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[德国特发性肺纤维化诊断与管理指南]

[German guideline for diagnosis and management of idiopathic pulmonary fibrosis].

作者信息

Behr J, Günther A, Ammenwerth W, Bittmann I, Bonnet R, Buhl R, Eickelberg O, Ewert R, Gläser S, Gottlieb J, Grohé C, Kreuter M, Kroegel C, Markart P, Neurohr C, Pfeifer M, Prasse A, Schönfeld N, Schreiber J, Sitter H, Theegarten D, Theile A, Wilke A, Wirtz H, Witt C, Worth H, Zabel P, Müller-Quernheim J, Costabel U

机构信息

Asklepios Fachkliniken München-Gauting und Medizinische Klinik V, Klinikum der Ludwig-Maximilians-Universität München.

出版信息

Pneumologie. 2013 Feb;67(2):81-111. doi: 10.1055/s-0032-1326009. Epub 2013 Jan 16.

Abstract

Idiopathic pulmonary fibrosis is a fatal lung disease with a variable and unpredictable natural history and limited treatment options. Since publication of the ATS-ERS statement on IPF in the year 2000 diagnostic standards have improved and a considerable number of randomized controlled treatment trials have been published necessitating a revision. In the years 2006 - 2010 an international panel of IPF experts produced an evidence-based guideline on diagnosis and treatment of IPF, which was published in 2011. In order to implement this evidence-based guideline into the German Health System a group of German IPF experts translated and commented the international guideline, also including new publications in the field. A consensus conference was held in Bochum on December 3rd 2011 under the protectorate of the "Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP)" and supervised by the "Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften" (AWMF). Most recommendations of the international guideline were found to be appropriate for the german situation. Based on recent clinical studies "weak negative" treatment recommendations for pirfenidone and anticoagulation were changed into "weak positive" for pirfenidone and "strong negative" for anticoagulation. Based on negative results from the PANTHER-trial the recommendation for the combination therapy of prednisone plus azathiorpine plus N-acetlycsteine was also changed into strong negative für patients with definite IPF. This document summarizes essential parts of the international IPF guideline and the comments and recommendations of the German IPF consensus conference.

摘要

特发性肺纤维化是一种致命的肺部疾病,其自然史多变且不可预测,治疗选择有限。自2000年美国胸科学会(ATS)和欧洲呼吸学会(ERS)发表关于特发性肺纤维化的声明以来,诊断标准有所改进,大量随机对照治疗试验已发表,因此有必要进行修订。2006年至2010年期间,一个国际特发性肺纤维化专家小组制定了一份关于特发性肺纤维化诊断和治疗的循证指南,并于2011年发表。为了将该循证指南应用于德国医疗体系,一群德国特发性肺纤维化专家对该国际指南进行了翻译和注释,其中还纳入了该领域的新出版物。2011年12月3日,在“德国肺病与重症医学学会(DGP)”的支持下,由“医学专业科学协会工作组”(AWMF)监督,在波鸿举行了一次共识会议。结果发现,国际指南的大多数建议适用于德国的情况。基于最近的临床研究,吡非尼酮的“弱阳性”治疗建议和抗凝治疗建议分别改为吡非尼酮的“弱阳性”和抗凝治疗的“强阴性”。基于PANTHER试验的阴性结果,对于确诊为特发性肺纤维化的患者,泼尼松联合硫唑嘌呤加N - 乙酰半胱氨酸的联合治疗建议也改为强阴性。本文总结了国际特发性肺纤维化指南的重要部分以及德国特发性肺纤维化共识会议的注释和建议。

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