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患者资料
问
根据以上信息,你的诊断治疗是什么?
答案
答案:根据影像学诊断,排除已知的肺纤维化原因,诊断为特发性肺纤维化。
由于疾病明确的放射学表现和潜在的慢性阻塞性呼吸系统疾病,未进行组织病理学确认。该患者符合抗纤维化IPF治疗的条件。经吡非尼酮治疗11个月后好转,TLC:80%;DLCO:55%。
问
该患者最有可能诊断为什么疾病?
答案
答案:根据影像学诊断,排除已知的肺纤维化原因,诊断为特发性肺纤维化。
答案:IPF易合并肺癌、慢性阻塞性肺病,肺动脉高压,充血性心力衰竭等疾病。其中肺癌对IPF患者死亡率影响最大,IPF-肺癌生存率明显低于单纯肺癌患者(中位生存期38.7个月vs.63.9个月)。IPF发生肺癌的相对风险大约是普通人群的7倍,据报道IPF患者的肺癌患病率为3-48%[1]。
问
如何考虑IPF伴发SLCL的治疗?
答案
答案:由于存在活动性肿瘤疾病是排除参与吡非尼酮药物项目的标准;病人停止抗纤维化治疗。并开始SCLC的全身治疗。
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参考文献:
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[2].Grodkiewicz M,Koziel P,Chmielewska I,Korbel MA,Milanowski J.Small Cell Lung Cancer in the Course of Idiopathic Pulmonary Fibrosis-Case Report and Literature Review.Curr Oncol.2022 Jul 18;29(7):5077-5083.doi:10.3390/curroncol29070401.PMID:35877261;PMCID:PMC9318736.https://pubmed.ncbi.nlm.nih.gov/35877261/
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本文首发:医学界肿瘤频道
本文作者:阿凯
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