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[系统性硬化症相关间质性肺疾病的治疗]

[Treatment of systemic sclerosis-associated interstitial lung disease].

作者信息

Prasse A, Bonella F, Müller-Ladner U, Witte T, Hunzelmann N, Distler J

机构信息

Klinik für Pneumologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.

Ruhrlandklinik, Klinik für Pneumologie, Universitätsmedizin Essen, Essen, Deutschland.

出版信息

Z Rheumatol. 2020 Apr;79(3):294-303. doi: 10.1007/s00393-019-00724-y.

DOI:10.1007/s00393-019-00724-y
PMID:31754786
Abstract

BACKGROUND

Systemic sclerosis (SSc) is a fibrosing autoimmune disease of the connective tissue. In addition to skin fibrosis, pulmonary involvement and interstitial lung disease (ILD) in particular are the most common and severe manifestations of SSc. The disease is associated with a substantial risk of morbidity and mortality, especially in progressive ILD. In the last 5 years new treatment concepts for SSc-ILD have been investigated in numerous clinical studies.

MATERIAL AND METHODS

This review is based on a literature search in PubMed, focusing on the most relevant papers published up to the end of 2018 with the keywords "SSc" and "treatment".

RESULTS

The treatment of SSc-ILD has changed over the last few years due to the results of many clinical studies. The updated guidelines of the European League Against Rheumatism (EULAR) recommend the use of cyclophosphamide or hematopoietic stem cell transplantation. Data for a positive influence on SSc-ILD are also available for mycophenolate, tocilizumab and anabasum. Because of the pathophysiological similarities to idiopathic pulmonary fibrosis, the use of the antifibrotic agents nintedanib and pirfenidone is currently being investigated in randomized, multicenter clinical trials and could be a novel and promising therapeutic strategy.

CONCLUSION

Current drug studies may provide innovative therapeutic perspectives for SSc-ILD and could significantly improve the prognosis of affected patients in the future.

摘要

背景

系统性硬化症(SSc)是一种结缔组织的纤维化自身免疫性疾病。除皮肤纤维化外,肺部受累尤其是间质性肺疾病(ILD)是SSc最常见和最严重的表现。该疾病与较高的发病和死亡风险相关,特别是在进行性ILD中。在过去5年中,针对SSc-ILD的新治疗理念已在众多临床研究中进行了调查。

材料与方法

本综述基于在PubMed上的文献检索,重点关注截至2018年底发表的最相关论文,关键词为“SSc”和“治疗”。

结果

由于许多临床研究的结果,过去几年中SSc-ILD的治疗发生了变化。欧洲抗风湿病联盟(EULAR)的更新指南推荐使用环磷酰胺或造血干细胞移植。霉酚酸酯、托珠单抗和阿那巴生对SSc-ILD也有积极影响的数据。由于与特发性肺纤维化在病理生理学上有相似之处,目前正在随机、多中心临床试验中研究使用抗纤维化药物尼达尼布和吡非尼酮,这可能是一种新颖且有前景的治疗策略。

结论

当前的药物研究可能为SSc-ILD提供创新的治疗前景,并可能在未来显著改善受影响患者的预后。

相似文献

1
[Treatment of systemic sclerosis-associated interstitial lung disease].[系统性硬化症相关间质性肺疾病的治疗]
Z Rheumatol. 2020 Apr;79(3):294-303. doi: 10.1007/s00393-019-00724-y.
2
Interstitial lung disease in systemic sclerosis.系统性硬皮病中的间质性肺疾病。
Autoimmun Rev. 2011 Mar;10(5):248-55. doi: 10.1016/j.autrev.2010.09.012. Epub 2010 Sep 21.
3
Current and future perspectives on management of systemic sclerosis-associated interstitial lung disease.系统性硬皮病相关间质性肺病的管理:现状和未来展望。
Expert Rev Clin Immunol. 2019 Oct;15(10):1009-1017. doi: 10.1080/1744666X.2020.1668269. Epub 2019 Sep 30.
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Nintedanib for the treatment of systemic sclerosis-associated interstitial lung disease.尼达尼布治疗系统性硬皮病相关的间质性肺病。
Expert Rev Clin Immunol. 2020 Jun;16(6):547-560. doi: 10.1080/1744666X.2020.1777857. Epub 2020 Jun 17.
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Interstitial lung disease associated with systemic sclerosis (SSc-ILD).系统性硬化症相关的间质性肺疾病(SSc-ILD)。
Respir Res. 2019 Jan 18;20(1):13. doi: 10.1186/s12931-019-0980-7.
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Management of systemic sclerosis: the first five years.系统性硬化症的管理:前五年。
Curr Opin Rheumatol. 2020 May;32(3):228-237. doi: 10.1097/BOR.0000000000000711.
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[Interstitial lung disease in rheumatic diseases - new therapeutic approaches].[风湿性疾病中的间质性肺疾病——新的治疗方法]
Dtsch Med Wochenschr. 2020 Apr;145(7):470-473. doi: 10.1055/a-0985-5793. Epub 2020 Apr 1.
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Management of systemic sclerosis-associated interstitial lung disease.系统性硬皮病相关间质性肺疾病的管理。
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Expert consensus on the management of systemic sclerosis-associated interstitial lung disease.专家共识:系统性硬皮病相关间质性肺疾病的管理。
Respir Res. 2023 Jan 9;24(1):6. doi: 10.1186/s12931-022-02292-3.

本文引用的文献

1
Nintedanib in Progressive Fibrosing Interstitial Lung Diseases.尼达尼布治疗进行性纤维化间质性肺疾病。
N Engl J Med. 2019 Oct 31;381(18):1718-1727. doi: 10.1056/NEJMoa1908681. Epub 2019 Sep 29.
2
Nintedanib for Systemic Sclerosis-Associated Interstitial Lung Disease.尼达尼布治疗系统性硬化症相关间质性肺疾病。
N Engl J Med. 2019 Jun 27;380(26):2518-2528. doi: 10.1056/NEJMoa1903076. Epub 2019 May 20.
3
Progressive skin fibrosis is associated with a decline in lung function and worse survival in patients with diffuse cutaneous systemic sclerosis in the European Scleroderma Trials and Research (EUSTAR) cohort.
进行性皮肤纤维化与弥漫性皮肤系统性硬皮病患者的肺功能下降和生存状况恶化相关,该研究来自于欧洲硬皮病临床试验和研究(EUSTAR)队列。
Ann Rheum Dis. 2019 May;78(5):648-656. doi: 10.1136/annrheumdis-2018-213455. Epub 2019 Mar 9.
4
Presentation, diagnosis and clinical course of the spectrum of progressive-fibrosing interstitial lung diseases.进行性纤维性间质性肺疾病谱的表现、诊断和临床过程。
Eur Respir Rev. 2018 Dec 21;27(150). doi: 10.1183/16000617.0076-2018. Print 2018 Dec 31.
5
Combination therapy with rituximab and mycophenolate mofetil in systemic sclerosis. A single-centre case series study.利妥昔单抗联合霉酚酸酯治疗系统性硬化症。单中心病例系列研究。
Clin Exp Rheumatol. 2018 Jul-Aug;36 Suppl 113(4):142-145. Epub 2018 Sep 30.
6
Interstitial lung disease in systemic sclerosis: challenges in early diagnosis and management.系统性硬化症中的间质性肺疾病:早期诊断与管理面临的挑战
Reumatologia. 2018;56(4):249-254. doi: 10.5114/reum.2018.77977. Epub 2018 Aug 31.
7
Intravenous cyclophosphamide vs rituximab for the treatment of early diffuse scleroderma lung disease: open label, randomized, controlled trial.静脉注射环磷酰胺与利妥昔单抗治疗早期弥漫性硬皮病肺疾病:开放标签、随机、对照试验。
Rheumatology (Oxford). 2018 Dec 1;57(12):2106-2113. doi: 10.1093/rheumatology/key213.
8
Myeloablative Autologous Stem-Cell Transplantation for Severe Scleroderma.用于严重硬皮病的清髓性自体干细胞移植
N Engl J Med. 2018 Jan 4;378(1):35-47. doi: 10.1056/nejmoa1703327.
9
Safety and efficacy of subcutaneous tocilizumab in systemic sclerosis: results from the open-label period of a phase II randomised controlled trial (faSScinate).托西珠单抗皮下注射治疗系统性硬化症的安全性和有效性:一项 II 期随机对照试验(faSScinate)开放性研究阶段的结果。
Ann Rheum Dis. 2018 Feb;77(2):212-220. doi: 10.1136/annrheumdis-2017-211682. Epub 2017 Oct 24.
10
Exploring efficacy and safety of oral Pirfenidone for progressive, non-IPF lung fibrosis (RELIEF) - a randomized, double-blind, placebo-controlled, parallel group, multi-center, phase II trial.探索口服吡非尼酮治疗进行性、非特发性肺纤维化(RELIEF)的疗效和安全性 - 一项随机、双盲、安慰剂对照、平行分组、多中心、二期临床试验。
BMC Pulm Med. 2017 Sep 6;17(1):122. doi: 10.1186/s12890-017-0462-y.