过敏性肺炎与非特异性间质性肺炎中的支气管肺泡灌洗液淋巴细胞模式：一项系统综述。
完整摘要 · 中文译文
背景：支气管肺泡灌洗（BAL）是间质性肺疾病（ILD）多学科评估中的重要辅助工具，尤其是过敏性肺炎（HP）和非特异性间质性肺炎（NSIP）。然而，BAL细胞学特征的显著重叠和不一致的淋巴细胞阈值限制了其独立诊断价值。本系统综述总结了关于BAL细胞学分析在鉴别HP与NSIP方面诊断和预后效用的当前证据。 方法：对PubMed/MEDLINE、Embase、CENTRAL进行系统性文献检索，确定了评估HP和NSIP中BAL细胞学、免疫表型和生物标志物发现的研究。研究选择遵循PRISMA建议。由于方法学异质性，证据以叙述性方式综合。 结果：21项研究符合纳入标准。BAL淋巴细胞增多持续支持HP的诊断，尤其是在阈值高于30%时，尽管更高的截断值提高了特异性但以敏感性为代价。观察到HP与NSIP之间存在显著重叠，尤其是在纤维化疾病中，限制了单纯淋巴细胞百分比的诊断性能。新兴的BAL生物标志物，包括CD4/CD8比值、NK/NKT细胞亚群、IL-9信号传导、KL-6和流式细胞术免疫表型分析，显示出改善鉴别诊断的潜力。此外，在选定的HP和NSIP人群中，较高的BAL淋巴细胞计数与良好的治疗反应和改善的预后相关。 结论：BAL细胞学分析 仍是一种有价值的补充诊断工具，而非用于区分HP与NSIP的独立检测。准确的解读需要结合暴露史、高分辨率计算机断层扫描、可获得时的组织病理学以及多学科讨论。需要标准化的BAL方案和先进免疫表型生物标志物的前瞻性验证，以提高纤维化ILDs的诊断精确性和临床决策。 系统综述注册：https://www.crd.york.ac.uk/PROSPERO/view/CRD420261397405，标识符PROSPERO（CRD420261397405）。
完整摘要 · 英文原文
BACKGROUND: Bronchoalveolar lavage (BAL) is an important adjunctive tool in the multidisciplinary evaluation of interstitial lung diseases (ILDs), particularly hypersensitivity pneumonitis (HP) and nonspecific interstitial pneumonia (NSIP). However, considerable overlap in BAL cellular profiles and inconsistent lymphocyte thresholds limit its independent diagnostic value. This systematic review summarizes current evidence regarding the diagnostic and prognostic utility of BAL cellular analysis in differentiating HP from NSIP. METHODS: A systematic literature search of PubMed/MEDLINE, Embase, CENTRAL identified studies evaluating BAL cellular, immunophenotypic, and biomarker findings in HP and NSIP. Study selection followed PRISMA recommendations. Owing to methodological heterogeneity, the evidence was synthesized narratively. RESULTS: Twenty-one studies met the inclusion criteria. BAL lymphocytosis consistently supported the diagnosis of HP, particularly at thresholds above 30%, although higher cut-offs improved specificity at the expense of sensitivity. Considerable overlap between HP and NSIP was observed, especially in fibrotic disease, limiting the diagnostic performance of isolated lymphocyte percentages. Emerging BAL biomarkers, including CD4/CD8 ratio, NK/NKT-cell subsets, IL-9 signaling, KL-6, and flow cytometric immunophenotyping, showed potential to improve differential diagnosis. In addition, higher BAL lymphocyte counts were associated with favorable treatment response and improved prognosis in selected HP and NSIP populations. CONCLUSION: BAL cellular analysis remains a valuable complementary diagnostic tool rather than a standalone test for distinguishing HP from NSIP. Accurate interpretation requires integration with exposure history, high-resolution computed tomography, histopathology when available, and multidisciplinary discussion. Standardized BAL protocols and prospective validation of advanced immunophenotypic biomarkers are needed to improve diagnostic precision and clinical decision-making in fibrotic ILDs. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261397405, identifier PROSPERO (CRD420261397405).