BNH PHI MÔ K VÀ XƠ PHI MÔ K VÔ CĂN
TS. BS. NGUYỄN HỮU LÂN
1. Đại cương
!
"#$%%&'()'*+,-'./ !
#$'
1.1. Định nghĩa
0!/ !+,1'2,34'56)'
'/748+9+://;2</='>?7@'A
/B='(B/CDE&B7='8:F8
4G !(' E7>HD/'+=:
;I'A !>J!&',1!+,-DKLM !'8 !
/&'92/7 !4>
1.2. Viêm phổi mô kẽ và xơ phổi mô kẽ vô căn.
N87'+O !:2I,D'(: 72
4/:4/'&P8: =Q9' =Q>N7P
.+,-' 'K>
R',1'RS$
8 6& $T S # /
#& S U = / ' VU N
S:=T 4WF',1'>
$X$,D'='"%%'SYZ'
+9![%S\0:=T2&
S0 W ' @7
S]@8'^'S#$ !'=
/&&%SJ_` !CD89'&
%
86&/'+3A='+a'48CD(,'
8='CD7/+b /=''>$c
86&I'7:3B'+AACD'&7(*
c',1'R/I'7CD'&7'V
8,D'/CDd^X/NZKeeM>
HD/c+,-I'B_f,'BXT;g'./='
CD7'Q'&P(+P&/CDEEBC7:=Th
I'/'&P' =Q>N*ca@'J\/a:=:
29'ACD,1' !Pi'&2/
P=4'*'j7'>0P&'1+.7 !Aa@'
J\Kekl,3+P&+O' 7g',1m'+P&/2
4X>
#,/+aACD/'noKMM>MMM(&'9B'/
nM(p!oq/rs^X/NZKeej>
2. Nguyên nhân
2.1. ?O =Q ! G97 GD('
GqD(D8+a(;(=C(5t(I,D'('
, u
2.2. d' =Q'&P='CD7( !(
! /&=H( :!A != +"!;'(3
'2(a@'Zv'( !w'(a@'N'Sa@'U[
(( !(4' E7
( !4='u
3. Các giai đoạn mô bệnh
>U+= /(8/'',D'@'3='2>
> U+a= /(g/='+b
/(:=Th xW(,D'@'3=' 72/4'
+/ +y/'+= />
>U+CD7'& /-'(-'B@7>NE
P !kx4CD7
[ HDB'z/CDE&B77='CD>
[ HD{'3Ba;I'('T^(*7I'
7g g,1' !:>
[ YGCDB'='8:=-E/3CD'>
> &:''+; ' '+:g/ '
& (</&'h'+,-2<A>
[ s8 !8y'+ !;=(3+E/= /
VECD7;I'CD x7p+:g/'/'+;
I'>
[ #'n@+aA,D' !|@+a+aA
2<
K 0=+B/=''='t*}'>
r N2<t*'&~,'*'='+E&x/= />
k N2<A=' x1/2=</ a>
l HD7/+a2<A>
n '>
d^X(d _(0•>Keejkg7'6 !
K s= /$
r J}-= //CDR>
k ''+;
[ $g8+b /8W;'='(,D'/+x+V'+y(
*Rg,D''+V'+yy !(g@/P ;S,D'/
sN$L€(+b /€€/ /,D'>
[ s'Rg'3B/'@4*0]]g<
B='/>
[
4. Cơ chế bệnh sinh của xơ phổi kẽ vô căn
N8q''&=y&y(•[0(_&(,1'5
' !ACD,''‚'+x+,->\i='+:'
@CD+'+a'g2&7= /',3q, E+
P'4( E+P7(= /&(+b /+y''-ƒm'
}&= /+y'/D= !ACD/&>N87'CD
,a !b58b7':/@-5x,/>HD8:
7:ca='b5C2!,a2=A:5Wa.
/'//Ba;4'+g>ND=5xACD/'
&=+,-y7''hg8b+V'2y'6 !ƒ37 !b
5>
a. Kháng nguyên'+,- =Q,'8ax4B/='>d7'
'&/&/7/'0(#)'2&'yS0C2
'U/'U'>dq='',12&8'U',3q('-ƒm'
' 5xC2('z/'&gg2&@-5
x',3q='>N/7,/+y8@-5x>s8
'U=-37''&@-5x+,-C2'&/W'
+a'B/='>
b. Phức hợp miễn dịch/'V44+b / /=y&=;7
N&'T`A'U/7GNk (,'&=;/ I'@'g
*, =Q>N8:m'b75xB/7:!,-'
/&g='('P,D'B/CD7>
c.Đại thực bào phế nang8*A;' !ACD( x@
-5x44V7/'8'7N&#[K/#[L7
''7.(7A :,
€„=;',B'+b /X_U`S&=;',B':E$U`>
€„=;' ,B''& /-`N`>
€` /A2' /'/= /%…(γS#[K(#[j>u
i='',12&7% x'7'2S7&=;8/7:
'& /-8:g2&',3i='/''KSp!
'Ko'k/lK>N8yƒ'B(}ƒP a
77,'T.'2/K>!''K'& /
-t+=7'-'B>Zb'-'Ga/X_U`(
% /:E>
€Zb'8'&=;7@'+a'YN`/4fY(•/',18:C7+x
B,3i='/B7t+=a/7Y(•(_/7= /SY
cT='&:/'='/q='',12&Y(•
+y'>N4Y7YN`+O''P&='(Y=^(
&^(7';C&7+:7p2<='>?b /+',',1
t+,1'T7g/CD)'8' /=7^(
'^((&^(+y8:'P&,D'',3
=A)',,D'= />?b /+O7@-5x
44*8:'8'7';C&b/&^}>
d. Bạch cầu đa nhân trung tính
s',3i='',12&82yY(,'24Y'(8
B+,1'B"Y8yDB='>YC272C&7'T7
G'A&C^(7^'P&+a= />N8K^AY/
'^8''P&,D'B/='/+a4+;3= //
',18:g2&',3i='>s8Y7g'8'
'^(^8'†3'K/r(+V'1'8'7';
C&b(7/&87G'7p//'BB/@
7>
e. Tế bào lymphô/= /=,=B !6'6 !'Y
=,=',3i='>‡7A&=/N$L€7
=7&8:44/&g/CD#[r(`Y[U(s`0ˆ&=;
',B' (&=;',B'0(&=;7@'+a'3'& /->
f. Bạch cầu ái toan•'-•N/_0/7+a48:'P&
,D'@//'& /-'>•*='^+:†3
'/>
g. Quá trình rối loạn tổng hợp collagen: +V'17p't+=,D'
CDB/'CD3+E/='= /Y'(•'
VCD7(;I'g/'7p>‡'++E
ACD7p!''(B'+;gA&=/'>#W'
+.''/,D'B'+;>0P&'1',18 m'@'y+a
'2y(8C2C{KM‰' x+a}'/&+a'bh'!>
Zb+a'/&'[/&=;T.''D=A='
CD7CD>Y',12&+h+ay'B7
'8,D'T93$#N]/8:+P&/{;=:A !>
Šs8W@-5x/+b /='7'8'
X_U`(`N`(` (#[K(%+:''& /-t+='
'K/7'-aCa>YN`+b /'8'a/
7Y(•+8YB=''8'^('^7';C&b+:
'P&+a'B>Zb;'B/&'P&CD>
5. Biểu hiện lâm sàng của xơ phổi mô kẽ lan toả mô căn (phế nang viêm xơ hoá vô
căn).
5.1. Lâm sàng
[N= !i/E=+:C7+x7&=;'&D2'T7@/
!>
- ‹'9B!Y(' gA !P/nM,'8:C2!B†
+=',1'/,1'/'3>Y'&P8:;5x9<
9 &y 8 4 2 ' +g ,' : ' +g 2 = '9>
[0:!+E/8B'W'@/>s/P!"(7(<
P(kM‰; !P8!@'';',5<+,1'2>d72&
"/';'=' 8 '4('QB;gB/B
+7&9>N8:8!@'A7+a'>Y'8&'9Brok
;,1'-C2!aD>
5.2.Xquang phổi
- Chụp X quang ngực và chụp cắt lớp điện toán độ phân giải cao (HRCT: High
resolution CT)
ZbTPA 7z+=gV''b+,-2b!,1'
C&+:+7'7Bq' !P3#$>
3 !P/!6+7/'WWGHT''b/
+7'7P/'(J\Ns/bb.=>
J\Ns8'7x'!7!#$B !P8HT''b g,1'>
s'!=hP/'4-(C2!J\Ns8::!+E&+A+9
,'+:cbE=0X#9=/C7h !.>
Yq'/HŒ'T+=!C7+x'@/5'AJ\Ns+*
"8&yfh/&/+ 2,-'/y,-' @C4
-+,-'@iG'>‹28a',1+,-+/yHT''b/
J\Ns>
NECC•+:/ha '=3&G:'J\Ns>
[0g,1'B'++EKl‰,1'-=6+7€,'
HT' g,1'A&=/$>
[Jg41A&=B+7&,3/'>
[Jg,3;"=,=BI',3A >
[N87'm'+9+:A8&/ 8'1'7c;
C;'+7&,'.''8,1/>
['B/',3/'>
[ xCD•/"
?a4C7A6+7++,-ŽŽ‰3GHT'V''b,''
ek‰3GW34>NGW348:7!+,- !,3HT'
6 2,1'>s,D'BI'+7&B'+3( !9'g,D'
7I'7//'PS2!+9,'ACD/8a
/'p.'y>Jg41=,=g,-';D3g
}D/,3=,=>NGW34+aP'J\Ns8'7x
+:C7+x+aa'ACD(':+a'3(G m'fh/&2&7
I'7'p.',3'41A&=B|,3(,3/'(*8:
2&7•4"cr+=rM+8/g'B'+;>G
W34*+x,8'=>
5.3.Thăm dò chức năng hô hấp
€s27 !P3#$'{'D/+='ƒ/+4,+O
g /&(I''2a !7-ƒ'@+a'.'A !>
€s'CD8` & % (a'CD8
g !.,R/'+9!YZ(q'@+a
s#N],+Og /&/a,3't+7'h&D37x;@'
'{'D7>_@s#N]4DlM‰{'4,3,-'A !
CD7>
€s'`+,1'D •KM‰`N9•Kn‰'s#N]'j[Kr7'+E
C7+x !P8p!i'Dy>•0‘
€0O*'1'i'!j<+ a,+Og /&/a&=;T&=
+xb 7D'`D/@''{'D>>>s&(7'@
'+,-&EC7+x*A7i'!b!,1'C&/
Q'`/#$7>
€$q!;+8:b!4D@''{'D'!+7'7@
+a'.'A#$,'+q4( g,1'('P/''
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[]
r
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[Z@Bz'>
[$#N]'(8a@' ='>
5.4. Các xét nghiệm cận lâm sàng khác>
[0D\i=T='0X#/o9=C&=Ts0#0
E=(+,-b!,3 W+E+yx>0X#+,-CC•'2
7 !P''15I'( !74/a;#$>s',1'-/&(
0X#8:+,-I'+:6+7>0X#/'E=,a'G6+7B
!P8!@'P/'/g+:gA`J\Ns>
3 !P/!6+7/'WW+7'7P/'/
J\Ns(2g :0X#+a'8:•6+7&9
+,-b!3b,B'3D>
s',1'-6+7/'WW/0X#+,-/AG+,-
b!a'Pb8&fh'7AG/P47
t0X#>s',3i='2&+b /='(= /&( E+
P'4( E+P77='(,',1''9=
'' E+P'4KM[rM‰+P&/{;b 7 !'= /
&,D'T3B7='>
0X#+,-b!'27 !PTs0#0>s0#0/AG
+EAbb.Bq' !P8:8#$'+88a;,-'"8:
+,-6+7(+9 !/ !/&8C,3'b' >J\Ns
+,-iG'+:,3't=>0;+=7ths0#0+,-b!>
s',1'-8''1(7t='/s0#0+,-&=
7g<'=-3 !22/',-'6+7s0#0'+,-
&=7,/b.= +E',1'-''1`/'+7'
h&'6+7 !=c='>
th=(E=(+,-b!,3 W+E+yx>
_a6+7 !ƒWWA`9q'7{8:+,-
b!=ath=+,-2&>
_a6+7P/'h&A`8:++,-b!'b!!
AJ\Ns+9,'/q'7!P/'>
Y=a=th+,-b!'7,1'-''1
(yDat=+,-b!cyDax4(;2c
7I&7>Yy=y|fh5/'D B6ha
}-XsZD/=B>XsZ)'4+D3
=B>‡ !P''1(b'' 2,1'9,D'+;
g,1'yy37bA7''+,-WG/h
3GG:A!C7+xR=8>
0!62&/=C&/=T9=TV'
'b2&,D' !'E2y</@+aS8P5= /(
+, //CDB7='>
[NGC27&'jŽ2&gC;+xA&=/+b /
7/B>s';+x'jŽ'9ŽM‰7,1'-
CDS='yg;+xy>
[N7C•'!7
• s;+aW'78:'>
• ‹2&V'E'9E !P,1'C&=C&7>
• …r/’[' '>
• scrM[lM‰g2&7':7'P(&=;'2/@-5x
,/>d7':7'Pp!4D>
5.5. Chẩn đoán: b/P/'(HT'(*'4GC
'jŽ/i='2/b/6+7 !=T/'
+:P !6+73CD =Q'&P, ! /&=
HEC•'!2<+:g:HS ! G( !>u/
b/+7@'+yx3/;@=5x>0'rg /&
6+:6+7CD8`',1'-'8th=
sJa#V'Y'bJd|XsZoJaJJ2NP“•\Z
s0TNS#X(J/NZKeejg7!CD m'HT'
8=TG‚'8Z+a&jl‰(Z+a+9!ŽL‰*G''Z
Žj‰/ZŽj‰>Y,h&( '1)'G'g+a&D
G‚'>
0'r>sJa#V'Y'bJd|XsZoJaJJ2NP“•\Z6+:6
+7CD8`',1'-'8th=
s64 s6G
€ #ca;'&P+O =A !
#$,+a4;(q'
=C<3,1'/q' !
=
€
?a•nM
€ Yq''@@' 2,1'
'Vb='N(,1'+F
3!'p!`•Ko`N/+4
•'X[]r(']r'{'D
&+a'9's#N]
€ \g4/+7&
9
:””••
€ Yq' 2,1'!,3+7&32
!41gGW3+!
7+aP'J\Ns
€ d8 B '2 'E 'W'
@>
€ Z=C&=T9 Di
=T='0X#2&'8
4'+:}-a6+7,D'b
€ s1' !•k7'
0X#( Di=T='S`•K(:44B;+''P&+/S`N(
:44B;+SJ\Ns(7&GW3+!78+aP'S#$( !
(X[]r(b7 !'q7b='/+a'S]r(7bC&
+a'Ss#N](&=;&BN]SN('4;'>
Tiêu chuẩn chẩn đoán bệnh phổi mô kẽ
Zb&+P'E+P&+Ot+=!+7'77@6+7+,-(/
+,-(++,-'b/P/'>s'=pT(–6/'—+:6
+7#$+,-ha'O/a6+7.bth=>s'
6+7P/'/H[T'/b&='+&E.>
s&(q'=A6+7{b/.'/&/'+,-'h>
‡y !P !T79'':b!ath=>Œ7g
/&'7G' !P/ 7z)',',1>JDq(,3q'
C•'!6+77(8ab&++7':yT7gQ>s'a
'@+,-b!X(@+aAb6+7+E/,3@'3
Aq''g+,-C/q4y,D'!P/'>s'y,1'-(q'
+9+:y./˜˜''4G(7+9+:,D'@'39y6
+7>NE2m'b76+7/DV|a/'!A
q'&'J\Ns(+9 !y,1'-8+;3th=>
_a&=;7'!+7'7.A=/}2&t'/
at=+,-.caI''+:gAT7g !>
_aC•'!'+,-C/a–6/'—6+7=
K'b!Ba;,-'3 !P(rb7 !'q',1+.3S
/k'2'' :'a;,1'->s&(8@
'+:‚'+xm'27 !P3Taath
= 2@/8:>Y,+Oh(a6+7A`8:+,-b
q'2!+:gJ\Ns/g'P/',D'@'''ŽM‰
,1'-(/',1'-/&(ath=/'q4>s&(
ath=,1'/'7+;37 !P84+9+:HT'+:
g>s'!<th=6+7+,-Ba'q'
' !{b/P/'H[T'+:>4G(6+7\0#$+,-2h/
/bq''@J\Ns+;3a',1<;!&(+9 !/
q''@0X#)'I->
th=)'8:'P&:E=CC•,D'!h/
'8b;-A'P/'/H[T'>s'tJ(
!@'.+:g'C2!'a;4,1'-(3t !
'9R[/YZ>
R8:C&' !=(,'=T7',-3`(';'
2>$+8(6+7 !"+*"a,D'7=h+'/3
q''yP/'(H[T'/.>,D'7/&E+E+,-4
@+7'7'a'@nM !P x''1T+=` B
q' 7z// !ƒ./'+E>Yq'=h4T+=b7'q
6+7Aq' 7zP/'(6+7.+,-b! B/ !ƒ.
/q'6+7;I'++,-ah'A2q'',1
'>‡q' !P/'8!@'P'+:g/+9+:J\Ns
A`(!6+7P'g&+''ai/6+7
.&+''rn‰,1'-3=h6+7;I'>Y,h&(
''y.8,B'yDg'8b+7'7&2+,-
;'2>Y'@/&I-3'! =a'Om'('P
/'(J\Ns/.+,-:'3(!6+7;I',1'/2
+y+:+/7/h,1'C&+:+;==T>
,D'7=h+'/+,-/a˜˜6/'—+:6+7 !
">?y/&+O,B'PW+=T7gb/P/'>s'xiB
XT;/'7!;'8@":!'0sZ( !"E
3+,-Tƒ+x,D'37,1'-87'P>!'2
a,D'7=h+'/+*"Ba'7'P&y !
"a'3! V,™'&yP/'(J\Ns/.(+,-h
+P&>
5. Mức độ nghiêm trọng và tiến triển của bệnh
s+7'7+,-'2c!GHT''b<;2C2C{@+a
A !'#$>H•'!@',1'7@+a'.'A
!4C7DGHT''b>s&(b7 !3' g
,1'A7C•'!@',1'+a'cLM‰+=KrM‰'7xb+7
c7('34(A'a/y/a=3'!6+77
!~>4G(&'Q!'@+a`N+=Žn‰Ab 7'::!
2@+y'gcb&'n‰+=ln‰'7x >JDq(C•'!@'
8:5/'2 BT7gW !+V'1>4G'@a'O2
/ba,1'C&A4=A'/CD7+=lM‰ !P`/
T'3:4/&','''PC@''
+4>s' !=a7T7g 2,1'( 'V !(
7•( !/'/ !D(,1'I'V,''8'z/
+ah3!+7'7@+ag7.( 7z'98'!g:/7
A&7gA&'@'>
Zb+1/@'G'AJ\Ns+O'2 7za,D'!&y
@+a'.'A !'7 !"(,'8q'='>
N7+:4A@+a !7G'''@P/''/˜˜˜˜',1
I'P!'b=,1'!>š'zP/'Aq' 2,1'J\Ns=
,1''WW(+9 !/Bq' !P8 !=/&'@
'Bx/>s',1'-7(8:/8'!P !'q
7+9+:J\Ns g,1'/41>s'27i'!@'
J\Ns ''<7 7z/&' !,1'T•J\Ns,'+9 !+:h
b+7A4CPh&:'8:+7'72J\Ns =/P
/'T.'>s'I'a'&W7G'+;3!'47&+;
='7i'!@'>U7xb 7'W&+@';=
+O+,-+ya'O'`/CDYZ>s&(q!;=E+,-4
-37DBP/'(J\Ns/7G'.'+:++,-,3,-'
4C728'=TP/>gh&(!'*7=TC•'!
@'J\Ns//aET.'AT7g+'//b9AT7
g+'/(4-7T7/(8:/',+7'7 +E>
7. Điều trị
+ NK'oP9'o'/&(;'cL+=KrE5SQ+7
'7=T m'P/'@'HT'/i='S,'= a+yx
K7',™/'jM‰; !P>Y='8=T/P/'9'/
@'C2+gK(n[r'oP9'o'/&(V&gyM(
rn'oP9'o'/&(9M(n'oP9'o'/&1'•/Dck+=j7'>Y=
'8=TgI';@=5x>
€ N& K 'oP 9'o'/&( ;' KE 9 X^ K[k 'oP
9'o'/&(I'I'3M(rn'oP9'o'/&>
€s'1'I';@=5xgQC•'x7/V'
E!>
€s;7''$[N(N(%…' =b
•''>N/'b'8'A+b /% /
&=;',B'+:'P&='SyI'M(j'orl(= a/+x+,-jM‰>
‡†8:I'T+:&=>
€J!&+''@I'7':7'&7'sY`…97'
sU`ˆ/%['+:+yxCD; & 'P&>
€NBC&=]r›nnJ'>
€?yxP=O=8>
€Y=+yxa'8=T'•a B'+;ACD
+O+,-7G'(nM‰; !P;'+,-r>
Những tiến bộ trong điều trị bệnh phổi lan tỏa
s'xi8247i'!P/'+yx#$/+9 !/`>s&
(7'@'E+P&(9I':=h(+O{-48:+yx
`3!iG'`Y[K (%( ,+,-' ; m' (
œ% 'E , &= G y D ! i G' Y[&& = - 3
y2/^>
s&( +:C@'+7'+,-2+9 !/
- s,3(7'&W/&+O+,-='a1'&+8'(
8+:+,7&=7y+yx;2!&>*A7!7;'C&
8/a4G;y2+y/&>N8a7T+:'78
@(cb*'+:T/7!AT+:'!
h>
- s@(!&'8+yxG:/8:+,-/+yx;2!
`( =2A7 !CD7O4/3b,-'22>
s&('h/Ba'7q!!/(4G(+yx m'2;'C&
7+,-ca'@3C&B_f(8:/8'/&/'8+:
b!7'@',-+,-:7'+;93b2h'/&
/''A˜˜a=+a;2!&˜˜>s@,3't2&m'1+:+8t
,+,-+3(,'q'7+a'8'PW>`8a=T,D'b
,',/ =D2y37;744D>Y=8ab7
!bb'=T8:++,-3+yx(8:/ah@'/&/''
m' !/&E+,-Tƒ7*'7&(4C7,+OC&
='3>Y=8yD7-4+yxC2!(Tƒ;2/8:&E
,D'7+yx+,-=-+:++,-b+yx;'2(/+y/&)'8:
&E'7+x&>
N;I'(7 7z!+'+;93a ah+yx'q`['+8
*A5'P&x !+O+,-+9P"/ag[CD/ !
/q' !CD77'+8+,-m'C&,3'P&CD
8>3y,-'I'+:+yx(!&+,-//',-3`(
8:8a*T.''a;7 !7g /&37gP
/'&y;'AN`Xa@'P/'>!iG';,7!7&y
;'+8+*"6+74C7+'/>
8. Chẩn đoán định hướng nguyên nhân của bệnh phổi kẽ.
8.1. Bệnh phổi kẽ có đặc điểm chung là:
[yP/'B+E9'(8B+a'(('8B
;gB/P(8:88'&>
[yHT'8a@'"+;C@' (8g4
1B'+;8g'>NGW38+aP'28
4+:6+7( ! GZ( ',( !
( ! /&=u
€y*@'28a@';'4=(a@''
'4(a@' ='>
€?:6+7C7+x',17G'7fhCPh,=
C&/=T=,1'"i='>Y='8=T6
+7gV''b96hBV''b;:+:=>N*GC
27&3'jŽg'8+9!/'8'7x6+7 !({8
E/-4'!>37 !62&+,-c(|
P/'+x,3'y'&P/g',18:/7C•'!+9 !
,C•'!7'2+;3 ! GSI':77'Pb/a
+"''z+= !78' aS:+!i+:C•'!2
<g:H+;3 ! /&=HSC7+x'@= ///E= /
',3i='‚''z+=CD= E+P'4(
E+P7(+b /='=,=S'z+= !+^D9
'='x@''=,3i='8p!
s>Y'/8:g6(<(ƒI'&)',=
/',',3i='',:=Th[='>
Các bước chẩn đoán bệnh phổi mô kẽ
8.2. Chẩn đoán định hướng nguyên nhân của bệnh phổi mô kẽ theo hình ảnh
Xquang.
L>r>K>NGHT'6
[P ;,D''>
[s,D'+:|8&('>
[N=,=B'CD'&7( ! G X (
!'(' E7(0]]>
• N=,=B'P !'>
• N=,=B7| !( ! G( ! G(
' E7( != /#' ! /&=H(
'>
• N=,=B7|,3CD'&7( ! G ( !
'>
osg,D'GW34>
• Y;/+,1'1( ! /&=H('( ! G
(',(>
• $E&7=' ! G (CD'&7('>
• 08'1,3':|CD'&7( ! G (
!'>
• ?,1'1',3/'/1BCD'&7(
! G >
• N87•"B ! /&=H>
• Jg41/+'+90]]( !4='>Jg4
1*'9'8&('(;'P&S
g+'+9*'9'' E7(',:=T
='(a9'>
os72!HT';->
[ N8 / x /' ' ,( ;( !
(=C( ! G ( !'>
[Z,''2-;F !(74(
',>‡ !'2['+K{8C,'B;
S'+rC,';=-3,D';BS'+
k,D'+DE'*C,'B;>
[N87B;:"@' ! G( !>
[N''O !CD7)( !'+l( ! /&=H(
!CDE('4>
[N7;7,3 !CD@' g(D g>
8.3. Chẩn đoán định hướng nguyên nhân bệnh phổi mô kẽ theo các xét nghiệm
sinh hoá.
[s=7&=7< +"7a@'Z@=}
-a@'Z8q' :!P/''<(CD@' g( g+D(
/87':7'\Y(=:/4w0(^s>Keej
;>
[s=7+‚'W !'( ',>
[s=7=2Wa@'U( !w'>
[U E !'(;>
[s' E'( !w'>
[s' E7B7' !(;
' E7( !w'('>
[U:E !'(;(>
[s'’[' 7 !'(CD'&7 !+.^D(
'(a@'Zv'(a@'Zv'•'V87!@'A
!=3'23=='7/!'P
5B&=!/&=,3 .Sa@'/&8:=-3CD
X0>•/NZKeen( ! G>
[U’[' 7'>
[sb7':&=;'2(&=;7'P !'( ! G
( !CD'&7( !( !'(
!w'>
[s'&:' !('( ! G
( ( a @' & 2 = : B ',1 3 X\$Z>
[@-5x,/'7CD'&7('
(3'2( +"7( !&= /H( !w'( !
(>
[s'C7 !( ',>
[d7':7'/'ya@'U/ !b58
7(8B(P5'T;(=7/&P9'(,D'
!/='C2&=(='+b /@W/P|E
hSD=8897':7'/'y7TA/Eh
s%`/NZKeŽn>
[d7':7' /,D'XYNXZ !w'>$cw'=
N'/# +,/P/'8,D'B/DT'/
,''8EhS+:g !w'8k!@'S
'/B+,1'B/,3FEhU X>\/NZ
Keen>
8.4. Chẩn đoán định hướng nguyên nhân bệnh phổi mô kẽ theo kết quả rửa phế nang.
os= /&A,3i='
[s= /&N$l=,= !(( ! G (/
0&>
[s= /&N$L=,='(X$Z( ! G(
!&= /H( !'( !( !2 &F>
os'@= /A,3i='>
[=''= /&•Kn‰ !('clM‰+=jM‰(
'(=C( ! G( !;
',((X$Z>
[=' E+P'4•lM‰CD'&
7( !'('( !'+;( ! G /
GW( !;>
[=' E7•r‰4' E7
!'( !N'[Z(a@'#%%( !;(
X\$Z(CD@' g( !&= /H(0]]>
[='}-'p!#(Y(•( !&= /H>
[='+b /'/E= /,''&+'@
= /7 ! G( !&= /H>
s/!
K. Xs(Z&S •\&(Z&•&rMMr> •X
s Z&o• \& Z& _& N
N%%>sv%X
sZ&XsZ(•\&Z&•\Zœ &XsZ
%(•rMMK &•\Z•CN(•rMMK•> Am. J.
Respir. Crit. Care Med.165rrŽŽžkMl>
r>0IHPs7Keee(–0!—(0ệnh hô hấp(>jej[ŽKe>YH0„.(J/Ya>
k> d^X#(_&•#KeeL>•&% %
'%•>Am. J. Respir. Crit. Care Med.157lKKkMKžKn>
l>s$%%&#'$U%0sZ&Keee( “The
Diagnosis, Assessment and Treatment of Diffuse Parenchymal Lung Diseases in
Adults”. Thorax(nlSZ>
n>wX>R>(JY>rMML(–''—(Thorax(jk(>K[nL>