儿童与成人囊性纤维化胸部CT应用指南：特殊情形/呼吸系统并发症（欧洲视角·第二部分）
欧洲囊性纤维化协会临床试验网络（ECFS-CTN）针对囊性纤维化患者咯血、曲霉相关肺病、非结核分枝杆菌感染及气胸等特殊情形，提出胸部CT使用指导。指南经匿名在线调查确定关键问题、文献检索支持声明、Delphi流程达成共识三步制定。共识支持在咯血、变应性支气管肺曲霉病及NTM培养阳性时使用胸部CT。
要点
- 咯血、ABPA及NTM培养阳性（≥2份独立痰或1份支气管镜阳性）时共识支持行胸部CT。
- NTM阳性定义为至少2份独立咳出痰标本或1份支气管镜标本培养阳性。
- 胸部CT检查的最终合理性判断由直接参与患者管理的医疗专业人员负责。
核心结论
- 共识支持在囊性纤维化患者出现咯血、变应性支气管肺曲霉病及NTM培养阳性时使用胸部CT。
- 胸部CT检查的最终合理性责任由直接参与患者管理的医疗专业人员承担。
研究设计与样本
- 本指南由欧洲囊性纤维化协会临床试验网络（ECFS-CTN）制定，针对儿童与成人囊性纤维化患者的胸部CT应用。
- 制定过程分三步：匿名在线调查确定最重要问题，全面文献检索支持首套声明，Delphi流程验证以获得参与者集体意见。
诊断标准与关键数值
- 共识支持在咯血、变应性支气管肺曲霉病（ABPA）及NTM培养阳性时使用胸部CT。
- NTM培养阳性指超过2份独立咳出痰标本或1份支气管镜结果阳性。
临床应用与阅片要点
- 对囊性纤维化患者出现咯血、ABPA或NTM培养阳性时，可依据本共识考虑胸部CT检查。
- 胸部CT检查的合理性判断应由直接参与患者管理的医疗专业人员最终负责。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
This manuscript covers guidance proposed by The European Cystic Fibrosis Society Clinical Trials Network (ECFS-CTN) for the use of chest computed tomography (CT) scans in special situations such as haemoptysis, aspergillus-related lung disease, non-tuberculous mycobacterial (NTM) infection and pneumothorax in people with CF. Guidance development followed a three-step process. The most important questions were first identified via anonymous online survey, then a comprehensive literature search was made to support a first set of statements. They were finally validated by a Delphi process to obtain collective opinion of participants. Consensus supported the use of chest CT in the presence of haemoptysis, Allergic Bronchopulmonary Aspergillosis, and NTM-positive cultures (>2 separate expectorated sputum samples, or 1 positive bronchoscopic result). The ultimate responsibility for justifying a chest CT scan lies with the healthcare professionals directly involved in patient management.
引用
- Fayon M, Hill K, Riberi L, et al. Guidance for chest-CT in children and adults with cystic fibrosis: A European perspective (part 2: special situations/respiratory complications). Respir Med. 2026. PMID: 42190839. doi:10.1016/j.rmed.2026.108911
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。