Rosenstein B J, Cutting G R
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
J Pediatr. 1998 Apr;132(4):589-95. doi: 10.1016/s0022-3476(98)70344-0.
The diagnostic criteria proposed here are not likely to cover every possible clinical scenario, and there will be clinical dilemmas. For the vast majority of patients with CF, the diagnosis will be suggested by the presence of one or more characteristic clinical features, a history of CF in a sibling, or a positive newborn screening test result and will then be confirmed by laboratory evidence of CFTR dysfunction (Table V). Abnormal CFTR function will usually be documented by two elevated sweat chloride concentrations obtained on separate days or identification of two CF mutations. For patients in whom sweat chloride concentrations are normal or borderline and in whom two CF mutations are not identified, an abnormal nasal PD measurement recorded on 2 separate days can be used as evidence of CFTR dysfunction. Clinical judgment will continue to be essential in patients who have typical or "atypical" clinical features but who lack conclusive evidence of CFTR dysfunction. Such patients will require close clinical follow-up along with laboratory reevaluation as appropriate.
此处提出的诊断标准不太可能涵盖每一种可能的临床情况,临床中会存在两难困境。对于绝大多数囊性纤维化(CF)患者而言,若出现一种或多种特征性临床特征、同胞有CF病史或新生儿筛查试验结果呈阳性,就可能提示诊断,随后通过CFTR功能障碍的实验室证据得以确诊(表五)。CFTR功能异常通常通过在不同日期测得的两次汗液氯化物浓度升高或鉴定出两个CF突变来记录。对于汗液氯化物浓度正常或处于临界值且未鉴定出两个CF突变的患者,在不同日期记录的两次异常鼻电位差测量结果可作为CFTR功能障碍的证据。对于具有典型或“非典型”临床特征但缺乏CFTR功能障碍的确凿证据者,临床判断仍至关重要。此类患者需要密切的临床随访以及适时的实验室重新评估。