特发性肺纤维化患者接受肺癌手术的围手术期抗纤维化治疗与早期术后结局：系统综述与荟萃分析。
完整摘要 · 中文译文
接受肺癌手术的特发性肺纤维化（IPF）患者发生IPF急性加重（AE-IPF）的风险较高，而AE-IPF与高死亡率相关。尽管抗纤维化治疗（AFT）已被提出作为一种预防策略，但证据仍然有限且异质性较大，尤其是在术后早期结局方面。我们系统检索了包括PubMed和Ichushi-Web在内的主要数据库，检索截至2025年8月，以评估接受手术的IPF患者围手术期AFT的情况。符合条件的研究报告了术后AE-IPF或30-90天内的死亡率。采用固定效应模型和随机效应模型合并风险比（RR）和95%置信区间（CI）。共纳入5项回顾性队列研究，主要评估吡非尼酮。AFT与术后30天内（RR，0.24；95% CI，0.07-0.76；I2 = 0%）和90天内（RR，0.23；95% CI，0.09-0.57；I2 = 0%）AE-IPF发生率较低相关。AFT与30天死亡率较低（RR，0.12；95% CI，0.02-0.91；I2 = 0%）和90天死亡率较低（RR，0.13；95% CI，0.02-0.76；I2 = 0%）相关。敏感性分析（包括一项全国性数据库研究）支持这一关联，尽管效应有所减弱。尼达尼布的证据仅限于一个小型病例系列。围手术期AFT，尤其是吡非尼酮，与较低的AE-IPF发生率和死亡率相关，包括肺癌手术后30天内。这些发现强调了术后早期结局的临床相关性，并支持进一步开展前瞻性研究以阐明 围手术期AFT。
完整摘要 · 英文原文
Patients with idiopathic pulmonary fibrosis (IPF) undergoing lung cancer surgery are at high risk of acute exacerbation of IPF (AE-IPF), which is associated with high mortality. Although antifibrotic therapy (AFT) has been proposed as a preventive strategy, evidence remains limited and heterogeneous, particularly regarding early postoperative outcomes. We systematically searched major databases, including PubMed and Ichushi-Web, through August 2025 to evaluate perioperative AFT in patients with IPF undergoing surgery. Eligible studies reported postoperative AE-IPF or mortality within 30-90 days. Risk ratios (RRs) and 95% confidence intervals (CIs) were pooled using common- and random-effects models. Five retrospective cohort studies predominantly evaluating pirfenidone were included. AFT was associated with a lower incidence of postoperative AE-IPF both within 30 days (RR, 0.24; 95% CI, 0.07-0.76; I2 = 0%) and 90 days (RR, 0.23; 95% CI, 0.09-0.57; I2 = 0%). AFT was associated with lower mortality at 30 days (RR, 0.12; 95% CI, 0.02-0.91; I2 = 0%) and 90 days (RR, 0.13; 95% CI, 0.02-0.76; I2 = 0%). Sensitivity analyses, including a nationwide database study, supported the association, although the effect was attenuated. Evidence for nintedanib was limited to a small case series. Perioperative AFT, particularly with pirfenidone, was associated with lower rates of AE-IPF and mortality, including within 30 days post-lung cancer surgery. These findings underscore the clinical relevance of early postoperative outcomes and support further prospective studies to clarify the role of perioperative AFT.