Robalo Cordeiro C, Campos P, Carvalho L, Campainha S, Clemente S, Figueiredo L, Jesus J M, Marques A, Souto-Moura C, Pinto Basto R, Ribeiro A, Serrado M, Morais A
Centre of Pulmonology, Coimbra University Hospital, Coimbra, Portugal.
Imagiology Department, Santa Marta Hospital, Northern Lisbon Hospital Centre, Lisbon, Portugal.
Rev Port Pneumol (2006). 2016 Mar-Apr;22(2):112-22. doi: 10.1016/j.rppnen.2016.01.003. Epub 2016 Feb 20.
Idiopathic pulmonary fibrosis is a rare interstitial lung disease included in the Idiopathic Interstitial Pneumonias group. Although several potential risk factors have been described, it is a progressive fibrosing disease of unknown cause affecting mainly adults over 50 years and associated with a poor prognosis, reflected in a median survival of 2-3 years after diagnosis. The concept of a multidisciplinary working group for the diagnosis of idiopathic pulmonary fibrosis is based on the need to have experienced pulmonologists, radiologists and pathologists in the evaluation and correct treatment of the disease, and requires the use of all available data about individual patients, standardized (largely through High Resolution Computed Tomography and pathology when needed) as well as non-standardized data (laboratory, serology and biomarkers). This approach helps to increase diagnostic accuracy and is an internationally accepted recommendation. In regard to therapy, the situation has changed radically since the publication of the ATS/ERS/JRS/ALAT 2011 guidelines on the diagnosis and management of idiopathic pulmonary fibrosis where it was stressed that no proven therapy exists for this disease. Currently besides non-pharmacological treatment, therapy of complications and comorbidities and palliative care, nintedanib and pirfenidone, two compounds with pleiotropic mechanisms of action, are to date, the two drugs with confirmed efficacy in slowing functional decline and disease progression in idiopathic pulmonary fibrosis patients.
特发性肺纤维化是一种罕见的间质性肺疾病,属于特发性间质性肺炎组。尽管已经描述了几种潜在的危险因素,但它是一种病因不明的进行性纤维化疾病,主要影响50岁以上的成年人,预后较差,诊断后的中位生存期为2至3年。特发性肺纤维化诊断多学科工作小组的概念基于这样一种需求,即需要有经验丰富的肺科医生、放射科医生和病理科医生参与该疾病的评估和正确治疗,并且需要使用关于个体患者的所有可用数据,包括标准化数据(主要通过高分辨率计算机断层扫描以及必要时的病理学)和非标准化数据(实验室检查、血清学和生物标志物)。这种方法有助于提高诊断准确性,是一项国际公认的建议。在治疗方面,自美国胸科学会(ATS)/欧洲呼吸学会(ERS)/日本呼吸学会(JRS)/拉丁美洲胸科协会(ALAT)2011年发布关于特发性肺纤维化诊断和管理的指南以来,情况发生了根本性变化,该指南强调目前尚无针对该疾病的经证实有效的治疗方法。目前,除了非药物治疗、并发症和合并症的治疗以及姑息治疗外,尼达尼布和吡非尼酮这两种具有多效作用机制的化合物是迄今为止在减缓特发性肺纤维化患者功能衰退和疾病进展方面已证实有效的两种药物。