{"title":"免疫抑制剂在轻度纤维化超敏性肺炎患者中的作用","authors":"Ryo Okuda , Tamiko Takemura , Toshihiro Misumi , Shigeru Komatsu , Eri Hagiwara , Takashi Ogura","doi":"10.1016/j.resinv.2024.11.011","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The efficacy of immunosuppressants in patients with fibrotic hypersensitivity pneumonitis (HP) is controversial. We hypothesized that pretreatment and posttreatment disease progression in immunosuppressant with prednisolone group and the immunosuppressant-naive prednisolone group would show a significant difference.</div></div><div><h3>Methods</h3><div>This was a single-center, retrospective, observational study. Patients with histopathological examination between January 2005 and March 2021, a diagnosis of fibrotic HP at multidisciplinary discussion and a diagnosis of fibrotic HP according to international guidelines were investigated. Propensity score matching which had covariates: age, gender, and forced vital capacity, was performed, and disease progression between the two groups was compared.</div></div><div><h3>Results</h3><div>Forty-two patients were included in this study. The mean change in forced vital capacity (FVC) in the 12 months prior to treatment was significantly decreased in the immunosuppressant with prednisolone group compared with the immunosuppressant-naive prednisolone (−8.2% and −2.7%, respectively, <em>P</em> = 0.033). During 12 months of treatment, the two groups did not differ significantly with regards to FVC change (−1.1% and 0.5%, respectively, <em>P</em> = 0.675). Between the two groups, the annual change in Krebs von den Lungen-6 before treatment and after treatment were not significantly different (<em>P</em> = 0.626 and 0.844, respectively). Transplant-free survival from the treatment in the two groups did not differ significantly (HR: 1.09, 95%CI (0.41–2.88), <em>P</em> = 0.873).</div></div><div><h3>Conclusions</h3><div>No significant differences were observed in FVC changes between the two groups following treatment, although the immunosuppressant with prednisolone group exhibited a greater decrease in FVC before treatment.</div></div>","PeriodicalId":20934,"journal":{"name":"Respiratory investigation","volume":"63 1","pages":"Pages 13-19"},"PeriodicalIF":2.4000,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effects of immunosuppressants in patients with mild fibrotic hypersensitivity pneumonitis\",\"authors\":\"Ryo Okuda , Tamiko Takemura , Toshihiro Misumi , Shigeru Komatsu , Eri Hagiwara , Takashi Ogura\",\"doi\":\"10.1016/j.resinv.2024.11.011\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>The efficacy of immunosuppressants in patients with fibrotic hypersensitivity pneumonitis (HP) is controversial. We hypothesized that pretreatment and posttreatment disease progression in immunosuppressant with prednisolone group and the immunosuppressant-naive prednisolone group would show a significant difference.</div></div><div><h3>Methods</h3><div>This was a single-center, retrospective, observational study. Patients with histopathological examination between January 2005 and March 2021, a diagnosis of fibrotic HP at multidisciplinary discussion and a diagnosis of fibrotic HP according to international guidelines were investigated. Propensity score matching which had covariates: age, gender, and forced vital capacity, was performed, and disease progression between the two groups was compared.</div></div><div><h3>Results</h3><div>Forty-two patients were included in this study. The mean change in forced vital capacity (FVC) in the 12 months prior to treatment was significantly decreased in the immunosuppressant with prednisolone group compared with the immunosuppressant-naive prednisolone (−8.2% and −2.7%, respectively, <em>P</em> = 0.033). During 12 months of treatment, the two groups did not differ significantly with regards to FVC change (−1.1% and 0.5%, respectively, <em>P</em> = 0.675). Between the two groups, the annual change in Krebs von den Lungen-6 before treatment and after treatment were not significantly different (<em>P</em> = 0.626 and 0.844, respectively). Transplant-free survival from the treatment in the two groups did not differ significantly (HR: 1.09, 95%CI (0.41–2.88), <em>P</em> = 0.873).</div></div><div><h3>Conclusions</h3><div>No significant differences were observed in FVC changes between the two groups following treatment, although the immunosuppressant with prednisolone group exhibited a greater decrease in FVC before treatment.</div></div>\",\"PeriodicalId\":20934,\"journal\":{\"name\":\"Respiratory investigation\",\"volume\":\"63 1\",\"pages\":\"Pages 13-19\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2024-11-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Respiratory investigation\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2212534524001801\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"RESPIRATORY SYSTEM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Respiratory investigation","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2212534524001801","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
引用次数: 0
摘要
背景:免疫抑制剂对纤维化超敏性肺炎(HP)患者的疗效存在争议。我们假设免疫抑制剂联合泼尼松龙组和免疫抑制剂联合泼尼松龙组治疗前和治疗后的疾病进展会有显著差异。方法本研究为单中心、回顾性观察性研究。研究了2005年1月至2021年3月期间进行组织病理学检查的患者,在多学科讨论中诊断为纤维化性HP,并根据国际指南诊断为纤维化性HP。对具有协变量:年龄、性别和强制肺活量的倾向评分进行匹配,并比较两组之间的疾病进展情况。结果共纳入42例患者。免疫抑制剂联合强的松龙组治疗前12个月用力肺活量(FVC)的平均变化明显低于单纯免疫抑制剂联合强的松龙组(分别为- 8.2%和- 2.7%,P = 0.033)。治疗12个月期间,两组FVC变化无显著差异(分别为- 1.1%和0.5%,P = 0.675)。两组患者治疗前后Krebs von den Lungen-6的年变化差异无统计学意义(P分别为0.626和0.844)。两组治疗后无移植生存无显著差异(HR: 1.09, 95%CI (0.41-2.88), P = 0.873)。结论两组治疗后FVC变化无显著性差异,但免疫抑制剂联合强的松龙组治疗前FVC下降幅度较大。
Effects of immunosuppressants in patients with mild fibrotic hypersensitivity pneumonitis
Background
The efficacy of immunosuppressants in patients with fibrotic hypersensitivity pneumonitis (HP) is controversial. We hypothesized that pretreatment and posttreatment disease progression in immunosuppressant with prednisolone group and the immunosuppressant-naive prednisolone group would show a significant difference.
Methods
This was a single-center, retrospective, observational study. Patients with histopathological examination between January 2005 and March 2021, a diagnosis of fibrotic HP at multidisciplinary discussion and a diagnosis of fibrotic HP according to international guidelines were investigated. Propensity score matching which had covariates: age, gender, and forced vital capacity, was performed, and disease progression between the two groups was compared.
Results
Forty-two patients were included in this study. The mean change in forced vital capacity (FVC) in the 12 months prior to treatment was significantly decreased in the immunosuppressant with prednisolone group compared with the immunosuppressant-naive prednisolone (−8.2% and −2.7%, respectively, P = 0.033). During 12 months of treatment, the two groups did not differ significantly with regards to FVC change (−1.1% and 0.5%, respectively, P = 0.675). Between the two groups, the annual change in Krebs von den Lungen-6 before treatment and after treatment were not significantly different (P = 0.626 and 0.844, respectively). Transplant-free survival from the treatment in the two groups did not differ significantly (HR: 1.09, 95%CI (0.41–2.88), P = 0.873).
Conclusions
No significant differences were observed in FVC changes between the two groups following treatment, although the immunosuppressant with prednisolone group exhibited a greater decrease in FVC before treatment.