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[与结缔组织病相关的间质性肺疾病]

[Interstitial lung disease associated with connective tissue disease].

作者信息

Fisseler-Eckhoff Annette, Märker-Hermann Elisabeth

机构信息

Institut für Pathologie und Zytologie, Helios Dr. Horst Schmidt-Kliniken Wiesbaden GmbH, Ludwig Erhard Str. 100, 65199, Wiesbaden, Deutschland.

Klinik für Rheumatologie, Klinische Immunologie und Nephrologie, Helios Dr. Horst Schmidt-Kliniken Wiesbaden, Wiesbaden, Deutschland.

出版信息

Pathologe. 2021 Feb;42(1):4-10. doi: 10.1007/s00292-020-00902-9. Epub 2021 Jan 8.

Abstract

Interstitial lung disease (ILD) is the most frequent organ manifestation in rheumatic autoimmune disease. Depending on the underlying autoimmune disease, differently pronounced affections of small airways, interstitial parenchyma, and vessels are found. The group of rheumatic autoimmune diseases mainly includes connective tissue diseases (CTDs), also known as collagen vascular diseases, such as rheumatoid arthritis (RA), systemic sclerosis, (SSc), systemic lupus erythematosus, primary Sjögren's syndrome, idiopathic inflammatory myositis (IIM), and interstitial pneumonia with autoimmune features (IPAF). Frequency and manifestations of parenchymal lung disorders are described clinically, radiologically, and morphologically in these entities. For the precise diagnosis and for the differentiation between the wide range of parenchymal disorders with known possible cause or with unknown origin, also called unclassifiable or idiopathic interstitial pneumonias (IIPs), high resolution computed tomography (HRCT) findings represent the diagnostic gold standard. A transbronchial biopsy, surgical biopsy, or cryobiopsy will be used in unclassifiable findings to confirm a definitive histological confirmation. A precise diagnosis of these ILDs is crucial since the different pathologies that encompass ILD have different therapeutic options. In this sense, the participation of a pneumologist, rheumatologist, radiologist, and pathologist become essential in the multidisciplinary evolution of ILD.

摘要

间质性肺疾病(ILD)是风湿性自身免疫性疾病中最常见的器官表现。根据潜在的自身免疫性疾病不同,可发现小气道、间质实质和血管受到不同程度的影响。风湿性自身免疫性疾病主要包括结缔组织病(CTD),也称为胶原血管病,如类风湿关节炎(RA)、系统性硬化症(SSc)、系统性红斑狼疮、原发性干燥综合征、特发性炎性肌病(IIM)以及具有自身免疫特征的间质性肺炎(IPAF)。临床上、放射学上和形态学上描述了这些疾病中肺实质疾病的发生率和表现。对于精确诊断以及区分各种已知可能病因或病因不明的实质疾病,即所谓的不可分类或特发性间质性肺炎(IIP),高分辨率计算机断层扫描(HRCT)结果是诊断的金标准。对于不可分类的结果,将采用经支气管活检、手术活检或冷冻活检来确认明确的组织学诊断。准确诊断这些ILD至关重要,因为涵盖ILD的不同病理有不同的治疗选择。从这个意义上讲,肺科医生、风湿科医生、放射科医生和病理科医生的参与在ILD的多学科诊疗过程中至关重要。

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