特发性肺纤维化患者抑酸与抗反流治疗的争议

Controversies about the roles of anti-acid and anti-reflux treatments in patients with idiopathic pulmonary fibrosis

特发性肺纤维化（IPF）平均生存期3～5年，发病机制仍未完全明确。胃食管反流病是IPF患者的常见合并症，可能参与了IPF的疾病进展和急性加重，微量误吸可能导致下呼吸道慢性炎症、损伤和异常修复，IPF也可能加重胃食管反流。回顾性研究数据提示抑酸治疗可能稳定IPF患者肺功能，减少急性加重频次，改善患者预后，也有前瞻性研究显示抗反流手术对IPF患者有益。现有国际和国内指南推荐IPF患者常规抗酸治疗，但目前仍存在较大争议。需要更深入的l临床和基础研究，探讨IPF患者中抑酸、抗反流治疗的作用和机制，为临床提供更可靠的证据。

Idiopathic pulmonary fibrosis （IPF） is a devastating disease with a median survival of 3 to 5 years, but its mechanisms are not fully understood. Gastroesophageal reflux disease （GERD） is a frequent comorbidity in IPF, which is suggested to be involved in the progression and exacerbation of IPF. Mieroaspiration may induce persistent inflammation that impairs lung infrastructure and lead to fibrosis, while IPF may increase intrathoracie pressure that aggravates GERD vice versa. The possible beneficial effects have been shown by retrospective studies of anti-acid therapy on lung function, acute exacerbation and survival, and anti reflux surgery has been shown to be beneficial to IPF patients in a prospective study. Basing on these data, the recent international and Chinese IPF guidelines recommend anti acid therapies for all IPF patients regardless of symptomatic GERD. Yet, these recommendations are not supported by some newer conflicting data. Elucidation of these questions by further clinical and bench to bedside research may provide us with rational clinical diagnostic and therapeutic approaches concerning GERD in IPF.