Division of Internal Medicine of Botucatu Medical School, São Paulo State University-UNESP, Botucatu, Brazil.
Department of Pathology and Legal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
Expert Rev Respir Med. 2021 Jun;15(6):791-803. doi: 10.1080/17476348.2021.1916472. Epub 2021 Apr 27.
Coronavirus disease 2019 (COVID-19) is still increasing worldwide, and as a result, the number of patients with pulmonary fibrosis secondary to COVID-19 will expand over time. Risk factors, histopathological characterization, pathophysiology, prevalence, and management of post-COVID-19 pulmonary fibrosis are poorly understood, and few studies have addressed these issues.This article reviews the current evidence regarding post-COVID-19 pulmonary fibrosis, with an emphasis on the potential risk factors, histopathology, pathophysiology, functional and tomographic features, and potential therapeutic modalities. A search on the issue was performed in the MEDLINE, Embase, and SciELO databases and the Cochrane library between 1 December 2019, and 25 January 2021. Studies were reviewed and relevant topics were incorporated into this narrative review. Pulmonary sequelae may occur secondary to COVID-19, which needs to be included as a potential etiology in the current differential diagnosis of pulmonary fibrosis. Therefore, serial clinical, tomographic, and functional screening for pulmonary fibrosis is recommended after COVID-19, mainly in patients with pulmonary involvement in the acute phase of the disease. Further studies are necessary to determine the risk factors, markers, pathophysiology, and appropriate management of post-COVID-19 pulmonary fibrosis.
2019 年冠状病毒病(COVID-19)仍在全球范围内不断增加,因此,随着时间的推移,继发于 COVID-19 的肺纤维化患者人数将不断增加。COVID-19 后肺纤维化的风险因素、组织病理学特征、病理生理学、患病率和管理尚不清楚,很少有研究涉及这些问题。本文综述了 COVID-19 后肺纤维化的现有证据,重点介绍了潜在的风险因素、组织病理学、病理生理学、功能和断层扫描特征以及潜在的治疗方式。对 MEDLINE、Embase 和 SciELO 数据库以及 Cochrane 图书馆 2019 年 12 月 1 日至 2021 年 1 月 25 日期间的该问题进行了检索。对研究进行了回顾,并将相关主题纳入本叙述性综述。COVID-19 可能导致肺部后遗症,在当前肺纤维化的鉴别诊断中需要将其纳入潜在病因。因此,建议在 COVID-19 后对肺纤维化进行连续的临床、断层扫描和功能筛查,主要针对在疾病急性期有肺部受累的患者。需要进一步研究以确定 COVID-19 后肺纤维化的风险因素、标志物、病理生理学和适当的管理。