Effects of Corticosteroid Treatment and Antigen Avoidance in a Large Hypersensitivity Pneumonitis Cohort: A Single-Centre Cohort Study
Effects of Corticosteroid Treatment and Antigen Avoidance in a Large Hypersensitivity Pneumonitis Cohort: A Single-Centre Cohort Study
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DOI：
10.3390/jcm8010014
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发表时间：
2019-01-01
影响因子：
3.9
通讯作者：
Wuyts, Wim A.
中科院分区：
文献类型：
--
作者：
De Sadeleer, Laurens J.;Hermans, Frederik;Wuyts, Wim A.
背景资料：尽管过敏性肺炎（HP）是第三常见的间质性肺病，但它仍然是一种神秘的疾病，没有明确的诊断和治疗指南。我们评估了HP队列中常用治疗干预（即避免暴露和皮质类固醇治疗）的效果。方法：我们收集了2005年1月1日至2016年12月31日期间在我们中心随访的所有HP患者的临床数据。HP患者根据胸部CT上纤维化的存在进行分层。采用多变量考克斯比例风险模型分析生存率。使用线性混合效应模型分析用力肺活量（预测百分比，FVC%）和一氧化碳肺弥散量（预测百分比，DLCO%）演变。结果如下：确定了202例HP患者：93例非纤维化HP（nfHP）和109例纤维化HP（fHP），治疗前每月FVC%分别下降0.93%和0.56%。虽然nfHP的生存率很高，但fHP患者的中位生存期为9.2年。皮质类固醇治疗和避免暴露未导致生存差异。虽然nfHP患者在开始皮质类固醇治疗后显示FVC%和DLCO%增加，但在fHP患者中未观察到治疗效果。nfHP患者在避免暴露后FVC%和DLCO%增加，而fHP患者在避免暴露后FVC%的数值趋势为正（p = 0.15）。结论：nfHP患者经历了极好的存活，在皮质类固醇启动以及抗原避免的肺功能测试中具有良好的治疗效果。相比之下，fHP患者的预后较差（中位生存期为9.2年），皮质类固醇治疗无任何疗效。抗原回避在fHP患者中是否有用尚不清楚。
Background: Although the third most frequent interstitial lung disease, hypersensitivity pneumonitis (HP) remains an enigmatic disease without clear diagnostic and therapeutic guidelines. We assessed the effect of the commonly used therapeutic interventions (i.e. exposure avoidance and corticosteroid treatment) in an HP cohort. Methods: We collected clinical data of all HP patients followed at our centre between January 1, 2005, and December 31, 2016. HP patients were stratified according to the presence of fibrosis on chest CT. Survival was analysed using the multivariate Cox proportional hazards model. Forced vital capacity (percent predicted, FVC%) and diffusing capacity of the lung for carbon monoxide (percent predicted, DLCO%) evolution were analysed using linear mixed-effect models. Results: Two hundred and two HP patients were identified: 93 non-fibrotic HP (nfHP) and 109 fibrotic HP (fHP), experiencing a monthly FVC% decline before treatment of 0.93% and 0.56%, respectively. While nfHP had an excellent survival, fHP patients experienced a median survival of 9.2 years. Corticosteroid treatment and exposure avoidance did not result in survival differences. Although nfHP patients showed FVC% and DLCO% increase after corticosteroid initiation, no therapeutic effect was seen in fHP patients. FVC% and DLCO% increased in nfHP patients after exposure avoidance, while a positive numerical trend was seen for FVC% after exposure avoidance in fHP patients (p = 0.15). Conclusions: nfHP patients experienced an excellent survival with good therapeutic effect on pulmonary function tests with both corticosteroid initiation as well as antigen avoidance. In contrast, fHP patients experienced a dismal prognosis (median survival of 9.2 years) without any therapeutic effect of corticosteroid treatment. Whether antigen avoidance is useful in fHP patients is still unclear.