Tacrolimus and Steroid Treatment for Acute Exacerbation of Idiopathic Pulmonary Fibrosis
Tacrolimus and Steroid Treatment for Acute Exacerbation of Idiopathic Pulmonary Fibrosis
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DOI：
10.2169/internalmedicine.50.4327
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发表时间：
2011-01-01
影响因子：
1.2
通讯作者：
To, Yasuo
中科院分区：
文献类型：
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作者：
Horita, Nobuyuki;Akahane, Makiko;To, Yasuo
目的特发性肺纤维化急性加重期（AE-IPF）发生于特发性肺纤维化的慢性进展过程中。死亡率估计为> 70%，因为没有建立有效的治疗方法。方法回顾性分析2001年1月至2010年4月期间AE-IPF患者接受甲基强的松龙冲击治疗联合或不联合他克莫司（靶向20 ng/mL）的情况。主要终点是生存率和持续时间。我们还观察了乳酸脱氢酶水平，动脉血氧分压/吸入氧比（P/F比），KL-6，再加重的发生，和计算机断层扫描scores.Results 15日本患者[他克莫司组年龄74.2 +/- 6.0岁（n=5），非他克莫司组年龄75.1 +/- 12.8岁（n=10）]被确定。两组治疗前临床参数无显著差异。他克莫司组5例中有4例存活，非他克莫司组10例中有1例存活（P < 0.05）。中位生存期> 92天（他克莫司组）和38天（非他克莫司组）（p < 0.05）。他克莫司组的乳酸脱氢酶水平和P/F比值也明显有利。KL-6和CT评分两组间差异无统计学意义。结论联合他克莫司和甲基强的松龙冲击治疗可减轻AE-IPF，防止再急性加重，并有助于改善预后。
Objective Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) occurs during the chronic progressive course of idiopathic pulmonary fibrosis. Mortality is estimated to be > 70%, because no effective treatment has been established. We evaluated the effectiveness of combination therapy of tacrolimus and methylprednisolone for AE-IPF.Methods Patients of AE-IPF treated with methylprednisolone pulse therapy with or without tacrolimus (targeting 20 ng/mL) during the period between January 2001 and April 2010 were retrospectively reviewed. The primary endpoints were survival rate and duration. We also observed lactate dehydrogenase levels, partial pressure of arterial oxygen/fraction of inspired oxygen ratio (P/F ratio), KL-6, occurrence of re-exacerbation, and computed tomography score.Results Fifteen Japanese patients [tacrolimus group aged 74.2 +/- 6.0 years old (n=5), non-tacrolimus group aged 75.1 +/- 12.8 years old (n=10)] were identified. Pre-treatment clinical parameters were not significantly different between the two groups. Four of 5 tacrolimus group patients and 1 of 10 non-tacrolimus group patients survived (p < 0.05). The median survival durations were > 92 days (tacrolimus group) and 38 days (non-tacrolimus group) (p < 0.05). Lactate dehydrogenase levels and the P/F ratio were also significantly favorable in the tacrolimus group. KL-6 and CT score were not significantly different in both groups. Four re-acute exacerbations were observed only in the non-tacrolimus group.Conclusion Combined tacrolimus and methylprednisolone pulse therapy mitigates AE-IPF, prevents re-acute exacerbation, and contributes to a better prognosis.