2020年 · 第43卷第02期

This issue focuses on lung cancer.

"Small airway" means diameter<The 2 mm airway is the most obvious and earliest affected lesion site of chronic airway diseases (such as COPD), and it is also the main location that affects lung ventilation function. However, the anatomical location and structural characteristics of small airways are not yet clear. Intraairway optical coherence tomography (EB-OCT) is a new optical simulation technique for airway imaging. Its imaging tube is 0.9 mm in diameter, which can be guided by bronchoscope to extend to the distal small airway for real-time in vivo imaging. Moreover, the spatial resolution is close to the level of histopathology, and it can clearly show the microstructure of bronchial mucosal epithelium, lamina propria and cartilage. In this study, EB-OCT imaging technique was used to observe the structure and morphological characteristics of normal small and medium airways in vivo and to explore the changes of airway structure related to aging.

BACKGROUND AND OBJECTIVE: Decrease in FVC as % of predicted value, decrease in 6 min walk distance, and hospitalization due to respiratory failure were all endpoint events associated with idiopathic pulmonary fibrosis (IPF) progression and death. The incidence of multiple endpoint events within 12 months in the same patient with pirfenidone for IPF is unknown. Methods: Study populations from the ASCEND (Study 016) and CAPACITY (Studies 004 and 006) studies were included in this study for post hoc analysis and divided into a pirfenidone-treated group (oral pirfenidone 2 403 mg/d, 623 patients) and a placebo group (oral placebo, 624 patients). Disease progression endpoint events were defined as ≥10% decrease in FVC as % of the predicted value, ≥50 m decrease in 6 min walk distance, hospitalization for respiratory failure, or death from any cause. Patients were analyzed for the incidence of disease progression endpoint events over 12 months. Results: FVC as % of the predicted value decreased among all disease progression endpoint events (pirfenidone groupvs202 in the placebo groupvs304) and a decrease in the 6-min walk distance (pirfenidone groupvs265 in the placebo groupvs348) had the highest incidence. Patients with more than 1 disease progression endpoint were less frequent in the pirfenidone group (pirfenidone groupvs17.0% for placebovs30.1%，P<0.01）。 Fewer patients died after ≥1 disease progression endpoint event in the pirfenidone group than in the placebo group (pirfenidone groupvs2.1% for placebovs6.3%，P =0.002）。 Conclusion: Pirfenidone can significantly reduce the incidence of events exceeding one endpoint of disease progression within 12 months and the mortality rate after disease progression in patients with IPF. This conclusion suggests that patients with IPF may still benefit from continued use of pirfenidone after any disease progression endpoint event.

idiopathic pulmonary fibrosis (IPF) has received widespread attention as a fatal disease with unknown etiology, fibrosis and progressive development in adults. The 2018 ATS/ERS/JRS/ALAT Clinical Practice Guidelines highlight the imaging and histopathological manifestations of interstitial pneumonia vulgaris (UIP) as its hallmark feature. However, the characteristics of the so-called UIP are not specific. A variety of interstitial lung diseases, including connective tissue disease, fibrotic or chronic allergic pneumonia, occupational interstitial lung disease, sarcoidosis, drug-related interstitial lung disease, etc. can be manifested as UIP. There is currently no accurate method or marker to distinguish the UIP of IPF from the UIP of other types of interstitial lung disease.