The Role of Hypertension and Renin-angiotensin-aldosterone System Inhibitors in Bleomycin-induced Lung Injury.
The Role of Hypertension and Renin-angiotensin-aldosterone System Inhibitors in Bleomycin-induced Lung Injury.
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DOI：
10.1016/j.clml.2020.10.004
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发表时间：
2020-10
期刊：
影响因子：
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通讯作者：
Ryujiro Hara;M. Onizuka;Sawako Shiraiwa;Kaito Harada;Yasuyuki Aoyama;Daisuke Ogiya;M. Toyosaki;R. Suzuki;Sinichiro Machida;K. Ohmachi;Y. Ogawa;H. Kawada;Shigeki Watanabe;A. Miyajima;R. Masuda;M. Iwazaki;M. Mikami;T. Koike;H. Mochizuki;K. Ando
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文献类型：
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作者：
Ryujiro Hara;M. Onizuka;Sawako Shiraiwa;Kaito Harada;Yasuyuki Aoyama;Daisuke Ogiya;M. Toyosaki;R. Suzuki;Sinichiro Machida;K. Ohmachi;Y. Ogawa;H. Kawada;Shigeki Watanabe;A. Miyajima;R. Masuda;M. Iwazaki;M. Mikami;T. Koike;H. Mochizuki;K. Ando
博来霉素诱导的肺损伤（BLI）是癌症化疗的致命并发症，其危险因素尚未明确。近年来研究表明，肾素-血管紧张素-醛固酮系统（RAAS）在肺损伤的发生发展中起重要作用。本研究阐明了高血压（HTN）和RAAS抑制剂给药对接受含博来霉素方案治疗的患者发生BLI的影响。患者和方法我们回顾性分析了2004年至2018年在我们机构接受含博来霉素方案治疗霍奇金淋巴瘤或生殖细胞肿瘤的190例患者的数据。21例（11.1%）出现症状性BLI。在多变量分析中，发现年龄≥ 65岁（比值比，10.90; 95%置信区间，3.72-32.20;P<0.001）和HTN病史（比值比，3.32; 95%置信区间，1.07-10.30;P= 0.04）是BLI发作的重要危险因素。无危险因素的患者中BLI发生率为3.6%（n = 5），唯一危险因素为HTN的患者中BLI发生率为11.8%（n = 2），唯一危险因素为年龄≥ 65岁的患者中BLI发生率为31.6%（n = 6），同时存在两种危险因素的患者中BLI发生率为57.1%（n = 8）（P<0.001）。各组BLI诱导的死亡率分别为0.0%（n = 0）、5.9%（n = 1）、10.5%（n = 2）和42.9%（n = 6）（P< .001）。在31例HTN患者中，BLI的发生率为12.5%的患者谁是管理RAAS抑制剂和53.3%的那些谁没有（P= 0.02）。ConclusionOlder age and history of HTN are independent risk factors for the development of BLI，and the administration of RAAS inhibitors may reduce the onset of BLI。
IntroductionThe risk factors for bleomycin-induced lung injury (BLI), a fatal complication of cancer chemotherapy, are not well-established. The renin-angiotensin-aldosterone system (RAAS) has recently been suggested to play a role in the development of lung injury. This study clarified the impact of hypertension (HTN) and the administration of RAAS inhibitors on BLI occurrence in patients treated with bleomycin-containing regimens.Patients and MethodsWe retrospectively analyzed the data of 190 patients treated with a bleomycin-containing regimen for Hodgkin lymphoma or germ cell tumors at our institutions from 2004 to 2018.ResultsOverall, 190 patients received bleomycin, and symptomatic BLI occurred in 21 (11.1%) cases. In the multivariate analysis, age ≥ 65 years (odd ratio, 10.90; 95% confidence interval, 3.72-32.20;P< .001) and history of HTN (odds ratio, 3.32; 95% confidence interval, 1.07-10.30;P= .04) were found to be significant risk factors for BLI onset. BLI occurred in 3.6% (n = 5) of patients with no risk, 11.8% (n = 2) of those whose only risk factor was HTN, 31.6% (n = 6) of those whose only risk factor was age ≥ 65 years, and 57.1% (n = 8) of those with both risk factors (P< .001). BLI-induced mortality rates in each group were 0.0% (n = 0), 5.9% (n = 1), 10.5% (n = 2), and 42.9% (n = 6) (P< .001), respectively. Among 31 patients with HTN, BLI incidence was 12.5% in patients who were administered RAAS inhibitors and 53.3% in those who were not (P= .02).ConclusionOlder age and history of HTN were independent risk factors for the development of BLI, and the administration of RAAS inhibitors might reduce the onset of BLI.