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--> 00:00.438\n嗯，\n\n00:00.438 --> 00:01.388\n大家晚上好，\n\n00:01.388 --> 00:05.438\n今天给大家讲一下肺纤维化的认识与药物的进展。\n\n00:06.861 --> 00:07.960\n肺纤首先呢，\n\n00:07.960 --> 00:09.461\n我们从以下两个方面，\n\n00:09.461 --> 00:14.260\n一个是肺纤维化的认识和肺纤维化机制与药物进展两个方面，\n\n00:14.260 --> 00:16.160\n来给大家介绍今天的情况。\n\n00:16.410 --> 00:18.361\n首先是肺纤维化的认识，\n\n00:18.461 --> 00:19.910\n什么是肺纤维化？\n\n00:19.910 --> 00:20.861\n肺纤维化呢，\n\n00:20.861 --> 00:22.910\n它是一种严重的肺部疾病，\n\n00:23.010 --> 00:26.760\n它持续进展将导致肺的换气功能障碍，\n\n00:26.760 --> 00:28.410\n进而出现呼吸衰竭，\n\n00:28.461 --> 00:30.961\n严重影响患者的身心健康。\n\n00:31.260 --> 00:32.160\n临床上呢，\n\n00:32.160 --> 00:36.011\n肺纤维化一般是指间质性肺疾病的一个终末期的改变。\n\n00:36.410 --> 00:36.761\n嗯，\n\n00:36.761 --> 00:37.261\n首先。\n\n00:37.312 --> 00:38.112\n先是肺纤维化，\n\n00:38.112 --> 00:41.112\n它会出现一个正常的人体组织受损后，\n\n00:41.213 --> 00:44.463\n被过度增生的纤维组织替代的过程，\n\n00:44.812 --> 00:46.513\n出现一个肺的纤维化，\n\n00:46.513 --> 00:47.362\n肺部受损，\n\n00:47.362 --> 00:50.662\n肺组织一个自我的修复留下的疤痕样的过程。\n\n00:51.858 --> 00:52.182\n嗯，\n\n00:52.182 --> 00:53.608\n肺组织在肺，\n\n00:53.608 --> 00:55.983\n主要因为肺组织是由肺实质，\n\n00:55.983 --> 00:57.658\n主要是支气管和肺泡。\n\n00:57.757 --> 00:58.658\n肺间质呢，\n\n00:58.658 --> 01:05.233\n是结缔组织淋巴管神经纤维以及血管肺间质分布在各个肺实质之间，\n\n01:05.233 --> 01:10.907\n它是起着一个连接充填固定营养等作用的是保证了肺组织的弹性，\n\n01:10.958 --> 01:13.258\n让肺泡可以储存大量的氧气，\n\n01:13.358 --> 01:15.407\n保证人体一个自由的呼吸。\n\n01:15.708 --> 01:17.557\n间质性肺疾病的分类呢，\n\n01:17.557 --> 01:21.758\n首先间质性肺疾病和或者是我们称之为弥漫性。\n\n01:22.080 --> 01:23.279\n实质性的肺疾病呢，\n\n01:23.330 --> 01:24.930\n它分为几大类。\n\n01:25.029 --> 01:27.580\n第一个是特发性的间质性肺炎。\n\n01:27.830 --> 01:30.330\n它其中有特发性的肺纤维化，\n\n01:30.330 --> 01:33.279\n特发性肺非特异性间质性肺炎，\n\n01:33.379 --> 01:36.680\n特发性的胸膜肺弹力纤维增生症，\n\n01:36.730 --> 01:38.529\n脱屑性的间质性肺炎，\n\n01:38.529 --> 01:40.629\n淋巴细胞性间质性肺炎，\n\n01:40.830 --> 01:42.504\n呼吸性的细支气管炎，\n\n01:42.504 --> 01:44.230\n伴有间质性的肺病，\n\n01:44.279 --> 01:48.080\n隐源性急性纤维素样的计化性肺炎，\n\n01:48.230 --> 01:49.779\n急性的间质性肺炎。\n\n01:49.779 --> 01:51.980\n还有一个未肺未分类的特。\n\n01:52.080 --> 01:53.379\n发性的间质性肺炎，\n\n01:53.680 --> 01:56.779\n有结缔组织病相关的间质性肺炎，\n\n01:56.779 --> 01:59.230\n有系统性的硬化症，\n\n01:59.330 --> 02:00.930\n类风湿性的关节炎，\n\n02:00.980 --> 02:02.279\n炎症性的疾病，\n\n02:02.379 --> 02:04.029\n原发性干燥综合征，\n\n02:04.080 --> 02:05.830\n混合性的结缔组织病，\n\n02:05.879 --> 02:07.504\n安卡相关的血管炎，\n\n02:07.504 --> 02:08.979\n系统性的红斑狼疮。\n\n02:09.080 --> 02:11.679\n具有免疫学特征的间质性肺炎，\n\n02:11.880 --> 02:15.130\n有环境和暴露因素相关的间质性肺病，\n\n02:15.279 --> 02:16.029\n包括呢，\n\n02:16.029 --> 02:17.380\n过敏性的肺炎，\n\n02:17.380 --> 02:18.604\n尘肺，\n\n02:18.604 --> 02:22.029\n药物或毒物相关的间质性肺病或者辐射。\n\n02:22.082 --> 02:23.608\n相关性的肺病啊，\n\n02:23.608 --> 02:33.733\n肉芽肿性疾病相关的间质性肺病包括结节病、朗格汉组织细胞增多症、嗜酸性粒细胞性肺炎以及其他的肉芽肿性的疾病。\n\n02:33.832 --> 02:38.533\n还有一些遗传或者是其他原因导致的弥漫性的实质性的肺疾病，\n\n02:38.632 --> 02:41.432\n包括家族性的间质性间质性肺病，\n\n02:41.533 --> 02:44.033\n肺泡蛋白沉积症以及其他原因。\n\n02:44.233 --> 02:46.757\n除了特发性的间质性肺炎之外呢，\n\n02:46.757 --> 02:50.158\n我们其他有结缔组织病相关的，\n\n02:50.158 --> 02:52.033\n或者是环境暴露。\n\n02:52.097 --> 02:52.671\n相关呢，\n\n02:52.671 --> 02:55.972\n我们认为它是属于一个已知原因的啊，\n\n02:55.972 --> 02:58.147\n弥漫性的实质性的肺疾病。\n\n02:59.076 --> 03:00.126\n包括，\n\n03:00.126 --> 03:01.526\n职业和环境因素，\n\n03:01.526 --> 03:08.026\n吸烟、放射治疗、药物、结缔组织病、胃食管反流以及新型的冠状病毒感染等等。\n\n03:08.276 --> 03:08.600\n嗯，\n\n03:08.600 --> 03:09.876\n肺纤维化的特征，\n\n03:09.876 --> 03:11.776\n大部分的肺纤维化患者呢，\n\n03:11.776 --> 03:14.126\n他可以看到杵状指，\n\n03:14.175 --> 03:19.425\n表现为手指或者是足趾远端的增生肥厚呈杵状膨大。\n\n03:19.475 --> 03:20.326\n就诊时呢，\n\n03:20.326 --> 03:23.925\n患者可在医生可在患者的双肺底部呢，\n\n03:23.925 --> 03:26.725\n闻及吸气末的细小的微克罗罗音。\n\n03:27.126 --> 03:27.501\n嗯，\n\n03:27.501 --> 03:28.850\n在疾病的早期呢，\n\n03:28.850 --> 03:29.276\n它的。\n\n03:29.348 --> 03:30.548\n症状会比较隐匿，\n\n03:30.548 --> 03:31.748\n很难被人发现。\n\n03:31.949 --> 03:32.298\n嗯，\n\n03:32.298 --> 03:36.048\n多以一个活动过后的出现呼吸困难为表现。\n\n03:36.298 --> 03:37.848\n在疾病进展期呢，\n\n03:37.848 --> 03:42.598\n会患者会出现一个症状逐渐明显并进行性加重的表现。\n\n03:42.699 --> 03:43.774\n严重时候呢，\n\n03:43.774 --> 03:45.048\n在静息状态下呢，\n\n03:45.048 --> 03:46.798\n也会出现一个呼吸困难。\n\n03:46.949 --> 03:49.649\n患者也可能会有一个持续性的干咳。\n\n03:49.748 --> 03:50.873\n少数的患者呢，\n\n03:50.873 --> 03:53.399\n会有咯血、胸痛和喘鸣。\n\n03:53.649 --> 03:54.923\n在疾病的晚期，\n\n03:54.923 --> 03:59.298\n患者有明显的唇甲紫绀、肺动脉高压以及右心功能。\n\n03:59.326 --> 03:59.776\n功能不全，\n\n03:59.876 --> 04:02.776\n同时可能会出现呼吸衰竭甚至死亡。\n\n04:03.126 --> 04:05.576\n肺纤维化的检查措施呢，\n\n04:05.576 --> 04:07.977\n首先我们可以从体征上发现，\n\n04:08.076 --> 04:10.826\n患者会出现一个呼吸频率的增快，\n\n04:10.927 --> 04:14.526\n这种可能是间质性肺病肺病的一个最早的表现。\n\n04:14.776 --> 04:15.776\n双下肺呢，\n\n04:15.776 --> 04:18.326\n可以听到捻发音或者是湿罗音，\n\n04:18.427 --> 04:19.476\n有杵状指。\n\n04:20.467 --> 04:20.666\n嗯，\n\n04:20.666 --> 04:22.117\n对于肺功能的检查呢，\n\n04:22.117 --> 04:24.717\n会发现一个限制性的通气功能障碍，\n\n04:24.766 --> 04:26.867\n弥漫性的降低，\n\n04:26.867 --> 04:30.367\n同时伴有一个低氧血症或者是异型的呼吸衰竭。\n\n04:30.566 --> 04:31.916\n胸部的影像学呢，\n\n04:31.916 --> 04:34.916\n胸部的X线会发现一个弥漫性的阴影，\n\n04:35.016 --> 04:36.592\n或者是较少见的，\n\n04:36.592 --> 04:39.766\n会看到一些结节样的间质性的阴影。\n\n04:39.867 --> 04:41.066\n胸部的CT呢，\n\n04:41.066 --> 04:45.217\n会看到高分辨CT是有利于发现早期病变的，\n\n04:45.316 --> 04:49.016\n如肺内呈现一个不规则的线条网格状改变。\n\n04:49.016 --> 04:50.816\n同时伴有一个囊性小。\n\n04:50.873 --> 04:52.123\n小气腔的形成，\n\n04:52.424 --> 04:52.824\n嗯，\n\n04:53.273 --> 04:54.549\n做支气管镜呢，\n\n04:54.549 --> 04:56.123\n支气管肺泡灌洗液呢，\n\n04:56.123 --> 05:00.023\n我们会发现一些炎性免疫效应细胞的比例，\n\n05:00.174 --> 05:05.273\n可以将间质性肺病分类为淋巴细胞增多型和中性粒细胞增多型。\n\n05:05.574 --> 05:07.023\n组织病理学检查呢，\n\n05:07.023 --> 05:11.973\n对于高分辨CT呈现一个不典型间质性肺炎的改变的患者呢，\n\n05:12.023 --> 05:15.123\n如果诊断不清楚以及没有手术禁忌的患者，\n\n05:15.174 --> 05:19.373\n我们是可以考虑外科肺活检来进一步明确病因的。\n\n05:19.623 --> 05:20.723\n肺纤维化的。\n\n05:20.928 --> 05:22.278\n危害首先呢，\n\n05:22.278 --> 05:24.003\n肺纤维化它难以治愈，\n\n05:24.053 --> 05:28.003\n它只能够通过治疗来控制肺纤维化疾病的进展。\n\n05:28.204 --> 05:28.928\n同时呢，\n\n05:28.928 --> 05:29.729\n肺纤维化呢，\n\n05:29.729 --> 05:32.053\n容易出现肺大泡和气胸。\n\n05:32.204 --> 05:34.704\n在没能较好的稳定病情的时候呢，\n\n05:34.704 --> 05:36.454\n就会引发一个肺大泡。\n\n05:36.503 --> 05:37.628\n肺大泡破裂呢，\n\n05:37.628 --> 05:39.354\n就会出现气胸的并发症。\n\n05:40.433 --> 05:40.759\n嗯，\n\n05:40.759 --> 05:41.734\n说再有呢，\n\n05:41.734 --> 05:45.033\n肺纤维化患者会出现一个呼吸困难的症状，\n\n05:45.033 --> 05:46.933\n主要是因为肺部的缺氧，\n\n05:46.984 --> 05:48.009\n同时呢，\n\n05:48.009 --> 05:50.283\n也容易继发一个心脏的衰竭，\n\n05:50.283 --> 05:51.484\n引发肺心病。\n\n05:51.634 --> 05:52.658\n一旦出现呢，\n\n05:52.658 --> 05:56.334\n可能就会导致一个患者的丧失劳动力，\n\n05:56.334 --> 05:57.359\n严重的时候呢，\n\n05:57.359 --> 05:59.234\n甚至会导致患者死亡。\n\n05:59.634 --> 05:59.959\n嗯，\n\n05:59.959 --> 06:00.884\n肺纤维化呢，\n\n06:00.884 --> 06:02.834\n会加速一个患者的死亡。\n\n06:02.834 --> 06:04.408\n首先说，\n\n06:04.408 --> 06:07.933\n多种各个类型的肺纤维化呢，\n\n06:07.933 --> 06:10.584\n它在确诊肺纤维化之后呢。\n\n06:10.852 --> 06:12.928\n到患者出现死亡，\n\n06:12.928 --> 06:15.803\n他的是生存期都是不长的。\n\n06:15.803 --> 06:16.403\n比如说，\n\n06:16.403 --> 06:19.102\n诊断间质性肺病到进展时间呢，\n\n06:19.102 --> 06:21.278\n一般是11.15个月。\n\n06:21.477 --> 06:21.803\n嗯，\n\n06:21.803 --> 06:23.453\n监测疾病进展的时间呢，\n\n06:23.453 --> 06:25.278\n一般是9.12个月。\n\n06:25.328 --> 06:27.028\n病情进展到死亡呢，\n\n06:27.028 --> 06:29.778\n大概是30.45个月的时间。\n\n06:31.010 --> 06:31.309\n嗯，\n\n06:31.309 --> 06:34.160\n肺纤维化的机制和药物的进展，\n\n06:34.260 --> 06:34.959\n首先呢，\n\n06:34.959 --> 06:37.559\n肺纤维化发的它的发病机制呢，\n\n06:37.559 --> 06:40.959\n首先是一个早期纤维化启动的阶段，\n\n06:41.059 --> 06:41.434\n嗯，\n\n06:41.434 --> 06:44.010\n疾它是具有一定的疾病的特异性。\n\n06:44.160 --> 06:44.510\n嗯，\n\n06:44.510 --> 06:45.760\n环境老化，\n\n06:45.760 --> 06:47.359\n一个遗传的易感性，\n\n06:47.410 --> 06:49.809\n肺泡上皮和血管内皮的损伤，\n\n06:49.959 --> 06:51.535\n抗原刺激免疫反应，\n\n06:51.535 --> 06:55.734\n肉芽肿的形成都会导致肺纤维化的启动，\n\n06:55.734 --> 06:58.410\n同也会导致肺纤维化的激活。\n\n07:00.266 --> 07:02.666\n肺纤维化发病机制在晚期呢，\n\n07:02.666 --> 07:05.967\n晚期的肺纤维化一般是肺纤维化机制是共享的，\n\n07:06.016 --> 07:11.516\n我们会有多种的细胞因子在参与肺纤维化的晚期发病过程当中，\n\n07:11.566 --> 07:14.467\n会导致肺纤维化的一个持续形成。\n\n07:14.666 --> 07:16.141\n然后在这段时间呢，\n\n07:16.141 --> 07:20.516\n我们可能会给他一个积极的抗纤维化治疗的措施。\n\n07:22.507 --> 07:26.183\n现在目前上已经上市的抗肺纤维化的治疗的药物呢，\n\n07:26.183 --> 07:27.257\n仅仅有两种，\n\n07:27.358 --> 07:28.657\n一个是比非尼酮，\n\n07:28.657 --> 07:29.858\n一个是尼达尼布。\n\n07:30.058 --> 07:32.558\n然后现在新药临床研究阶段呢，\n\n07:32.558 --> 07:33.407\n目前有三期，\n\n07:33.407 --> 07:34.757\n临床试验的药物呢，\n\n07:34.757 --> 07:35.407\n有3个，\n\n07:35.558 --> 07:37.058\n二期有22个，\n\n07:37.058 --> 07:38.558\n一期有24个。\n\n07:38.708 --> 07:39.958\n药物的类型呢，\n\n07:39.958 --> 07:41.208\n有化学药品呢，\n\n07:41.208 --> 07:42.108\n有35个，\n\n07:42.157 --> 07:43.483\n生物制剂药品呢，\n\n07:43.483 --> 07:44.407\n有14个，\n\n07:44.407 --> 07:45.558\n研发国家呢，\n\n07:45.558 --> 07:45.808\n有，\n\n07:45.808 --> 07:48.407\n国外有三十三十三个，\n\n07:48.407 --> 07:50.108\n中国也有16个，\n\n07:50.358 --> 07:50.757\n嗯，\n\n07:51.108 --> 07:52.708\n首先已经上市了。\n\n07:52.774 --> 07:54.725\n就是比非尼酮和尼达尼布，\n\n07:54.875 --> 07:59.524\n然后还有一些目前正在临床试验当中的药品。\n\n08:01.730 --> 08:01.855\n嗯，\n\n08:01.855 --> 08:02.880\n比菲尼酮呢，\n\n08:02.880 --> 08:07.880\n它是通过作用于TGF贝塔和TNF阿尔法呢，\n\n08:07.880 --> 08:10.630\n它发挥一个抗纤维化作用的，\n\n08:10.679 --> 08:11.704\n它的别称呢，\n\n08:11.704 --> 08:16.880\n又称为五甲基一苯基二二一羟丙啶酮。\n\n08:17.179 --> 08:17.579\n嗯，\n\n08:17.829 --> 08:20.954\n然后它是在2015年的，\n\n08:20.954 --> 08:25.204\n肺纤维化特发性肺间质纤维化的临床治疗指南当中呢，\n\n08:25.204 --> 08:29.980\n是推荐比非尼酮是用于特发性肺间质纤维化的治疗的。\n\n08:30.230 --> 08:30.579\n嗯，\n\n08:30.579 --> 08:31.880\n上市时间是。\n\n08:31.998 --> 08:33.049\n2008年，\n\n08:33.049 --> 08:33.773\n2011年，\n\n08:33.773 --> 08:34.648\n2013年，\n\n08:34.648 --> 08:36.323\n比菲尼酮分别在日本，\n\n08:36.323 --> 08:38.348\n欧盟和中国获批上市，\n\n08:38.898 --> 08:39.948\n然后发现呢，\n\n08:39.948 --> 08:42.348\n它是在1974年发现的啊，\n\n08:42.348 --> 08:43.174\n比非尼酮呢，\n\n08:43.174 --> 08:46.874\n它是作为一个抗癫痫药和抗惊厥药的药物呢，\n\n08:46.874 --> 08:52.448\n是在80年代被证明可能会对特发性肺间质纤维化是有用的。\n\n08:53.724 --> 08:54.724\n比非尼酮呢，\n\n08:54.724 --> 09:00.224\n它是通过由作用细胞因子机制来发挥一个抗纤维化的作用。\n\n09:00.325 --> 09:01.299\n比菲尼酮呢，\n\n09:01.299 --> 09:06.950\n它是通过作用于转化生长因子贝塔和特发生化生长因子啊，\n\n09:06.950 --> 09:09.674\n阿尔法发挥一个抗纤维化的作用。\n\n09:09.825 --> 09:11.349\n有实验研究表明呢，\n\n09:11.349 --> 09:16.974\n比非尼酮除了治疗特发性肺间质纤维化以外的肺纤维化，\n\n09:16.974 --> 09:21.375\n它同时可以减缓患者的FVC的下降趋势，\n\n09:21.474 --> 09:22.525\n可能是呢，\n\n09:22.525 --> 09:23.525\n就是。\n\n09:24.947 --> 09:25.273\n嗯，\n\n09:25.273 --> 09:27.122\n这种间质性肺病的患者呢，\n\n09:27.122 --> 09:29.098\n它也是一种合理的选择。\n\n09:29.348 --> 09:30.023\n首先呢，\n\n09:30.023 --> 09:33.547\n它可以抑制TGF贝塔一介导的肺纤维化，\n\n09:33.598 --> 09:36.547\n也可以抑制TNF阿尔法的促炎因子，\n\n09:36.598 --> 09:38.598\n减少成纤维细胞的增殖，\n\n09:38.598 --> 09:40.447\n抑制成纤维细胞的分化，\n\n09:40.598 --> 09:42.197\n减少胶原的沉积，\n\n09:42.297 --> 09:44.797\n来起到一个抗纤维化的作用。\n\n09:45.047 --> 09:46.322\n我们通过实验呢，\n\n09:46.322 --> 09:48.648\n也能够看到比非尼酮治疗组呢，\n\n09:48.648 --> 09:51.023\n它的用力肺活量的预计值呢，\n\n09:51.023 --> 09:53.797\n从基线水平至第四四十八周的。\n\n09:53.835 --> 09:56.935\n下降是显于显著低于安慰剂组的。\n\n09:58.984 --> 09:59.085\n嗯，\n\n09:59.085 --> 09:59.984\n尼达尼布呢，\n\n09:59.984 --> 10:02.434\n它是一种络氨酸激酶抑制剂，\n\n10:02.835 --> 10:05.059\n通过通过了同同时呢，\n\n10:05.059 --> 10:07.559\n通过高通量的筛选策略呢，\n\n10:07.559 --> 10:09.885\n获得了一个先导的化学药物。\n\n10:09.934 --> 10:11.159\n2001年呢，\n\n10:11.159 --> 10:14.284\n先导物的结构优化促进了尼达尼布的发现，\n\n10:14.534 --> 10:17.284\n也促进了尼达尼布进入了临床试验。\n\n10:17.585 --> 10:17.909\n嗯，\n\n10:17.909 --> 10:19.260\n1998年呢，\n\n10:19.260 --> 10:21.835\nBI优化血管生长因子抑制剂呢，\n\n10:21.835 --> 10:23.434\n是用于治疗肿瘤的，\n\n10:23.484 --> 10:24.609\n2007年呢，\n\n10:24.609 --> 10:25.159\n被证明，\n\n10:25.159 --> 10:28.734\n尼达尼布可以减轻博来霉素诱导的肺纤维化。\n\n10:29.258 --> 10:31.609\n进入了肺纤维化的二期临床试验，\n\n10:31.708 --> 10:32.859\n2011年呢，\n\n10:32.859 --> 10:34.508\n进入了三期临床试验。\n\n10:34.859 --> 10:35.208\n嗯，\n\n10:35.208 --> 10:35.859\n同时呢，\n\n10:35.859 --> 10:40.109\n在2014年美国在美国获批治疗特发性肺间质纤维化。\n\n10:40.158 --> 10:43.059\n在2015年哈日本和欧洲获批啊，\n\n10:43.059 --> 10:45.359\n治疗肺特发性肺间质纤维化。\n\n10:45.458 --> 10:46.708\n2017年呢，\n\n10:46.708 --> 10:49.958\n治疗获批特发性肺间质纤维化。\n\n10:49.958 --> 10:50.583\n后续呢，\n\n10:50.583 --> 10:53.458\n也有其他相关的间质性肺病呢，\n\n10:53.458 --> 10:56.908\n也是在获批使用的尼达尼布呢，\n\n10:56.908 --> 10:59.158\n它是通过作用于血管内皮。\n\n10:59.237 --> 11:04.663\n生长因子受体来发挥一个抗纤纤维化作用的尼达尼布呢，\n\n11:04.663 --> 11:07.138\n它是一种酪氨酸激酶的抑制剂。\n\n11:07.187 --> 11:08.263\n研究表明呢，\n\n11:08.263 --> 11:13.237\n尼达尼布可以有效的减缓肺纤维化患者的用力肺活量的下降率。\n\n11:14.388 --> 11:16.088\n它的抗纤维化机制呢，\n\n11:16.088 --> 11:19.987\n首先是抑制血小板氧化生长因子受体，\n\n11:20.038 --> 11:22.638\n抑制血管内皮的生长因子受体，\n\n11:22.737 --> 11:27.138\n和抑制成纤维细胞生长因子受体来起到作用的。\n\n11:28.502 --> 11:31.476\n比非尼酮和尼达尼布的说明书的不良反应，\n\n11:31.476 --> 11:32.726\n首先比非尼酮呢，\n\n11:32.726 --> 11:34.651\n它具有一个胃肠道的反应，\n\n11:34.802 --> 11:36.526\n恶心呕吐，\n\n11:36.526 --> 11:37.252\n消化不良，\n\n11:37.252 --> 11:37.901\n厌食，\n\n11:38.101 --> 11:39.452\n同时有皮肤疾病，\n\n11:39.452 --> 11:40.202\n有光过敏，\n\n11:40.202 --> 11:41.052\n出现皮疹，\n\n11:41.151 --> 11:41.827\n同时呢，\n\n11:41.827 --> 11:44.252\n可能会出现肝功能的损害，\n\n11:44.252 --> 11:46.726\n严重的可能会导致肝功能的衰竭。\n\n11:46.726 --> 11:48.452\n同在治疗期间呢，\n\n11:48.452 --> 11:51.827\n建议要定期检查肝功能的神经系统呢，\n\n11:51.827 --> 11:52.127\n患者，\n\n11:52.127 --> 11:55.351\n可能具会具有嗜睡、眩晕和行走不稳感。\n\n11:55.552 --> 11:57.202\n尼达尼布的不良反应呢？\n\n11:57.202 --> 11:58.752\n它最常见的不良反应是？\n\n11:58.791 --> 12:05.841\n是腹泻、恶心、腹痛、呕吐、肝酶升高、食欲下降、头痛、体重减轻和高血压。\n\n12:06.091 --> 12:06.491\n嗯，\n\n12:06.491 --> 12:10.616\n其中有62.4%的使用尼达尼布的患者呢，\n\n12:10.616 --> 12:12.291\n报告是有腹泻症状的。\n\n12:12.390 --> 12:13.366\n肝酶升高呢，\n\n12:13.366 --> 12:16.890\n是大概有13%点6的使用尼达尼布的患者，\n\n12:16.890 --> 12:19.765\n报告有发生肝酶升高的血小板减少，\n\n12:19.765 --> 12:20.841\n血小板减少症呢，\n\n12:20.841 --> 12:22.341\n可能会有发生，\n\n12:22.440 --> 12:24.716\n会有导致出血的严重病例呢，\n\n12:24.716 --> 12:25.890\n也是有报道的。\n\n12:27.059 --> 12:28.208\n中医药治疗呢，\n\n12:28.208 --> 12:29.158\n病因清楚，\n\n12:29.158 --> 12:31.458\n整体观用药安全是有效的。\n\n12:31.458 --> 12:32.708\n首先呢，\n\n12:32.809 --> 12:36.309\n肺纤维化都属于中医的一个肺痿的范畴，\n\n12:36.408 --> 12:38.059\n其病位在肺，\n\n12:38.109 --> 12:40.333\n久之极肾治疗呢，\n\n12:40.333 --> 12:43.809\n它总体的治疗原则是一个补肺生津。\n\n12:43.958 --> 12:45.333\n肺痿急性期呢，\n\n12:45.333 --> 12:47.559\n当以化痰清肺为主，\n\n12:47.708 --> 12:48.583\n缓解期呢，\n\n12:48.583 --> 12:50.408\n当以扶正固本为主，\n\n12:50.458 --> 12:51.708\n兼以祛邪。\n\n12:52.109 --> 12:53.984\n然后用药过程用药呢，\n\n12:53.984 --> 12:57.258\n首先是可以有效的改善患者的。\n\n12:57.367 --> 12:59.567\n咳嗽和呼吸困难的症状，\n\n12:59.567 --> 13:01.918\n减缓患者疾病的一个进展。\n\n13:02.018 --> 13:02.742\n同时呢，\n\n13:02.742 --> 13:04.468\n它的用药呢，\n\n13:04.468 --> 13:05.567\n是比较安全的，\n\n13:05.567 --> 13:06.567\n不良反应小。\n\n13:08.088 --> 13:08.612\n其中，\n\n13:08.612 --> 13:09.737\n中成药的话，\n\n13:09.737 --> 13:10.788\n中药成分呢，\n\n13:10.788 --> 13:12.788\n一个是冬虫夏草制剂，\n\n13:12.888 --> 13:18.737\n是具有一个抗炎抗氧化和抗纤维肺纤维化作用的冬虫夏草呢，\n\n13:18.737 --> 13:22.038\n它有一定的抗炎抗氧化和抗纤维化的作用。\n\n13:22.088 --> 13:29.362\n它也是可以通过抑制TGF贝塔一的表达来调整一型和二型细胞因子平衡，\n\n13:29.362 --> 13:31.138\n来达到抗纤维化的作用。\n\n13:32.854 --> 13:36.104\n能够显著的改善特发性肺纤维化患者的肺功能，\n\n13:36.155 --> 13:37.280\n有研究表明呢，\n\n13:37.280 --> 13:41.455\n加氟可以能够显著的改善特发性肺纤维化患者的肺功能。\n\n13:41.604 --> 13:42.080\n其中，\n\n13:42.080 --> 13:45.955\nF 1 V1比FVC的改善值约为对照组的两倍。\n\n13:46.054 --> 13:48.630\n白令用于特发性肺纤维化的治疗呢，\n\n13:48.630 --> 13:51.854\n总的有有效率高达93%，\n\n13:51.955 --> 13:54.005\n是明显优于对照组的。\n\n13:54.583 --> 13:54.833\n嗯，\n\n13:54.833 --> 13:55.734\n总结一下，\n\n13:55.833 --> 13:56.234\n嗯，\n\n13:56.283 --> 13:57.333\n肺纤维化呢，\n\n13:57.333 --> 13:59.434\n它是一种严重的肺部疾病，\n\n13:59.484 --> 14:00.908\n它是持续进展，\n\n14:00.908 --> 14:03.809\n将导致一个肺的换气功能障碍，\n\n14:03.809 --> 14:05.484\n进而出现呼吸衰竭，\n\n14:05.533 --> 14:08.234\n严重影响患者身心健康的疾病。\n\n14:08.434 --> 14:09.658\n目前上呢，\n\n14:09.658 --> 14:13.684\n临床上仍然缺乏对肺纤维化的一个特异性的治疗方案。\n\n14:14.187 --> 14:14.286\n嗯，\n\n14:14.286 --> 14:16.637\n已经上市的抗纤维化的治疗药物呢，\n\n14:16.637 --> 14:19.687\n仅仅有两种是比非尼酮和尼达尼布。\n\n14:19.786 --> 14:20.711\n第三个呢，\n\n14:20.711 --> 14:22.036\n中医治疗肺纤维化，\n\n14:22.036 --> 14:24.387\n它是具有一定的明显的优势的，\n\n14:24.387 --> 14:27.187\n可以改善患者的咳嗽呼吸困难的症状，\n\n14:27.236 --> 14:29.137\n延缓疾病的进展。\n\n14:29.187 --> 14:29.604\n同时，\n\n14:29.604 --> 14:30.786\n有研究表明呢，\n\n14:30.786 --> 14:35.236\n冬虫夏草制剂它具有一定的抗炎抗氧化抗纤维化的作用，\n\n14:35.236 --> 14:41.586\n它可以通过抑制TGF贝塔一的表达来调整一型和二型细胞因子平衡，\n\n14:41.736 --> 14:43.586\n来达到抗纤维化的作用。\n\n14:43.687 --> 14:44.387\n临床研。\n\n14:44.481 --> 14:45.231\n研究也表明呢，\n\n14:45.231 --> 14:48.831\n是能够显著的改善肺纤维化患者的肺功能的。\n\n14:48.981 --> 14:50.231\n我的汇报到此结束，\n\n14:50.231 --> 14:50.981\n谢谢大家。\n\n","v0347cg10004d61b2mqljhtamh34qjbg",902,663,"2026-01-24 23:41:34"," 肺纤维化的认识与药物进展 - 最新研究与治疗突破  "," 肺纤维化, 特发性肺纤维化, 肺纤维化治疗, 抗纤维化药物, 肺纤维化研究进展, 肺纤维化症状, 肺纤维化病因  "," 本文深入探讨肺纤维化的病因、症状及最新药物研究进展，涵盖抗纤维化药物的突破性治疗和未来发展方向，为患者和医疗从业者提供权威参考信息。","2026-04-03 22:30:00",[38],{"menuId":39,"menuName":40,"parentId":17,"orderNum":41,"path":42,"component":43,"isFrame":44,"isCache":45,"menuType":46,"visible":27,"status":17,"createDept":6,"remark":25,"createTime":47,"children":48,"columnImage":49,"columnLogo":50,"uncheckedLogo":6,"checkedLogo":6,"isHot":17,"isHome":17,"forceLogin":17,"color":6,"seoTitle":51,"seoKeywords":52,"seoDescription":53,"contentNum":6,"promotionalPoster":54,"menuFrame":7,"innerLink":7,"parentView":7,"routeName":55,"routerPath":42,"componentInfo":43},"1986622624134549505","科普视频",3,"video","/video.html","1","0","T","2025-11-07 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