5 血液检查
目前,尚未在血液中找到特异性诊断IPF的标志物,但发现了一些能间接反应IPF活动性的物质,如肺表面活性物质D [6 ]等。类似标志物将来可能成为诊断IPF的手段之一。
综上所述,单用一种方法很难对IPF进行特异性诊断,多学科共同诊断才能提高IPF诊断的准确性。美国胸科学会和欧洲呼吸病学会于2002年提出了IPF诊断的临床标准[ 7 ] : ①主要标准:排除已知原因间质性肺疾病,如药物性、环境暴露、结缔组织疾病; 肺功能异常,包括肺活量减少、FEV1 /FVC减少、肺泡动脉氧分压差在休息和运动中增加幅度不同、CO弥散能力减小; HRCT表现为双肺底部网格影并轻度毛玻璃影;支气管肺活检或BAL 不支持其他诊断。②次要标准:年龄> 50岁;隐性起病、不能解释的运动性呼吸困难;病程≥3个月;双肺基底部湿罗音。目前,大多数学者认为,临床、影像、病理三者联合诊断IPF才是最准确的。但足量的病理组织往往难以获得,故目前对IPF的诊断较多依赖临床和影像诊断。怎样更准确地认识IPF的临床和影像学表现成为正确诊断IPF的关键。
[参考文献]
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来源:山东医药 作者:李洪波,吕长俊,张晓荣