Molina C
Rev Fr Mal Respir. 1983;11(4):427-38.
Hypersensitivity pneumonitis is one model of environmental pulmonary disease. If the clinical and radiological pictures are now well established the risk of allergic disorders in the community can only be appreciated by large epidemiological enquiries which ought to be carried out with the utmost vigor, yet may be deceptive. As regards diagnosis, one should take note on the one hand of: --respiratory function tests showing the involvement of the alveoli and the interstitium in the pathological process but also that of the peripheral bronchioles, that is the distal lung as a whole. --On the other hand systemic immunological studies (search for precipitating antibodies to allergens, always considered to be a diagnostic test of major value) may nonetheless be reinforced by cell counts lymphocytes) or skin tests and even provocation tests. --The study of bronchoalveolar lavage yields very important information: An increase in the number of cells, notably " T " lymphocytes, biochemical disturbances characterized by an increase in protein and lipid levels with qualitative changes in the phospholipids: a fall in the lecithin and a rise of the other fractions which lead to an increase in the microviscosity of alveolar liquid. Finally an aetiological study is required to identify the allergen in the ambient atmosphere of the patient or worker and if possible, an experimental study trying to reproduce the pathological lesions and the immunological disturbances. Finally the treatment should consist of excluding the offending agent. Steroid therapy is justified in acute situations with disturbed function, but this does not prevent a final outcome of irreversible fibrosis.
过敏性肺炎是环境性肺部疾病的一种类型。尽管目前临床和影像学表现已较为明确，但社区中过敏性疾病的风险只能通过大规模的流行病学调查来评估，此类调查应大力开展，然而其结果可能具有误导性。关于诊断，一方面应注意：——呼吸功能测试显示肺泡、间质以及外周细支气管（即整个肺远端）均参与了病理过程。——另一方面，系统性免疫学研究（寻找针对过敏原的沉淀抗体，这一直被视为具有重要价值的诊断测试）可通过细胞计数（淋巴细胞）、皮肤试验甚至激发试验加以强化。——支气管肺泡灌洗研究能提供非常重要的信息：细胞数量增加，尤其是“T”淋巴细胞；生化紊乱表现为蛋白质和脂质水平升高，磷脂出现定性变化，即卵磷脂减少，其他组分增加，导致肺泡液微黏度增加。最后，需要进行病因学研究以确定患者或工人周围环境中的过敏原，如有可能，开展实验研究以重现病理病变和免疫紊乱情况。最后，治疗应包括避免接触致病因素。在功能紊乱的急性情况下，使用类固醇疗法是合理的，但这并不能阻止最终出现不可逆纤维化的结局。
