Feigin D S
Crit Rev Diagn Imaging. 1986;25(2):159-76.
Four basic immune reactions in the lung are fundamental to our understanding of allergic lung diseases. The first, immediate hypersensitivity, principally involves airway obstruction because of hypersecretion and bronchospasm. Resulting roentgenographic changes are those of large and small airway disease. The second reaction, cytotoxic antibody-mediated disease, produces air space filling by hemorrhage. The third form, immune complex-mediated hypersensitivity, causes mixed patchy consolidation and interstitial roentgenographic patterns caused by inflammation stimulated by antigen-antibody complexes. Fourth, cell-mediated immunity usually produces a granulomatous reaction, roentgenographically manifest by nodules, masses, and enlarged lymph nodes. Applying our understanding of these four basic reactions permits understanding the common allergic disease of the lungs: hypersensitivity pneumonitis, asthma, allergic bronchopulmonary fungal disease, chronic eosinophilic pneumonia, hypereosinophilic syndrome, Goodpasture's syndrome and idiopathic pulmonary hemosiderosis (IPH), Wegener's granulomatosis, and allergic granulomatosis (Churg-Strauss disease). The clinical, pathologic, and roentgenographic manifestations of these diseases are explained and related to the basic immune mechanisms.
肺部的四种基本免疫反应对于我们理解过敏性肺部疾病至关重要。第一种，速发型超敏反应，主要涉及因分泌亢进和支气管痉挛导致的气道阻塞。产生的X线表现为大小气道疾病的特征。第二种反应，细胞毒性抗体介导的疾病，会导致气腔因出血而充盈。第三种形式，免疫复合物介导的超敏反应，由抗原 - 抗体复合物刺激炎症引发，导致混合性斑片状实变和间质X线表现。第四种，细胞介导的免疫通常产生肉芽肿反应，在X线片上表现为结节、肿块和肿大的淋巴结。运用我们对这四种基本反应的理解，有助于理解常见的肺部过敏性疾病：过敏性肺炎、哮喘、变应性支气管肺真菌病、慢性嗜酸性粒细胞性肺炎、高嗜酸性粒细胞综合征、古德帕斯彻综合征和特发性肺含铁血黄素沉着症（IPH）、韦格纳肉芽肿和过敏性肉芽肿（变应性肉芽肿性血管炎）。这些疾病的临床、病理和X线表现得到解释，并与基本免疫机制相关联。
