Impact of Serial Intralesional Steroid Injections on Idiopathic Subglottic Stenosis.-猫眼课题宝

连续病灶内类固醇注射对特发性声门下狭窄的影响。

DOI：

10.1002/lary.30449

发表时间：

2023

期刊：

The Laryngoscope

影响因子：

通讯作者：

中科院分区：

文献类型：

作者：

Hoffman,MatthewR;Patro,Ankita;Huang,Li-Ching;Chen,Sheau-Chiann;Berry,LynnD;Gelbard,Alexander;Francis,DavidO;NorthAmericanAirwayCollaborative

目的：连续性病变内类固醇注射（SILSI）已越来越多地用于治疗特发性声门下狭窄（iSGS）。先前的研究已经显示了有效性，但并非在所有患者中。这项多机构研究评估了SILSI对复发手术时间、呼气峰流速（PEF）和呼吸困难的影响。对北美气道协作数据进行了事后二次分析，以评估接受和不接受SILSI的iSGS患者的结局。主要结局是使用Kaplan-Meier曲线和考克斯回归分析评估的复发手术时间。次要结局是PEF和临床慢性阻塞性肺疾病问卷（CCQ）评分的变化。在接受SILSI的患者，人口统计学，从最后一个程序的时间，并在开始SILSI的PEF进行了评估，以确定对recurrence.ResultsTwo百和九十例患者，238只接受内镜扩张和52进行扩张和SILSI。未观察到基线特征差异。复发时间无差异（风险比：0.64;p= 0.183）。在2.5年研究期间，PEF或CCQ无差异。在52例接受SILSI的患者中，开始SILSI时的PEF对复发无影响（χ2= 0.09，p = 0.77）。预测接受SILSI的患者复发的因素尚未确定。这些结果支持一项采用统一SILSI方案的随机对照试验，以量化SILSI对客观和主观结局的影响，并帮助确定哪些iSGS患者受益最大。证据等级3喉镜，133：2255-2263，2023

ObjectivesSerial intralesional steroid injection (SILSI) has been increasingly used to treat idiopathic subglottic stenosis (iSGS). Prior studies have shown effectiveness, but not in all patients. This multi‐institutional study evaluates the effect of SILSI on time to recurrent operation, peak expiratory flow (PEF), and dyspnea.MethodsPost‐hoc secondary analysis of the North American Airway Collaborative data were performed to evaluate the outcomes of iSGS patients undergoing and not undergoing SILSI. The primary outcome was time to recurrent operation, evaluated using Kaplan–Meier curves and Cox regression analysis. Secondary outcomes were change in PEF and clinical chronic obstructive pulmonary disease questionnaire (CCQ) score. Within patients undergoing SILSI, demographics, time from last procedure, and PEF at initiation of SILSI were evaluated to determine the effect on recurrence.ResultsTwo hundred and ninety patients were included, 238 undergoing endoscopic dilation alone and 52 undergoing dilation and SILSI. No differences in baseline characteristics were observed. There was no difference in time to recurrence (hazard ratio: 0.64;p= 0.183). There were no differences in PEF or CCQ across the 2.5‐year study period. Among 52 patients undergoing SILSI, PEF at the time of starting SILSI did not affect recurrence (χ2= 0.09,p= 0.77).ConclusionPatients undergoing and not undergoing SILSI had similar times to recurrence, PEF, and CCQ. Factors predicting recurrence among patients undergoing SILSI were not identified. These results support a randomized controlled trial with a uniform SILSI protocol to quantify the effects of SILSI on objective and subjective outcomes and help determine which iSGS patients benefit most.Level of Evidence3Laryngoscope, 133:2255–2263, 2023

Impact of Serial Intralesional Steroid Injections on Idiopathic Subglottic Stenosis.

连续病灶内类固醇注射对特发性声门下狭窄的影响。

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