新型冠状病毒感染背景下间质性肺疾病患者临床管理中国专家共识(2023年版)  

Expert consensus on the management of interstitial lung disease during the COVID-19 epidemic

作　　者：中国研究型医院学会呼吸病学专业委员会 徐作军[2] Respiratory Council of Chinese Research Hospital Association;Xu Zuojun(不详;Department of Pulmonary and Critical Care Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]不详 [2]中国医学科学院北京协和医学院北京协和医院呼吸和危重症医学科,北京100730

出　　处：《中华结核和呼吸杂志》2023年第12期1204-1218,共15页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：中央高水平医院临床科研基金 (2022-PUMCH-B-108,2022-PUMCH-A-130,2022-PUMCH-C-069)。

摘　　要：新型冠状病毒感染(coronavirus disease 2019,COVID-19)在世界范围内流行,然而目前对于如何管理间质性肺疾病(interstitial lung disease,ILD)合并COVID-19患者的临床认识非常有限。另一方面,急性COVID-19后发生的ILD(post-acute covid-19 ILD,PC-ILD)也很常见,如何规范管理也是临床面临的问题。为此,中国研究型医院学会呼吸分会邀请国内ILD领域专家组成共识编写组,充分收集临床意见,基于临床收集问题,组织专家讨论,最终确定纳入了22个问题,主要包括ILD合并COVID-19患者临床特征、重症/死亡风险和风险因素、治疗管理、PC-ILD临床特征、风险因素和治疗等方面。基于国内外指南、临床研究数据等证据,经过多次讨论和投票表决,形成15条推荐意见,共同制定了《新型冠状病毒感染疫情下间质性肺疾病患者临床管理中国专家共识》,旨在提升对ILD合并COVID-19以及PC-ILD的认识,为临床决策提供依据,提高临床救治水平。推荐意见1:新冠肺炎与急性/亚急性起病的ILD建议从暴露史、症状体征、肺高分辨率CT(HRCT)特征、实验室检查5个方面鉴别。推荐意见2:参考新型冠状病毒感染诊疗方案(试行第十版),对ILD合并COVID-19疾病严重程度分级及管理。推荐意见3:ILD是COVID-19重症/危重症独立危险因素,ILD合并COVID-19患者应尽早进行抗病毒治疗,最佳使用时机为出现症状5 d以内。推荐意见4:基础ILD无激素治疗指征者急性COVID-19时激素使用遵照COVID-19激素使用原则。基础ILD需开始或已使用激素者出现急性COVID-19时可继续使用激素,剂量调整依据基础ILD和COVID-19病情需要:重型/危重型ILD合并COVID-19但不符合SARS-Cov-2触发AE-ILD者激素使用遵照重型/危重型COVID-19使用原则;符合AE-ILD者按AE-ILD处理。推荐意见5:IL-6抑制剂在COVID-19合并ILD人群中的使用尚无针对此类人群的临床研究证据,建议参照一般COVID-19患者使用原则。推荐Coronavirus disease 2019(COVID-19)is prevalent around the world,and pre-existing ILD is associated with increased severity and mortality of COVID-19.However,the current knowledge on the management strategy for COVID-19 patients with pre-existing interstitial lung disease(ILD)is very limited.There is still a need for consensus on treatments for these patients.In addition,ILD that occurs after the acute phase of COVID-19(Post-acute Covid-19 ILD,PC-ILD)is also very common,and how to manage PC-ILD is also under debate.Therefore,a consensus was established by experts from the related disciplines in the field of ILD based on available scientific evidence and experience of the expert working group.This consensus elucidated 22 practical questions for practicing physicians,such as clinical characteristics,risk factors and treatment of COVID-19 patients with pre-existing ILD and PC-ILD patients.Finally,15 recommendations were made regarding the diagnosis and management of COVID-19 patients with pre-existing ILD and PC-ILD patients.We hope to assist physicians in making appropriate decisions,thereby improving the management of COVID-19 with pre-existing ILD and PC-ILD.Recommendation 1:It is recommended to differentiate COVID-19 from ILD with acute/subacute onset based on duration,exposure history,symptoms and signs,chest high-resolution CT(HRCT)features,and laboratory tests.Recommendation 2:According to the guidelines on the diagnosis and treatment of new coronavirus pneumonia(version 10)issued by the National Health Commission of China on January 6th,2023,we recommended the following disease severity definition and management for the COVID-19 patients with pre-existing ILD.Recommendation 3:ILD is an independent risk factor for severe/critical COVID-19.We recommend antiviral treatment for COVID-19 patients with pre-existing ILD as early as possible after symptoms onset,ideally within 5 days.Recommendation 4:We recommend that the use of systemic corticosteroids in COVID-19 patients with pre-existing ILD who had no indication

关 键 词：间质性肺疾病 结缔组织疾病 血液学检查 肺间质病变 危重型 病情控制 推荐意见 冠状病毒感染 

分 类 号：R563[医药卫生—呼吸系统]