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特发性肺纤维化:现有知识综述。

Idiopathic Pulmonary Fibrosis: Review of Current Knowledge.

机构信息

6Department of Anatomy of the Faculty of Medicine of Pavol Jozef Šafárik University in Košice, Slovakia.

出版信息

Physiol Res. 2024 Aug 31;73(4):487-497. doi: 10.33549/physiolres.935322.

Abstract

Idiopathic pulmonary fibrosis (IPF) is a severe and currently incurable disease that is associated with irreversible fibrotic remodeling of the lung parenchyma. Pathological remodeling of the lung leads to damage of the alveolo-capillary barrier. There is a reduction in the diffusing capacity of the lungs for respiratory gases. Later, changes in the mechanical properties of lung tissue occur - their compliance decreases and respiratory work increases. Impaired respiratory gases exchange with restrictive ventilatory failure lead to tissue hypoxia and muscle weakness. Progressive respiratory insufficiency develops. The triggers of fibrotic remodeling of the lung are currently unknown, as are the pathomechanisms that keep this process active. IPF can only be slowed pharmacologically, not reversed. It is therefore very important to start its treatment as soon as possible. Early detection of IPF patients requires a multidisciplinary approach. Diagnosis, treatment initiation, and monitoring in specialized centers offer the best chance of slowing disease progression, enhancing quality of life, and extending patient survival. In addition to antifibrotic therapy, good lifestyle management, maintenance of physical fitness and treatment of associated chronic diseases such as diabetes and cardiac comorbidities are important. Lung transplantation is an option for some patients with IPF. This is a challenging treatment modality, requiring close collaboration with transplant centers and expert selection of suitable candidates, influenced, among other things, by the availability of suitable donor lungs. Our article aims to provide current information about IPF, focusing on its functional consequences and clinical manifestation. We discuss the molecular and cellular mechanisms potentially involved in IPF development, as well as the morphological changes observed in lung biopsies and high-resolution computed tomography (HRCT) images. Finally, we summarize the existing treatment options. Key words: Idiopathic pulmonary fibrosis, Lung biopsy, HRCT, Antifibrotic therapy, Lung transplantation.

摘要

特发性肺纤维化(IPF)是一种严重且目前无法治愈的疾病,其特征是肺实质发生不可逆转的纤维化重塑。肺部的病理性重塑导致肺泡-毛细血管屏障损伤。肺部呼吸气体的扩散能力降低。随后,肺组织的机械性能发生变化——顺应性降低,呼吸功增加。呼吸气体交换受损导致限制性通气衰竭,进而引起组织缺氧和肌肉无力。进行性呼吸功能不全随之发展。目前尚不清楚导致肺纤维化重塑的触发因素,也不清楚维持这一过程的病理机制。IPF 只能通过药物来减缓其进展,而无法逆转。因此,尽早开始治疗非常重要。早期发现 IPF 患者需要采取多学科方法。在专门的中心进行诊断、开始治疗和监测可最大程度地减缓疾病进展、提高生活质量并延长患者生存时间。除了抗纤维化治疗外,良好的生活方式管理、保持身体机能以及治疗糖尿病和心脏合并症等相关慢性疾病也很重要。肺移植是一些 IPF 患者的一种选择。这是一种具有挑战性的治疗方式,需要与移植中心密切合作,并由专家选择合适的候选者,这受到合适供体肺的可用性等因素的影响。我们的文章旨在提供有关 IPF 的最新信息,重点介绍其功能后果和临床表现。我们讨论了可能参与 IPF 发展的分子和细胞机制,以及在肺活检和高分辨率计算机断层扫描(HRCT)图像中观察到的形态变化。最后,我们总结了现有的治疗选择。

关键词

特发性肺纤维化、肺活检、HRCT、抗纤维化治疗、肺移植。

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本文引用的文献

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