Hagmeyer Lars, Stieglitz S, Röcken C, Randerath W
Krankenhaus Bethanien gGmbH, Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Solingen.
Pneumologie. 2012 Aug;66(8):483-92. doi: 10.1055/s-0032-1309811. Epub 2012 Jun 12.
Amyloidosis is a rare disorder within the field of pneumology, however, it is estimated that there are a relevant number of unreported cases. In routine clinical practice, the disease is seldom considered in the diagnostic work-up of unclear respiratory symptoms and radiological findings. For amyloidosis to be considered as a differential diagnosis, the clinician must be aware of the broad variety of its clinical manifestations. In cases where amyloidosis is suspected, it is important to obtain an early tissue biopsy. If the diagnosis can be confirmed by Congo red staining, further subtyping of the amyloid protein is necessary in order to identify a treatable cause of the disease. The amyloidoses are classified according to the type of amyloid protein, with clinical subclassifications distinguishing hereditary from acquired forms and localised from generalised manifestations. Apart from causal therapy of the primary disease, the treatment of generalised amyloidosis includes specific systemic therapy. The majority of localised forms are treated with specific local interventions showing good long-term results. This review outlines the pathophysiology, classification, diagnostic pathways and therapeutic modalities in amyloidosis. Furthermore, typical manifestations of amyloidosis of the lung and the specific treatment options are discussed.
淀粉样变性是肺病领域的一种罕见疾病,然而,据估计有相当数量的未报告病例。在常规临床实践中,在对不明原因的呼吸道症状和影像学表现进行诊断检查时,很少会考虑到这种疾病。要将淀粉样变性视为鉴别诊断,临床医生必须了解其广泛的临床表现。在怀疑淀粉样变性的病例中,尽早进行组织活检很重要。如果刚果红染色能确诊,为了确定可治疗的病因,有必要对淀粉样蛋白进行进一步的亚型分类。淀粉样变性根据淀粉样蛋白的类型进行分类,临床亚分类将遗传性与获得性形式以及局限性与全身性表现区分开来。除了对原发性疾病进行病因治疗外,全身性淀粉样变性的治疗还包括特定的全身治疗。大多数局限性形式采用特定的局部干预措施进行治疗,长期效果良好。本综述概述了淀粉样变性的病理生理学、分类、诊断途径和治疗方式。此外,还讨论了肺淀粉样变性的典型表现和具体治疗选择。