Šterclová Martina
Vnitr Lek. 2022 Winter;68(8):525-531. doi: 10.36290/vnl.2022.111.
Interstitial lung diseases (ILDs) are not just a matter of scarring or inflammation in the lung tissue. The lungs can also serve as a repository for products that can be produced in excessive amounts in the human body as a result of disease. Geneticaly based dysfunctions of lysosomal enzymes, which leads to an unefficient degradation and transport of various macromolecules from lysosomes, are considered to be storage diseases sensu stricto. ILDs were described in patients with Gaucher disease, Niemann-Pick disease and Fabry disease. In a broader context, however, the accumulation of various substances in the lung tissue is also encountered in cases of pediatric pulmonary interstitial glycogenosis (PIG), alveolar lipoproteinosis or pulmonary amyloidosis. The cause of PIG is not clear. The disease was first described in 2002 and a lung tissue sample is required to establish this diagnosis. Even though PIG usually goes well in childhood and the patients difficulties spontaneously subside over time, the long-term prognosis of the patients is unknown. Alveolar lipoproteinoses can be acquired (e.g. after massive exposure to silica dust), autoimmune, but also genetically determined. Unlike lysosomal storage diseases, in the case of pulmonary alveolar lipoproteinosis, accumulation of abnormal macromolecules occurs only in the lungs of affected individuals. Similarly, amyloidosis is not a single disease, but a group of diseases with different etiopathogenesis, as a result of which amyloid - a group of different proteins with a distinctvive conformation, which can be deposited in various organs, including the lungs - is formed. The diagnosis of pulmonary alveolar lipoproteinosis is based on the typical appearance and biochemical composition of the fluid obtained by bronchoalveolar lavage, the diagnosis of amyloidosis is histological.
间质性肺疾病(ILDs)不仅仅是肺组织的瘢痕形成或炎症问题。肺还可能成为因疾病在人体内过量产生的产物的储存场所。基于遗传的溶酶体酶功能障碍会导致各种大分子从溶酶体的降解和运输效率低下,被认为是严格意义上的储存疾病。在戈谢病、尼曼-匹克病和法布里病患者中曾有ILDs的描述。然而,从更广泛的角度来看,小儿肺间质糖原沉积症(PIG)、肺泡蛋白沉积症或肺淀粉样变性病例中也会出现肺组织中各种物质的蓄积。PIG的病因尚不清楚。该病于2002年首次被描述,需要肺组织样本才能确诊。尽管PIG在儿童期通常病情良好,患者的症状会随着时间自发缓解,但患者的长期预后尚不清楚。肺泡蛋白沉积症可以是后天获得性的(如大量接触二氧化硅粉尘后)、自身免疫性的,也可以是由遗传决定的。与溶酶体储存疾病不同,在肺泡蛋白沉积症中,异常大分子的蓄积仅发生在受影响个体的肺部。同样,淀粉样变性不是单一疾病,而是一组具有不同病因发病机制的疾病,其结果是形成了淀粉样蛋白——一组具有独特构象的不同蛋白质,可沉积在包括肺在内的各种器官中。肺泡蛋白沉积症的诊断基于支气管肺泡灌洗所获液体的典型外观和生化组成,淀粉样变性的诊断则依靠组织学检查。