Central Clinical School, Monash University, Melbourne, VIC, Australia.
Alfred Hospital, Melbourne, VIC, Australia.
Allergy. 2022 Feb;77(2):442-453. doi: 10.1111/all.15017. Epub 2021 Jul 29.
Hypersensitivity pneumonitis is an immune-mediated interstitial lung disease caused by an aberrant response to an inhaled exposure, which results in mostly T cell-mediated inflammation, granuloma formation, and fibrosis in some cases. HP is diagnosed by exposure identification, HRCT findings of ground-glass opacities, centrilobular nodules, and mosaic attenuation, with traction bronchiectasis and honeycombing in fibrotic cases. Additional testing including serum IgG testing for the presence of antigen exposure, bronchoalveolar lavage lymphocytosis, and lung biopsy demonstrating granulomas, inflammation, and fibrosis, increases the diagnostic confidence. Treatment for HP includes avoidance of the implicated exposure, immunosuppression, and anti-fibrotic therapy in select cases. This narrative review presents the recent literature in the understanding of the immunopathological mechanisms, diagnosis, and treatment of HP.
过敏性肺炎是一种由吸入暴露引起的免疫介导的间质性肺疾病，其特征是异常的免疫反应，导致大多数情况下以 T 细胞介导的炎症、肉芽肿形成和纤维化，在某些情况下则出现纤维化。HP 的诊断依据是暴露识别、高分辨率 CT 显示磨玻璃影、小叶中心结节和马赛克衰减，纤维化病例中可见牵引性支气管扩张和蜂窝肺。包括血清 IgG 检测抗原暴露、支气管肺泡灌洗液淋巴细胞增多以及肺活检显示肉芽肿、炎症和纤维化在内的其他检测方法可提高诊断的可信度。HP 的治疗包括避免接触可疑暴露、免疫抑制和选择性纤维化病例的抗纤维化治疗。本文综述了近年来关于 HP 的免疫病理机制、诊断和治疗的文献。
