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肺泡蛋白沉积症诊治研究进展

Research progress of diagnosis and treatment of pulmonary alveolar proteinosis

  • 摘要: 肺泡蛋白沉积症(pulmonary alveolar proteinosis,PAP)是罕见的慢性间质性肺部疾病,以肺泡及细支气管腔内积聚大量磷脂蛋白样物质为特征, 目前国内对于PAP的临床治疗仍为全肺灌洗。国内外相关基础及临床试验发现PAP不仅与粒细胞-巨噬细胞集落刺激因子(GM-CSF)自身抗体有关,而且与CSF2ra、CSF2rb、SFTPB等基因的突变和靶向性巨噬细胞胆固醇稳态相关。随着疾病基因层面研究的深入,对于该疾病的诊断和治疗也有了相应的进展,诊断方面除肺活检病理检查外,近年来血清GM-CSF自身抗体检测、血清GM-CSF水平检测以及基因诊断获得较大进展;治疗方面除全肺灌洗外,吸入或皮下注射GM-CSF、利妥昔单抗、吡格列酮、他汀类药物、基因治疗、血浆置换等方法成为研究热点。本文对近年来PAP的诊治进展作一综述。

     

    Abstract: Objective Pulmonary alveolar proteinosis (PAP) is a rare chronic interstitial lung disease characterized by accumulation of phospholipid protein-like substances in alveoli and bronchioles. At present, the clinical treatment of PAP in China is still whole lung lavage. Basic and clinical trials at home and abroad have found that PAP is not only related to GM-CSF autoantibodies, but also related to CSF2ra, CSF2rb, SFTPB gene mutations and targeted macrophage cholesterol homeostasis (peroxisome proliferator-activated receptor, PPARγ).With the progress of the research on the genetic level of the disease, the corresponding progress in diagnosis and treatment of the disease have also be made. In addition to pathological examination of lung biopsy, serum GM-CSF autoantibody detection, serum GM-CSF level detection and genetic testing have also got progress and are widely used in clinical practice. Recently, inhalation or subcutaneous injection of GM-CSF, rituximab, pioglitazone, statins, gene therapy, and plasma exchange have become research hots. This paper reviewed these new diagnosis and treatment methods of PAP.

     

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