Berezowska Sabina
Institut Universitaire de Pathologie, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Rue du Bugnon 25, 1011, Lausanne, Schweiz.
Pathologe. 2021 Feb;42(1):48-54. doi: 10.1007/s00292-020-00885-7. Epub 2020 Dec 23.
Hypersensitivity pneumonia (HP), also called exogenous allergic alveolitis, is a chronic interstitial pneumonia induced by a hypersensitivity reaction to an identified or unidentified antigen in exposed and susceptible individuals that may progress to terminal lung fibrosis. The diagnosis of HP presents a diagnostic challenge. Though therapeutically important, it may be particularly difficult to differentiate fibrotic HP, historically termed chronic HP, from idiopathic pulmonary fibrosis (IPF) or interstitial lung disease associated with connective tissue diseases (CTD-ILD). Multidisciplinary discussion and thus a synoptic evaluation of all findings is firmly established as the gold standard diagnostic approach in interstitial lung diseases including HP. Nonetheless, the high interobserver variability between experts from the individual disciplines (pulmonology, radiology, and pathology) and between experienced multidisciplinary teams in assessing the diagnostic probability of HP has highlighted the need for widely accepted guidelines.The present review summarizes pathology-relevant aspects of the new ATS/JRS/ALAT clinical practice guideline for the diagnosis of HP in adults.
过敏性肺炎（HP），也称为外源性过敏性肺泡炎，是一种慢性间质性肺炎，由暴露且易感个体对已识别或未识别抗原的超敏反应引起，可能进展为终末期肺纤维化。HP的诊断具有挑战性。尽管在治疗上很重要，但将纤维化型HP（历史上称为慢性HP）与特发性肺纤维化（IPF）或与结缔组织病相关的间质性肺病（CTD-ILD）区分开来可能特别困难。多学科讨论以及对所有检查结果的综合评估已被牢固确立为包括HP在内的间质性肺病的金标准诊断方法。尽管如此，各学科（肺病学、放射学和病理学）的专家之间以及经验丰富的多学科团队在评估HP诊断可能性时观察者间的高度变异性凸显了制定广泛认可指南的必要性。本综述总结了美国胸科学会/日本呼吸学会/拉丁美洲胸科协会关于成人HP诊断的新临床实践指南中与病理学相关的方面。
