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特发性肺纤维化诊断与治疗的进展

Advances in idiopathic pulmonary fibrosis diagnosis and treatment.

作者信息

Liu Hongli, Shen Jiaxi, He Chao

机构信息

Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA.

Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX 77024, USA.

出版信息

Chin Med J Pulm Crit Care Med. 2025 Mar 7;3(1):12-21. doi: 10.1016/j.pccm.2025.02.001. eCollection 2025 Mar.

Abstract

Significant advances have been made in diagnosing and treating idiopathic pulmonary fibrosis (IPF) in the last decade. The incidence and prevalence of IPF are increasing, and morbidity and mortality remain high despite the two Food and Drug Administration (FDA)-approved medications, pirfenidone and nintedanib. Hence, there is an urgent need to develop new diagnostic tools and effective therapeutics to improve early, accurate diagnosis of IPF and halt or reverse the progression of fibrosis with a better safety profile. New diagnostic tools such as transbronchial cryobiopsy and genomic classifier require less tissue and generally have good safety profiles, and they have been increasingly utilized in clinical practice. Advances in artificial intelligence-aided diagnostic software are promising, but challenges remain. Both pirfenidone and nintedanib focus on growth factor-activated pathways to inhibit fibroblast activation. Novel therapies targeting different pathways and cell types (immune and epithelial cells) are being investigated. Biomarker-based personalized medicine approaches are also in clinical trials. This review aims to summarize recent diagnostic and therapeutic development in IPF.

摘要

在过去十年中,特发性肺纤维化(IPF)的诊断和治疗取得了重大进展。IPF的发病率和患病率在上升,尽管有两种药物已获美国食品药品监督管理局(FDA)批准,即吡非尼酮和尼达尼布,但发病率和死亡率仍然很高。因此,迫切需要开发新的诊断工具和有效的治疗方法,以改善IPF的早期、准确诊断,并以更好的安全性阻止或逆转纤维化进程。诸如经支气管冷冻活检和基因分类器等新的诊断工具所需组织较少,且通常具有良好的安全性,它们在临床实践中的应用越来越多。人工智能辅助诊断软件取得了一些进展,但挑战依然存在。吡非尼酮和尼达尼布都聚焦于生长因子激活的通路以抑制成纤维细胞活化。针对不同通路和细胞类型(免疫细胞和上皮细胞)的新型疗法正在研究中。基于生物标志物的个性化医疗方法也在进行临床试验。本综述旨在总结IPF近期在诊断和治疗方面的进展。

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