Effect of maintenance azithromycin on established bronchiolitis obliterans syndrome in lung transplant patients
Effect of maintenance azithromycin on established bronchiolitis obliterans syndrome in lung transplant patients
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DOI：
10.1155/2008/158681
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发表时间：
2008-05-01
影响因子：
2.2
通讯作者：
Bshouty, Zoheir
中科院分区：
文献类型：
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作者：
Porhownik, Nancy R.;Batobara, Wael;Bshouty, Zoheir
背景技术背景：闭塞性细支气管炎综合征（BOS）是肺移植术后晚期死亡的主要原因，其定义为1秒用力呼气量（FEV1）的不可逆下降。以前的研究使用阿奇霉素的BOS在肺移植患者已经证明了一个潜在的可逆性的下降FEV1.PROTETIVES：检查是否启动阿奇霉素逆转下降FEVI在肺移植受者与建立BOS至少3个月。方法：肺功能测试进行了每三个月在7个肺移植受者与建立BOS至少3个月。在开始治疗前6个月和3个月、开始治疗时以及开始治疗后3个月、6个月、9个月和12个月记录FEV。主要终点是FEV的变化，I在研究期间，没有免疫抑制药物的变化或急性排斥反应事件happened.Results：平均时间从移植到阿奇霉素开始是64个月（范围17至117个月）。从BOS诊断到开始使用阿奇霉素的平均时间为22个月（范围3至67个月）。阿奇霉素治疗开始前6个月FEV下降率和治疗开始后3个月和12个月FEV增加率无统计学意义（分别为P=0.32、P=0.16和P=0.18）。在治疗开始后的前三个月，FEVI趋于稳定的趋势改善：虽然有几项研究解决了可能的好处，维持阿奇霉素在肺移植患者BOS，药物的作用仍然未经证实，在这些患者中，最好是解决一个大型随机对照试验。
BACKGROUND: Bronchiolitis obliterans syndrome (BOS), the main cause of late mortality following lung transplantation, is defined as an irreversible decline in forced expiratory volume in 1 s (FEV1). Previous studies using azithromycin for BOS in lung transplant patients have demonstrated a potential reversibility of the decline in FEV1.OBJECTIVES: To examine whether initiating azithromycin reverses decline in FEVI in lung transplant recipients with established BOS of at least three months.METHODS: Pulmonary function tests were performed every three months in seven lung transplant recipients with established BOS of at least three months. FEV, was recorded at six and three months before initiation, at time of initiation, and three, six, nine and 12 months postazithromycin initiation. The primary end point was change in FEV, I During the study, no immunosuppressive medication changes or acute rejection episodes occurred.RESULTS: Mean time from transplant to azithromycin initiation was 64 months (range 17 to 117 months). Mean time from BOS diagnosis to azithromycin initiation was 22 months (range three to 67 months). Rate of FEV, decline from six months before azithromycin initiation, and rates of FEV, increase from initiation to three and 12 months post-treatment initiation, were not statistically significant (P=0.32, P=0.16 and P=0.18, respectively). Following a trend toward improvement in the first three months after treatment initiation, FEVI tended to stabilize.DISCUSSION: Although several studies address the possible benefit of maintenance azithromycin in lung transplant patients with BOS, the role of the drug remains unproven in these patients, and would best be addressed by a large randomized controlled trial.