呼吸臨床

【特集】特発性間質性肺炎の診療の現状と将来展望

企画：小倉高志


　最近，特発性間質性肺炎(IIPs)は次の点で注目されています。①IIPsの中でも頻度の高く，難治性といわれている特発性肺線維症（IPF）に対する２つの抗線維化薬（ピルフェニドン，ニンテダティブ）が出現して，IIPsならIPFか，それ以外のnon-IPFかの鑑別がすることが治療選択や予後に大きく影響を与えるようになりました。②無症状で潜在性な間質性肺炎患者が増加している可能性が示唆されています。すなわち，いくつもの成人病のコホート，肺癌やCOPDのCT検診でInterstitial Lung Abnormalities(ILA)を８〜10％に認めて，その一部はIPFに進展する可能性あるという報告がされています。呼吸器内科医すべてが，IIPsの診断，治療にかかわる機会が多くなることが予想されます。今回，IIPs診療の第一線で治療にあたっている専門家にIIPsの最近の診断と治療について解説していただきます。

特発性間質性肺炎の治療の基本的な考え方

冨岡洋海*

*神戸市立医療センター西市民病院呼吸器内科（〒653-0013　兵庫県神戸市長田区一番町2-4）


Basic approach for the treatment of the idiopathic interstitial pneumonias

Hiromi Tomioka*

*Department of Respiratory Medicine, Kobe City Medical Center West Hospital


Keywords：特発性間質性肺炎，特発性肺線維症，抗線維化薬，ステロイド，疾患経過／IIPs，IPF，anti-fibrotic agents，steroid，disease behavior


呼吸臨床 2018年2巻7号　論文No.e00042
Jpn Open J Respir Med 2018 Vol.2 No.7  Article No.e00042

DOI: 10.24557/kokyurinsho.2.e00042


掲載日：2018年7月20日


©️Hiromi Tomioka. 本論文の複製権，翻訳権，上映権，譲渡権，貸与権，公衆送信権（送信可能化権を含む）は弊社に帰属し，それらの利用ならびに許諾等の管理は弊社が行います。





要旨

　特発性間質性肺炎の治療の基本は，最も難治性の特発性肺線維症（IPF）に対する抗線維化薬の承認，また，ステロイド・免疫抑制薬による抗炎症治療はIPF慢性期では有害との見解に基づき，抗線維化薬と抗炎症薬の適応を見極めることである。疾患の経過（disease behavior）に対応した治療目標を患者と共有し，治療を継続することが重要であり，早期診断・早期治療によって生存期間の延長を目指すべきである。


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