在纤维化间歇性肺病急性恶化时,使用类固醇治疗
Kavya Koshy1,2, Hayley Barnes1, Erica Farrand3
1Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia.
Respirology (Carlton, Vic.)
|June 2, 2024
概括
对于纤维化间歇性肺病 (AE-FILD) 的急性恶化,类固醇治疗没有改善住院生存率,并且与死亡风险增加有关. 临床医生应在AE-FILD患者中谨慎使用类固醇,并考虑恶化的其他因素.
科学领域:
- 肺部病理学 肺部病理学
- 关键护理医学 关键护理医学
- 药理学 药理学是指药理学的学科.
背景情况:
- 类固醇治疗是纤维化间歇性肺病 (ILD) 的常见治疗方法,但其在异常性肺纤维化 (IPF) 的急性恶化 (AEs) 中的疗效尚不确定.
- 这项研究调查了类固醇治疗对患有纤维化间歇性肺病 (AE-FILD) 急性恶化患者的结果的影响,包括IPF和非IPFILD.
研究的目的:
- 评估皮质类固醇治疗对AE-FILD患者住院死亡率的影响.
- 评估类固醇使用与肺移植,再入院,整体存活率和氧气需求等其他结果之间的关联.
主要方法:
- 一项回顾性观察性研究分析了107个AE-FILD病例超过10年,来自两个中心.
- 使用二进制逻辑回归来确定皮质类固醇治疗 (按剂量和持续时间定义) 与住院死亡率或需要肺移植之间的关系.
- 二次结局包括再入院,生存和依赖氧气.
主要成果:
- 在107名患者中,有46人接受了急性类固醇治疗. 类固醇组较年轻,伴随性疾病较少,但需要更高的氧气水平.
- 类固醇使用与住院患者死亡或移植的风险增加有关 (OR 4.11,p=0.049).
- 在类固醇组中,中位生存时间显著降低 (221 vs 520.5天),所有原因死亡风险更高 (HR 3.25,p<0.01). 非IPF患者表现出使用类固醇降低死亡率的趋势.
结论:
- AE-FILD携带高死亡风险,类似于AE-IPF,即使在类固醇治疗中.
- 在AE-FILD中使用类固醇似乎与增加的死亡率和减少的存活率有关,需要谨慎应用.
- 进一步的前性研究对于阐明皮质类固醇在管理AE-FILD中的确切作用至关重要.
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