Behr J, Günther A, Bonella F, Dinkel J, Fink L, Geiser T, Geißler K, Gläser S, Handzhhiev S, Jonigk D, Koschel D, Kreuter M, Leuschner G, Markart P, Prasse A, Schönfeld N, Schupp J C, Sitter H, Müller-Quernheim J, Costabel U
Medizinische Klinik und Poliklinik V, Klinikum der Universität München und Asklepios Fachkliniken München-Gauting, Comprehensive Pneumology Center, Mitglied des Deutschen Zentrums für Lungenforschung, München.
Schwerpunkt Fibrosierende Lungenerkrankungen, Universitätsklinikum Gießen - Marburg, Standort Gießen, Justus-Liebig-Universität Gießen, sowie Agaplesion Pneumologische Klinik Waldhof-Elgershausen, Greifenstein, University of Giessen Marburg Lung Center, Mitglied des Deutschen Zentrums für Lungenforschung.
Pneumologie. 2020 May;74(5):263-293. doi: 10.1055/a-1120-3531. Epub 2020 Mar 30.
Idiopathic pulmonary fibrosis (IPF) is a severe and often fatal disease. Diagnosis of IPF requires considerable expertise and experience. Since publication of the international IPF guideline in the year 2011 and Update 2018 several studies and technical advances occurred, which made a new assessment of the diagnostic process mandatory. In view of the antifibrotic drugs which have been approved for the treatment of IPF patients, the goal of this guideline is to foster early, confident and effective diagnosis of IPF. The guideline focusses on the typical clinical setting of an IPF patient and provides tools to exclude known causes of interstitial lung disease including standardised questionnaires, serologic testing and cellular analysis of bronchoalveolar lavage. High resolution computed tomography remains crucial in the diagnostic work-up. If it is necessary to obtain specimen for histology transbronchial lung cryobiopsy is the primary approach, while surgical lung biopsy is reserved for patients who are fit for it and in whom bronchoscopic diagnosis did not provide the information needed. Despite considerable progress, IPF remains a diagnosis of exclusion and multidisciplinary discussion remains the golden standard of diagnosis.
特发性肺纤维化(IPF)是一种严重且往往致命的疾病。IPF的诊断需要相当的专业知识和经验。自2011年国际IPF指南发布以及2018年更新以来,出现了多项研究和技术进展,这使得必须对诊断过程进行重新评估。鉴于已批准用于治疗IPF患者的抗纤维化药物,本指南的目标是促进IPF的早期、准确且有效的诊断。该指南聚焦于IPF患者的典型临床情况,并提供排除间质性肺疾病已知病因的工具,包括标准化问卷、血清学检测以及支气管肺泡灌洗的细胞分析。高分辨率计算机断层扫描在诊断检查中仍然至关重要。如果有必要获取组织学标本,经支气管肺冷冻活检是主要方法,而外科肺活检则保留给适合进行该检查且支气管镜诊断未能提供所需信息的患者。尽管取得了相当大的进展,但IPF仍然是一种排除性诊断,多学科讨论仍然是诊断的金标准。