Moua Teng, Petnak Tananchai, Charokopos Antonios, Baqir Misbah, Ryu Jay H
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, USA.
J Clin Med. 2022 Mar 8;11(6):1473. doi: 10.3390/jcm11061473.
Recent advances in fibrotic hypersensitivity pneumonitis include improved diagnostic guidance, systematic assessments of immunosuppressive therapy, and the recent availability of antifibrotic therapy (nintedanib) for those with progressive disease. A standardized approach to diagnosis may lead to better inclusion criteria for future therapeutic protocols and delineation of disease or treatment response predictors for real-world management. This review will highlight current diagnostic and treatment challenges and remaining knowledge gaps or areas of uncertainty, with a practical overview of supporting evidence and its clinical implications. Exposure history, serologic testing for antigen sensitivity, bronchoalveolar lavage lymphocytosis, histopathology, and radiologic findings will be covered in the diagnosis section, with immunosuppression, antifibrotic therapy, lung transplantation, and disease prognosis in the treatment and management section.
纤维化性过敏性肺炎的近期进展包括改进诊断指导、对免疫抑制治疗进行系统评估，以及近期为患有进展性疾病的患者提供了抗纤维化治疗（尼达尼布）。标准化的诊断方法可能会为未来的治疗方案带来更好的纳入标准，并明确疾病或治疗反应预测指标，以用于实际管理。本综述将重点介绍当前的诊断和治疗挑战以及尚存的知识空白或不确定性领域，并对支持证据及其临床意义进行实际概述。诊断部分将涵盖接触史、抗原敏感性血清学检测、支气管肺泡灌洗淋巴细胞增多症、组织病理学和影像学表现，治疗与管理部分将涉及免疫抑制、抗纤维化治疗、肺移植和疾病预后。
