肺癌术后肺纤维化急性加重的诊疗进展
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摘要
特发性肺纤维化(IPF)是一种特殊类型的间质性肺炎,以缓慢进展为特点,其病变局限在肺部,老年人多见,一部分病例会出现急性加重的过程,表现为原有肺部病变突然恶化和致死性的呼吸衰竭,并出现新的肺部阴影和弥漫性肺泡病理改变。特发性肺纤维化急性加重(AEIPF)可发生于接受肺切除术后的原发性肺癌患者,起病通常呈急性或亚急性过程,病因尚不明确,通常认为与不明原因的肺损伤相关,起病隐匿,病情进展迅速,病死率高,而且在临床缺乏常规的预防和治疗措施,成为困扰临床医生的难题。本文就肺癌术后特发性肺纤维化急性加重的病因、发生的危险因素、预测指标、预防、治疗、预后等方面做一系统综述。
Idiopathic pulmonary fibrosis(IPF) is a respiratory disease characterized by slow progression. It is a special type of interstitial pneumonia. Its pathological changes are confined to lungs. It is common in the elderly. However some cases occur with acute exacerbation that manifested by sudden deterioration of the original pulmonary lesions,fatal respiratory failure and new pulmonary shadow and diffuse alveolar pathological changes. This acute exacerbation of IPF can occur in patients with primary lung cancer after lung resection,usually with an acute or subacute onset. The etiology of acute exacerbation of pulmonary fibrosis after lung cancer surgery is still unclear. It is usually considered to be related to pulmonary injury of unknown causes. Because of its hidden onset,rapid progression,high mortality and lack of routine preventive and therapeutic measures in clinic,it has become a difficult problem for clinicians. This article reviews the etiology,risk factors,predictive indicators,prophylaxis,treatment and prognosis of acute exacerbation of IPF after lung cancer surgery.
Idiopathic pulmonary fibrosis(IPF) is a respiratory disease characterized by slow progression. It is a special type of interstitial pneumonia. Its pathological changes are confined to lungs. It is common in the elderly. However some cases occur with acute exacerbation that manifested by sudden deterioration of the original pulmonary lesions,fatal respiratory failure and new pulmonary shadow and diffuse alveolar pathological changes. This acute exacerbation of IPF can occur in patients with primary lung cancer after lung resection,usually with an acute or subacute onset. The etiology of acute exacerbation of pulmonary fibrosis after lung cancer surgery is still unclear. It is usually considered to be related to pulmonary injury of unknown causes. Because of its hidden onset,rapid progression,high mortality and lack of routine preventive and therapeutic measures in clinic,it has become a difficult problem for clinicians. This article reviews the etiology,risk factors,predictive indicators,prophylaxis,treatment and prognosis of acute exacerbation of IPF after lung cancer surgery.
引文
[1]Provencher DM,Jauregui AR.Recommendations for evaluating and managing idiopathic pulmonary fibrosis[J].JAAPA,2018,31(9):21-26.doi:10.1097/01.JAA.0000544299.00459.a4.
[2]Enomoto N,Oyama Y,Enomoto Y,et al.Differences in clinical features of acute exacerbation between connective tissue diseaseassociated interstitial pneumonia and idiopathic pulmonary fibrosis[J].Chron Respir Dis,2019,16:396948092.doi:10.1177/1479972318809476.
[3]Park J,Kim DS,Shim TS,et al.Lung cancer in patients with idiopathic pulmonary fibrosis[J].Eur Respir J,2001,17(6):1216-1219.doi:10.1183/09031936.01.99055301.
[4]Collard HR,Ryerson CJ,Corte TJ,et al.Acute exacerbation of idiopathic pulmonary fibrosis.An international working group report[J].Am J Respir Crit Care Med,2016,194(3):265-275.doi:10.1164/rccm.201604-0801CI.
[5]Kishaba T,Nagano H,Nei Y,et al.Clinical characteristics of idiopathic pulmonary fibrosis patients according to their smoking status[J].J Thorac Dis,2016,8(6):1112-1120.doi:10.21037/jtd.2016.03.89.
[6]Balestro E,Calabrese F,Turato G,et al.Immune inflammation and disease progression in idiopathic pulmonary fibrosis[J].PLoS One,2016,11(5):e154516.doi:10.1371/journal.pone.0154516.
[7]Miyamoto A,Sharma A,Nishino M,et al.Expanded acceptance of acute exacerbation of nonspecific interstitial pneumonia,including7 additional cases with detailed clinical pathologic correlation[J].Pathol Int,2018,68(7):401-408.doi:10.1111/pin.12676.
[8]Min H,Fan S,Song S,et al.Plasma microRNAs are associated with acute exacerbation in idiopathic pulmonary fibrosis[J].Diagn Pathol,2016,11(1):135.doi:10.1186/s13000-016-0583-2.
[9]Shintani Y,Ohta M,Iwasaki T,et al.Predictive factors for postoperative acute exacerbation of interstitial pneumonia combined with lung cancer[J].Gen Thorac Cardiovasc Surg,2010,58(4):182-185.doi:10.1007/s11748-009-0569-z.
[10]Watanabe A,Kawaharada N,Higami T.Postoperative acute exacerbation of IPF after lung resection for primary lung cancer[J].Pulm Med,2011,2011:960316.doi:10.1155/2011/960316.
[11]Sato T,Teramukai S,Kondo H,et al.Impact and predictors of acute exacerbation of interstitial lung diseases after pulmonary resection for lung cancer[J].J Thorac Cardiovasc Surg,2014,147(5):1604-1611.doi:10.1016/j.jtcvs.2013.09.050.
[12]Kumar P,Goldstraw P,Yamada K,et al.Pulmonary fibrosis and lung cancer:risk and benefit analysis of pulmonary resection[J].JThorac Cardiovasc Surg,2003,125(6):1321-1327.doi:10.1016/S0022-5223(03)00028-X.
[13]Sakata R,Fujii Y,Kuwano H.Thoracic and cardiovascular surgery in Japan during 2008:annual report by The Japanese Association for Thoracic Surgery[J].Gen Thorac Cardiovasc Surg,2010,58(7):356-383.doi:10.1007/s11748-010-0604-0.
[14]Tzouvelekis A,Herazo-Maya J,Sakamoto K,et al.Biomarkers in the evaluation and management of idiopathic pulmonary fibrosis[J].Curr Top Med Chem,2016,16(14):1587-1598.doi:10.2174/1568026616666150930120959.
[15]Guiot J,Moermans C,Henket M,et al.Blood biomarkers in idiopathic pulmonary fibrosis[J].Lung,2017,195(3):273-280.doi:10.1007/s00408-017-9993-5.
[16]Sato T,Kondo H,Watanabe A,et al.A simple risk scoring system for predicting acute exacerbation of interstitial pneumonia after pulmonary resection in lung cancer patients[J].Gen Thorac Cardiovasc Surg,2015,63(3):164-172.doi:10.1007/s11748-014-0487-6.
[17]Brunelli A,Kim AW,Berger KI,et al.Physiologic evaluation of the patient with lung cancer being considered for resectional surgery:diagnosis and management of lung cancer,3rd ed:American College of Chest Physicians evidence-based clinical practice guidelines[J].Chest,2013,143(5):e166S-e190S.doi:10.1378/chest.12-2395.
[18]Yano M,Sasaki H,Moriyama S,et al.Post-operative acute exacerbation of pulmonary fibrosis in lung cancer patients undergoing lung resection[J].Interact Cardiovasc Thorac Surg,2012,14(2):146-150.doi:10.1093/icvts/ivr029.
[19]Kim KN,Kim DW,Jeong MA,et al.Comparison of pressurecontrolled ventilation with volume-controlled ventilation during one-lung ventilation:a systematic review and meta-analysis[J].BMC Anesthesiol,2016,16(1):72.doi:10.1186/s12871-016-0238-6.
[20]Mizuno Y,Iwata H,Shirahashi K,et al.The importance of intraoperative fluid balance for the prevention of postoperative acute exacerbation of idiopathic pulmonary fibrosis after pulmonary resection for primary lung cancer[J].Eur J Cardiothorac Surg,2012,41(6):e161-e165.doi:10.1093/ejcts/ezs147.
[21]Tsubochi H,Shibano T,Endo S.Recommendations for perioperative management of lung cancer patients with comorbidities[J].Gen Thorac Cardiovasc Surg,2018,66(2):71-80.doi:10.1007/s11748-017-0864-z.
[22]Oyama K,Kanzaki M,Kondo M,et al.Early detection of the acute exacerbation of interstitial pneumonia after the surgical resection of lung cancer by planned chest computed tomography[J].Korean JThorac Cardiovasc Surg,2017,50(3):177-183.doi:10.5090/kjtcs.2017.50.3.177.
[23]Rogliani P,Calzetta L,Cavalli F,et al.Pirfenidone,nintedanib and N-acetylcysteine for the treatment of idiopathic pulmonary fibrosis:A systematic review and meta-analysis[J].Pulm Pharmacol Ther,2016,40:95-103.doi:10.1016/j.pupt.2016.07.009.
[24]Spagnolo P,Wuyts W.Acute exacerbations of interstitial lung disease:lessons from idiopathic pulmonary fibrosis[J].Curr Opin Pulm Med,2017,23(5):411-417.doi:10.1097/MCP.0000000000000405.
[25]Marchioni A,Tonelli R,Ball L,et al.Acute exacerbation of idiopathic pulmonary fibrosis:lessons learned from acute respiratory distress syndrome?[J].Crit Care,2018,22(1):80.doi:10.1186/s13054-018-2002-4.
[26]Itai J,Ohshimo S,Kida Y,et al.A pilot study:a combined therapy using polymyxin-B hemoperfusion and extracorporeal membrane oxygenation for acute exacerbation of interstitial pneumonia[J].Sarcoidosis Vasc Diffuse Lung Dis,2015,31(4):343-349.
[27]Juarez MM,Chan AL,Norris AG,et al.Acute exacerbation of idiopathic pulmonary fibrosis-a review of current and novel pharmacotherapies[J].J Thorac Dis,2015,7(3):499-519.doi:10.3978/j.issn.2072-1439.2015.01.17.(2019-03-12收稿2019-05-31修回)
[2]Enomoto N,Oyama Y,Enomoto Y,et al.Differences in clinical features of acute exacerbation between connective tissue diseaseassociated interstitial pneumonia and idiopathic pulmonary fibrosis[J].Chron Respir Dis,2019,16:396948092.doi:10.1177/1479972318809476.
[3]Park J,Kim DS,Shim TS,et al.Lung cancer in patients with idiopathic pulmonary fibrosis[J].Eur Respir J,2001,17(6):1216-1219.doi:10.1183/09031936.01.99055301.
[4]Collard HR,Ryerson CJ,Corte TJ,et al.Acute exacerbation of idiopathic pulmonary fibrosis.An international working group report[J].Am J Respir Crit Care Med,2016,194(3):265-275.doi:10.1164/rccm.201604-0801CI.
[5]Kishaba T,Nagano H,Nei Y,et al.Clinical characteristics of idiopathic pulmonary fibrosis patients according to their smoking status[J].J Thorac Dis,2016,8(6):1112-1120.doi:10.21037/jtd.2016.03.89.
[6]Balestro E,Calabrese F,Turato G,et al.Immune inflammation and disease progression in idiopathic pulmonary fibrosis[J].PLoS One,2016,11(5):e154516.doi:10.1371/journal.pone.0154516.
[7]Miyamoto A,Sharma A,Nishino M,et al.Expanded acceptance of acute exacerbation of nonspecific interstitial pneumonia,including7 additional cases with detailed clinical pathologic correlation[J].Pathol Int,2018,68(7):401-408.doi:10.1111/pin.12676.
[8]Min H,Fan S,Song S,et al.Plasma microRNAs are associated with acute exacerbation in idiopathic pulmonary fibrosis[J].Diagn Pathol,2016,11(1):135.doi:10.1186/s13000-016-0583-2.
[9]Shintani Y,Ohta M,Iwasaki T,et al.Predictive factors for postoperative acute exacerbation of interstitial pneumonia combined with lung cancer[J].Gen Thorac Cardiovasc Surg,2010,58(4):182-185.doi:10.1007/s11748-009-0569-z.
[10]Watanabe A,Kawaharada N,Higami T.Postoperative acute exacerbation of IPF after lung resection for primary lung cancer[J].Pulm Med,2011,2011:960316.doi:10.1155/2011/960316.
[11]Sato T,Teramukai S,Kondo H,et al.Impact and predictors of acute exacerbation of interstitial lung diseases after pulmonary resection for lung cancer[J].J Thorac Cardiovasc Surg,2014,147(5):1604-1611.doi:10.1016/j.jtcvs.2013.09.050.
[12]Kumar P,Goldstraw P,Yamada K,et al.Pulmonary fibrosis and lung cancer:risk and benefit analysis of pulmonary resection[J].JThorac Cardiovasc Surg,2003,125(6):1321-1327.doi:10.1016/S0022-5223(03)00028-X.
[13]Sakata R,Fujii Y,Kuwano H.Thoracic and cardiovascular surgery in Japan during 2008:annual report by The Japanese Association for Thoracic Surgery[J].Gen Thorac Cardiovasc Surg,2010,58(7):356-383.doi:10.1007/s11748-010-0604-0.
[14]Tzouvelekis A,Herazo-Maya J,Sakamoto K,et al.Biomarkers in the evaluation and management of idiopathic pulmonary fibrosis[J].Curr Top Med Chem,2016,16(14):1587-1598.doi:10.2174/1568026616666150930120959.
[15]Guiot J,Moermans C,Henket M,et al.Blood biomarkers in idiopathic pulmonary fibrosis[J].Lung,2017,195(3):273-280.doi:10.1007/s00408-017-9993-5.
[16]Sato T,Kondo H,Watanabe A,et al.A simple risk scoring system for predicting acute exacerbation of interstitial pneumonia after pulmonary resection in lung cancer patients[J].Gen Thorac Cardiovasc Surg,2015,63(3):164-172.doi:10.1007/s11748-014-0487-6.
[17]Brunelli A,Kim AW,Berger KI,et al.Physiologic evaluation of the patient with lung cancer being considered for resectional surgery:diagnosis and management of lung cancer,3rd ed:American College of Chest Physicians evidence-based clinical practice guidelines[J].Chest,2013,143(5):e166S-e190S.doi:10.1378/chest.12-2395.
[18]Yano M,Sasaki H,Moriyama S,et al.Post-operative acute exacerbation of pulmonary fibrosis in lung cancer patients undergoing lung resection[J].Interact Cardiovasc Thorac Surg,2012,14(2):146-150.doi:10.1093/icvts/ivr029.
[19]Kim KN,Kim DW,Jeong MA,et al.Comparison of pressurecontrolled ventilation with volume-controlled ventilation during one-lung ventilation:a systematic review and meta-analysis[J].BMC Anesthesiol,2016,16(1):72.doi:10.1186/s12871-016-0238-6.
[20]Mizuno Y,Iwata H,Shirahashi K,et al.The importance of intraoperative fluid balance for the prevention of postoperative acute exacerbation of idiopathic pulmonary fibrosis after pulmonary resection for primary lung cancer[J].Eur J Cardiothorac Surg,2012,41(6):e161-e165.doi:10.1093/ejcts/ezs147.
[21]Tsubochi H,Shibano T,Endo S.Recommendations for perioperative management of lung cancer patients with comorbidities[J].Gen Thorac Cardiovasc Surg,2018,66(2):71-80.doi:10.1007/s11748-017-0864-z.
[22]Oyama K,Kanzaki M,Kondo M,et al.Early detection of the acute exacerbation of interstitial pneumonia after the surgical resection of lung cancer by planned chest computed tomography[J].Korean JThorac Cardiovasc Surg,2017,50(3):177-183.doi:10.5090/kjtcs.2017.50.3.177.
[23]Rogliani P,Calzetta L,Cavalli F,et al.Pirfenidone,nintedanib and N-acetylcysteine for the treatment of idiopathic pulmonary fibrosis:A systematic review and meta-analysis[J].Pulm Pharmacol Ther,2016,40:95-103.doi:10.1016/j.pupt.2016.07.009.
[24]Spagnolo P,Wuyts W.Acute exacerbations of interstitial lung disease:lessons from idiopathic pulmonary fibrosis[J].Curr Opin Pulm Med,2017,23(5):411-417.doi:10.1097/MCP.0000000000000405.
[25]Marchioni A,Tonelli R,Ball L,et al.Acute exacerbation of idiopathic pulmonary fibrosis:lessons learned from acute respiratory distress syndrome?[J].Crit Care,2018,22(1):80.doi:10.1186/s13054-018-2002-4.
[26]Itai J,Ohshimo S,Kida Y,et al.A pilot study:a combined therapy using polymyxin-B hemoperfusion and extracorporeal membrane oxygenation for acute exacerbation of interstitial pneumonia[J].Sarcoidosis Vasc Diffuse Lung Dis,2015,31(4):343-349.
[27]Juarez MM,Chan AL,Norris AG,et al.Acute exacerbation of idiopathic pulmonary fibrosis-a review of current and novel pharmacotherapies[J].J Thorac Dis,2015,7(3):499-519.doi:10.3978/j.issn.2072-1439.2015.01.17.(2019-03-12收稿2019-05-31修回)