特发性肺纤维化:2023 年的最新进展。

Idiopathic pulmonary fibrosis: state of the art for 2023.

机构信息

Department of Medicine, Weill Cornell Medical College, New York, NY, USA.

Division of Pulmonary and Critical Care, Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Harvard Medical School, Boston, MA, USA.

出版信息

Eur Respir J. 2023 Apr 20;61(4). doi: 10.1183/13993003.00957-2022. Print 2023 Apr.

Abstract

Idiopathic pulmonary fibrosis (IPF) is a progressive fibrotic lung disease characterised by worsening respiratory symptoms and physiological impairment. Increasing awareness of the clinical manifestations of IPF, more widespread use of computed tomography scans and other potential factors have contributed to a rising prevalence of IPF over the last two decades, especially among people over the age of 65 years. Significant advances in the understanding of the pathobiology of IPF have emerged, and multiple genetic and nongenetic contributors have been identified. The individual patient course and the rate of disease progression in IPF are often unpredictable and heterogeneous. The rate of lung function decline is further modified by treatment with antifibrotic therapies, which have been shown to slow down disease progression. The presence of comorbid conditions may increase symptom burden and impact survival. Clinical monitoring at regular intervals to assess for disease progression by worsening symptoms, physiological parameters and/or radiological features is essential to assess the natural disease course and to guide further management, including prompt detection of complications and comorbid conditions that warrant additional treatment considerations, and timely consideration of referral to palliative care and lung transplantation for the appropriate patient. More studies are needed to determine whether early detection of IPF might improve patient outcomes. The purpose of this concise clinical review is to provide an update on IPF diagnosis, epidemiology, natural history and treatment in the context of new knowledge and latest clinical practice guidelines.

摘要

特发性肺纤维化(IPF)是一种进行性肺纤维化疾病,其特征是呼吸症状恶化和生理功能损害。对 IPF 临床表现认识的提高、计算机断层扫描(CT)的更广泛应用以及其他潜在因素导致 IPF 的患病率在过去二十年中不断上升,尤其是在 65 岁以上人群中。对 IPF 的病理生物学的认识已经取得了重大进展,已经确定了多个遗传和非遗传因素。IPF 患者的个体病程和疾病进展速度往往是不可预测的和异质的。肺纤维化治疗药物(抗纤维化药物)的使用进一步改变了肺功能下降的速度,这些药物已被证明可以减缓疾病进展。合并症的存在可能会增加症状负担并影响生存。定期进行临床监测,通过恶化的症状、生理参数和/或影像学特征评估疾病进展,对于评估自然病程和指导进一步治疗至关重要,包括及时发现需要额外治疗考虑的并发症和合并症,并及时考虑转介姑息治疗和肺移植适合的患者。需要更多的研究来确定早期发现 IPF 是否可以改善患者的预后。本简明临床综述的目的是根据新的知识和最新的临床实践指南,更新 IPF 的诊断、流行病学、自然病史和治疗。

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