SYSTEMIC GLUCOCORTICOIDS PLUS CYCLOPHOSPHAMIDE FOR ACUTE EXACERBATION OF IDIOPATHIC PULMONARY FIBROSIS: A RETROSPECTIVE NATIONWIDE STUDY
SYSTEMIC GLUCOCORTICOIDS PLUS CYCLOPHOSPHAMIDE FOR ACUTE EXACERBATION OF IDIOPATHIC PULMONARY FIBROSIS: A RETROSPECTIVE NATIONWIDE STUDY
复制标题
DOI：
10.36141/svdld.v36i2.7181
复制
发表时间：
2019-01-01
影响因子：
1.6
通讯作者：
Yasunaga, Hideo
中科院分区：
文献类型：
--
作者：
Aso, Shotaro;Matsui, Hiroki;Yasunaga, Hideo
目的：特发性肺纤维化急性加重期病死率高，目前尚不清楚环磷酰胺是否是治疗该病的有效药物。目的：本研究比较环磷酰胺联合全身糖皮质激素与单用全身糖皮质激素的疗效。方法：使用日本的诊断程序组合数据库，确定2010年7月1日至2014年3月31日入院时接受大剂量甲基强的松龙和机械通气治疗的特发性肺纤维化患者。根据医院对环磷酰胺的偏好进行工具变量分析，以比较住院结果。结果：符合条件的患者1847例，分为甲基强的松龙联合环磷酰胺组104例和单用甲基强的松龙组1743例。仪器变量分析的结果发现，两组在住院死亡率(优势比，1.11；95%可信区间，0.19-6.43)、无呼吸机天数(差异，2.2；95%可信区间，-2.6至7.0)方面没有显著差异。结论：在一项日本住院患者数据库研究中，分析了接受全身糖皮质激素治疗的急性加重期特发性肺纤维化患者的结果，添加环磷酰胺与改善住院死亡率和无呼吸机天数无关。
Purpose: Mortality of acute exacerbation of idiopathic pulmonary fibrosis is high, and it remains unknown whether cyclophosphamide is an effective treatment for this condition. Objectives: This study compared the effects of cyclophosphamide combined with systemic glucocorticoids with those of systemic glucocorticoids alone. Methods: Using the Diagnosis Procedure Combination database in Japan, adult patients with idiopathic pulmonary fibrosis who had received high-dose methylprednisolone and mechanical ventilation at admission from July 1, 2010, to March 31, 2014, were identified. Instrumental variable analyses based on a hospital preference for cyclophosphamide were performed to compare in-hospital outcomes. Results: Eligible patients (n=1847) were divided into the methylprednisolone plus cyclophosphamide group (n=104) and the methylprednisolone alone group (n=1743). The results of an instrumental variable analysis detected no significant differences between the groups with respect to in-hospital mortality (odds ratio, 1.11; 95% confidence interval, 0.19-6.43), ventilator-free days (difference, 2.2; 95% confidence interval, -2.6 to 7.0). Conclusions: In a Japanese inpatient database study analyzing outcomes from patients with acute exacerbation idiopathic pulmonary fibrosis receiving systemic glucocorticoids, the addition of cyclophosphamide was not associated with improved in-hospital mortality and ventilator free days.