过敏性肺炎的研究

Studies on Hypersensitivity Pneumonia

摘要: 过敏性肺炎(HP)是一种最常见的间质性肺病(ILD)，现阶段最大的挑战就是确切的诊断和有限的治疗手段，该疾病是由暴露于易感个体的各种刺激抗原，导致T细胞过度激活和细支气管肺泡炎症引发。然而，其遗传风险和致病机制仍未完全阐明。最近提出了修订的诊断标准，建议将该病分为纤维化和非纤维化HP，因为这具有很强的治疗效果和预后。有信心的诊断取决于肺间质性肺病的临床特征、抗原的识别、高分辨率计算机断层扫描(HRCT)上的典型图像、特征性的组织病理学特征和支气管肺泡灌洗液中的淋巴细胞增生。然而，确定抗原的来源通常具有挑战性，而且HRCT和组织病理学通常是异质性的和不典型的，这支持了诊断应该包括多学科评估的观点。抗原去除和治疗炎症过程在疾病的进展中是至关重要的，因为慢性持续炎症似乎是导致肺纤维化重建的机制之一。纤维化HP有一些治疗选择，但有效性的证据仍然缺乏。破译HP的分子病理生物学将有助于开辟新的治疗途径，并将为寻找新的诊断和预后的生物标志物提供重要的见解。

Abstract: Hypersensitivity pneumonia (HP) is a common interstitial lung disease (ILD). The biggest challenge at this stage is the exact diagnosis and limited treatment. The disease is caused by exposure to various stimulating antigens in susceptible individuals, resulting in excessive activation of T cells and inflammation of the bronchioli and alveoli. However, its genetic risk and pathogenesis are still not fully understood. Recently revised diagnostic criteria have been proposed, suggesting that the disease be divided into fibrosis and non-fibrosis HP, as this has a strong therapeutic effect and prognosis. A confident diagnosis depends on the clinical features of pulmonary interstitial lung disease, antigen recognition, typical images on high-resolution computed tomography (HRCT), char-acteristic histopathological features, and lymphocyte proliferation in bronchoalveolar lavage fluid. However, identifying the source of the antigen is often challenging, and HRCT and histopathology are often heterogeneous and atypical, supporting the idea that diagnosis should include multidis-ciplinary evaluation. Antigen removal and treatment of inflammatory processes are critical in the progression of the disease, as chronic persistent inflammation appears to be one of the mechanisms leading to reconstitution of pulmonary fibrosis. There are some treatment options for fibrotic HP, but evidence of effectiveness is still lacking. Deciphering the molecular pathobiology of HP will help open up new therapeutic pathways and will provide important insights into the search for new diagnostic and prognostic biomarkers.