一般人群
由于AAT 缺乏症是无法治愈的,而许多患者(尤其是非吸烟者)将有正常的寿命,因此AAT 缺乏症并非常规的筛查项目,除非是出于研究的目的。[3]American Thoracic Society/European Respiratory Society Statement. Standards for the diagnosis and management of individuals with alpha 1-antitrypsin deficiency. Am J Respir Crit Care Med. 2003 Oct 1;168(7):818-900.http://www.ncbi.nlm.nih.gov/pubmed/14522813?tool=bestpractice.com[47]Seersholm N, Kok-Jensen A, Dirksen A. Survival of patients with severe alpha-1 antitrypsin deficiency with special reference to non-index cases. Thorax. 1994;49:695-698.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC475060/pdf/thorax00299-0073.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/8066566?tool=bestpractice.com
倾向性试验
建议对携带异常AAT变异体的纯合型个体(如PI*ZZ)的兄弟姐妹进行基因筛查。[3]American Thoracic Society/European Respiratory Society Statement. Standards for the diagnosis and management of individuals with alpha 1-antitrypsin deficiency. Am J Respir Crit Care Med. 2003 Oct 1;168(7):818-900.http://www.ncbi.nlm.nih.gov/pubmed/14522813?tool=bestpractice.com 应当同其后代、父母、以及远亲探讨进行筛查,但接受或者拒绝筛查都是合情合理的。 应当同杂合型个体的所有亲属探讨基因筛查。
在生殖机构中的携带者检查
应当同 AAT 缺乏症的高风险个体,以及AAT 缺乏症患者的配偶讨论进行基因筛查。[3]American Thoracic Society/European Respiratory Society Statement. Standards for the diagnosis and management of individuals with alpha 1-antitrypsin deficiency. Am J Respir Crit Care Med. 2003 Oct 1;168(7):818-900.http://www.ncbi.nlm.nih.gov/pubmed/14522813?tool=bestpractice.com
慢性阻塞性肺疾病
应对所有 COPD 患者进行 AAT 缺乏症检测。[28]Sandhaus RA, Turino G, Brantly ML, et al. The diagnosis and management of alpha-1 antitrypsin deficiency in the adult. Chronic Obstr Pulm Dis (Miami). 2016;3:668-682.http://journal.copdfoundation.org/jcopdf/id/1115/The-Diagnosis-and-Management-of-Alpha-1-Antitrypsin-Deficiency-in-the-Adult
哮喘
美国胸科学会(American Thoracic Society)/欧洲呼吸学会(European Respiratory Society)指南建议对那些接受高强度支气管扩张剂治疗但仍有持续性呼吸道阻塞症状的哮喘患者进行筛查。[3]American Thoracic Society/European Respiratory Society Statement. Standards for the diagnosis and management of individuals with alpha 1-antitrypsin deficiency. Am J Respir Crit Care Med. 2003 Oct 1;168(7):818-900.http://www.ncbi.nlm.nih.gov/pubmed/14522813?tool=bestpractice.com 一种推荐的在哮喘患者中筛查AAT 缺乏症的策略建议是对等位基因S和Z进行分型。 只要任何一种被检测到,就应该进行血清AAT的检测。[48]Siri D, Farah H, Hogarth DK. Distinguishing alpha1-antitrypsin deficiency from asthma. Ann Allergy Asthma Immunol. 2013;111:458-464.http://www.ncbi.nlm.nih.gov/pubmed/24267358?tool=bestpractice.com