每日一题_2023.03.25

A 61-year-old man is frustrated because he is no longer able to walk up a flight of stairs without stopping to catch his breath. He has also been plagued by a dry cough for the past six months. He has not visited his primary care physician because he is not a smoker and does not believe that he could have a serious pulmonary condition. He ignores his symptoms for another eight months, during which time they continue to worsen. He finally visits his physician at the urging of his wife. While shaking hands, his physician notices that the patient has clubbing of the fingers. A clinical work-up and medical history fail to find a cause for this restrictive lung disease. What is the definitive therapy for this patient’s most likely condition?

一位61岁的老人很沮丧，因为他再也不能不停下来喘口气就上一段楼梯了。在过去的六个月里，他还饱受干咳的困扰。他没有去看他的初级保健医师，因为他不吸烟，并且不相信他可能有严重的肺部疾病。在接下来的8个月里，他忽视了自己的症状，在此期间，症状继续恶化。在妻子的催促下，他终于去看了医生。在握手时，他的医生注意到病人的手指有杵状指。临床检查和病史未能找到这种限制性肺疾病的病因。对于该患者最有可能的病情，确定的治疗方法是什么?

(A) Albuterol 沙丁胺醇

(B) Azathioprine 咪唑硫嘌呤

(C) Cyclosporine 环孢霉素

(D) Lung transplantation 肺移植

(E) Steroids 类固醇

答案解析：

间质性(或特发性)肺纤维化(IPF)是一种累及老年人的慢性、进行性下呼吸道纤维化疾病。以间质细胞异常增殖、胶原结构破坏和气体交换受损为特征。IPF的确切发病机制尚不清楚。如果不治疗，IPF通常会在五年内导致死亡。肺移植是目前唯一的“治愈”方法。在胸部x线片上，IPF通常在双肺下部表现为白线网状结构。

正确答案：D