Royal Brompton and Harefield NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.
National Institute for Health Research Biomedical Research Centre, University of Nottingham, Nottingham, UK.
Lancet Respir Med. 2020 Aug;8(8):807-815. doi: 10.1016/S2213-2600(20)30225-3. Epub 2020 May 15.
In December, 2019, reports emerged from Wuhan, China, of a severe acute respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). By the end of April, 2020, over 3 million people had been confirmed infected, with over 1 million in the USA alone, and over 215 000 deaths. The symptoms associated with COVID-19 are diverse, ranging from mild upper respiratory tract symptoms to severe acute respiratory distress syndrome. The major risk factors for severe COVID-19 are shared with idiopathic pulmonary fibrosis (IPF), namely increasing age, male sex, and comorbidities such as hypertension and diabetes. However, the role of antifibrotic therapy in patients with IPF who contract SARS-CoV-2 infection, and the scientific rationale for their continuation or cessation, is poorly defined. Furthermore, several licensed and potential antifibrotic compounds have been assessed in models of acute lung injury and viral pneumonia. Data from previous coronavirus infections such as severe acute respiratory syndrome and Middle East respiratory syndrome, as well as emerging data from the COVID-19 pandemic, suggest there could be substantial fibrotic consequences following SARS-CoV-2 infection. Antifibrotic therapies that are available or in development could have value in preventing severe COVID-19 in patients with IPF, have the potential to treat severe COVID-19 in patients without IPF, and might have a role in preventing fibrosis after SARS-CoV-2 infection.
2019 年 12 月，中国武汉报告了一种由严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）引起的严重急性呼吸道疾病。到 2020 年 4 月底，已有超过 300 万人被确诊感染，仅美国就有超过 100 万人感染，超过 21.5 万人死亡。COVID-19 相关症状多种多样，从轻度上呼吸道症状到严重急性呼吸窘迫综合征不等。COVID-19 重症的主要危险因素与特发性肺纤维化（IPF）相同，即年龄增长、男性和高血压、糖尿病等并存疾病。然而，在感染 SARS-CoV-2 的 IPF 患者中，抗纤维化治疗的作用及其继续或停止的科学依据尚不清楚。此外，几种已批准和潜在的抗纤维化化合物已在急性肺损伤和病毒性肺炎模型中进行了评估。以前的冠状病毒感染（如严重急性呼吸综合征和中东呼吸综合征）的数据，以及 COVID-19 大流行的新出现数据表明，SARS-CoV-2 感染后可能会产生实质性的纤维化后果。现有的或正在开发的抗纤维化疗法可能对预防 IPF 患者的严重 COVID-19 有价值，对无 IPF 的严重 COVID-19 患者有治疗潜力，并可能在预防 SARS-CoV-2 感染后的纤维化方面发挥作用。
