特发性肺纤维化急性加重期类固醇脉冲治疗的初始治疗反应与预后的关系

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine Pub Date : 2025-07-24 DOI:10.1016/j.rmed.2025.108269

Tsuyoshi Sasada, Chigusa Shirakawa, Kazuma Nagata, Katsuyuki Furuta, Ryosuke Hirabayashi, Yuki Sato, Atsushi Nakagawa, Keisuke Tomii, Ryo Tachikawa

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引用次数: 0

摘要

特发性肺纤维化急性加重（AE-IPF）严重影响患者生存。本研究旨在确定早期治疗反应是否能准确预测AE-IPF患者的预后。方法本回顾性队列研究在神户市医疗中心总医院进行，分析了2012年1月至2021年12月期间接受类固醇脉冲治疗的100例AE-IPF患者。印心日定义为第1天。根据第1-4天外周毛细血管氧饱和度/吸入氧分数（S/F）比率的变化将患者分为反应组和无反应组。主要终点为28天死亡率。Cox比例风险模型评估了28天死亡率与潜在预后因素之间的关系，包括年龄、KL-6水平、第1天的S/F比率和反应者组状态。结果研究队列分别纳入应答组和非应答组60例和40例患者。应答组的IgG中位水平明显较高（1519 mg/dL vs 1014 mg/dL），死亡率较低（28天时为12% vs 42.5%）。在第1天，两组之间的S/F比率具有可比性。同样，年龄和克雷布斯·冯·登·伦根-6的水平也没有显着差异。多变量Cox比例风险分析显示，应答组较高的初始S/F比（HR: 0.18, 95% CI: 0.06-0.52）和分类（HR: 0.22, 95% CI: 0.10-0.53）与较低的28天死亡率相关。结论早期S/F比值的改善可能表明AE-IPF患者生存率的提高，提示其在早期治疗决策中的潜在重要性。

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Association between initial treatment response and prognosis in acute exacerbations of idiopathic pulmonary fibrosis treated with steroid pulse therapy

Background

Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) critically affects patient survival. This study aimed to determine whether an early treatment response could accurately predict prognostic outcomes in patients with AE-IPF.

Methods

This retrospective cohort study conducted at Kobe City Medical Centre General Hospital analysed 100 patients with AE-IPF treated with steroid pulse therapy during January 2012–December 2021. The initiation day was defined as Day 1. Patients were classified into Responder or Non-Responder groups based on the changes in peripheral capillary oxygen saturation/fraction of inspired oxygen (S/F) ratios from Days 1–4. The primary outcome was 28-day mortality. Cox proportional hazards models assessed the association between 28-day mortality and potential prognostic factors, including age, KL-6 levels, S/F ratios on Day 1, and Responder group status.

Results

The study cohort included 60 and 40 patients in the Responder and Non-Responder groups, respectively. The Responder group has significantly higher median IgG levels (1519 mg/dL vs. 1014 mg/dL) and lower mortality rates (12 % vs. 42.5 % at 28 days). On Day 1, the S/F ratios were comparable between the two groups. Similarly, age and levels of Krebs von den Lungen-6 also showed no significant differences. Multivariable Cox proportional hazards analysis revealed that higher initial S/F ratios (HR: 0.18, 95 % CI: 0.06–0.52) and classification in the Responder group (HR: 0.22, 95 % CI: 0.10–0.53) were associated with lower 28-day mortality.

Conclusion

Early improvements in S/F ratios may indicate improved survival in patients with AE-IPF, suggesting their potential importance in early therapeutic decisions.

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来源期刊

Respiratory medicine 医学-呼吸系统

CiteScore

7.50

自引率

0.00%

发文量

199

审稿时长

38 days

期刊介绍： Respiratory Medicine is an internationally-renowned journal devoted to the rapid publication of clinically-relevant respiratory medicine research. It combines cutting-edge original research with state-of-the-art reviews dealing with all aspects of respiratory diseases and therapeutic interventions. Topics include adult and paediatric medicine, epidemiology, immunology and cell biology, physiology, occupational disorders, and the role of allergens and pollutants. Respiratory Medicine is increasingly the journal of choice for publication of phased trial work, commenting on effectiveness, dosage and methods of action.