Diagnosis of Idiopathic Pulmonary Fibrosis An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline
Diagnosis of Idiopathic Pulmonary Fibrosis An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline
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DOI：
10.1164/rccm.201807-1255st
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发表时间：
2018-09-01
影响因子：
24.7
通讯作者：
Wilson, Kevin C.
中科院分区：
文献类型：
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作者：
Raghu, Ganesh;Remy-Jardin, Martine;Wilson, Kevin C.
背景：本文件提供了诊断特发性肺纤维化（IPF）的临床建议。它代表了美国胸科学会、欧洲呼吸学会、日本呼吸学会和拉丁美洲胸科学会之间的合作努力。方法：由 IPF 专家组成的多学科委员会讨论了证据综合并制定了建议。使用建议分级、评估、制定和评估方法对证据进行评估，并制定、撰写和分级建议。结果：指南小组更新了 IPF 的诊断标准。先前定义的普通间质性肺炎 (UIP) 模式被细化为 UIP、可能 UIP、不确定和替代诊断模式。对于新发现的间质性肺疾病（ILD）患者，其高分辨率计算机断层扫描模式为可能的 UIP、不确定或替代诊断，有条件地建议进行 BAL 和外科肺活检；由于缺乏证据，没有建议或反对进行经支气管肺活检或肺冷冻活检。相反，对于新发现的 ILD 且具有 UIP 高分辨率计算机断层扫描模式的患者，强烈建议不要进行外科肺活检、经支气管肺活检和肺冷冻活检，并有条件建议不要进行 BAL。其他建议包括有条件地建议进行多学科讨论，并强烈建议不要仅出于区分 IPF 与其他 ILD 的目的而测量血清生物标志物。 结论：指南小组提供了与 IPF 诊断相关的建议。
Background: This document provides clinical recommendations for the diagnosis of idiopathic pulmonary fibrosis (IPF). It represents a collaborative effort between the American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Latin American Thoracic Society.Methods: The evidence syntheses were discussed and recommendations formulated by a multidisciplinary committee of IPF experts. The evidence was appraised and recommendations were formulated, written, and graded using the Grading of Recommendations, Assessment, Development, and Evaluation approach.Results: The guideline panel updated the diagnostic criteria for IPF. Previously defined patterns of usual interstitial pneumonia (UIP) were refined to patterns of UIP, probable UIP, indeterminate, and alternate diagnosis. For patients with newly detected interstitial lung disease (ILD) who have a high-resolution computed tomography scan pattern of probable UIP, indeterminate, or an alternative diagnosis, conditional recommendations were made for performing BAL and surgical lung biopsy; because of lack of evidence, no recommendation was made for or against performing transbronchial lung biopsy or lung cryobiopsy. In contrast, for patients with newly detected ILD who have a high-resolution computed tomography scan pattern of UIP, strong recommendations were made against performing surgical lung biopsy, transbronchial lung biopsy, and lung cryobiopsy, and a conditional recommendation was made against performing BAL. Additional recommendations included a conditional recommendation for multidisciplinary discussion and a strong recommendation against measurement of serum biomarkers for the sole purpose of distinguishing IPF from other ILDs.Conclusions: The guideline panel provided recommendations related to the diagnosis of IPF.