Collard Harold R, King Talmadge E
Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Sciences Center, Denver, USA.
Arch Intern Med. 2003 Jan 13;163(1):17-29. doi: 10.1001/archinte.163.1.17.
Careful histopathological evaluation has shown the traditionally clinical diagnosis of idiopathic interstitial pneumonia to be more heterogeneous than once thought. Its subclassification, based on clinicopathological criteria, has important therapeutic and prognostic implications. The most important distinction is the presence of usual interstitial pneumonia, the histopathological pattern seen in idiopathic pulmonary fibrosis. Idiopathic pulmonary fibrosis has a worse response to therapy and prognosis. New insight into the pathophysiology of idiopathic pulmonary fibrosis suggests a distinctly fibroproliferative process, and antifibrotic therapies show promise. Although the clinical and radiographic diagnosis of idiopathic pulmonary fibrosis can be made confidently in some cases, many patients require surgical lung biopsy to determine their underlying histopathological pattern. A structured, clinicopathological approach to the diagnosis of idiopathic interstitial pneumonia, with particular attention to the identification of idiopathic pulmonary fibrosis, ensures proper therapy, enhances prognosis, and allows for further investigation of therapies aimed at the distinct pathophysiology.
仔细的组织病理学评估显示，传统上临床诊断的特发性间质性肺炎比以往认为的更加异质性。基于临床病理标准的亚分类具有重要的治疗和预后意义。最重要的区别是普通型间质性肺炎的存在，这是特发性肺纤维化中所见的组织病理学模式。特发性肺纤维化对治疗的反应和预后较差。对特发性肺纤维化病理生理学的新见解表明这是一个明显的纤维增生过程，抗纤维化治疗显示出前景。尽管在某些情况下可以自信地做出特发性肺纤维化的临床和影像学诊断，但许多患者需要进行外科肺活检以确定其潜在的组织病理学模式。一种结构化的临床病理方法来诊断特发性间质性肺炎，尤其关注特发性肺纤维化的识别，可确保适当的治疗，改善预后，并允许针对独特病理生理学的治疗进行进一步研究。
