胸部高分辨率CT新分型对特发性肺纤维化早期诊断的影响

Effect of the new typing of high-resolution CT of the lung on early diagnosis of idiopathic pulmonary fibrosis

胸部高分辨率CT (HRCT)在特发性肺纤维化(IPF)的诊断中起核心作用。根据现有指南和专家共识,临床怀疑IPF患者的HRCT表现可分为肯定寻常型间质性肺炎(UIP)、可能UIP和不符合UIP三个基本类型,而对一些不典型病例可考虑为不确定UIP型。当患者具有典型的IPF临床表现且HRCT表现为肯定UIP型或可能UIP型,可作出有信心的IPF的诊断。表现为不符合UIP型的患者多考虑为非IPF,针对不确定型UIP可采用积极活检获取病理诊断或密切观察。HRCT这种分型方法便于临床上分层管理,将有助于IPF早期诊断。

High-resolution CT of the lung plays a core role in diagnosis of idiopathic pulmonary fibrosis. For patients with suspected IPF, the current diagnostic guidelines and consensus statement provide 3 categories of UIP diagnosis by HRCT： definite UIP pattern, possible UIP pattern, and inconsistent UIP pattern. Some untypical cases may be considered indeterminate UIP pattern, A diagnosis of IPF can be confidently made in a patient with a typical clinical context of IPF, with a HRCT pattern of definite or possible UIP. q-he patient with inconsistent UIP pattern may not be considered IPF. Surgical biopsy or close follow-up can be used for the patient with indeterminate UIP pattern. This HRCT classification is convenient for clinical stratification management, and will help early diagnosis ofIPF.