficial response to corticosteroids, but it may be difficult to distinguish between the effects of treatment, the natural course of the disease and the effect of antigen avoidance.