Persistent Post-COVID-19 Interstitial Lung Disease. An Observational Study of Corticosteroid Treatment.
Persistent Post-COVID-19 Interstitial Lung Disease. An Observational Study of Corticosteroid Treatment.
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DOI：
10.1513/annalsats.202008-1002oc
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发表时间：
2021-05
影响因子：
8.3
通讯作者：
West AG
中科院分区：
文献类型：
--
作者：
Myall KJ;Mukherjee B;Castanheira AM;Lam JL;Benedetti G;Mak SM;Preston R;Thillai M;Dewar A;Molyneaux PL;West AG
理由：严重急性呼吸综合征冠状病毒2（SARS-CoV-2）恢复的自然史仍然未知。由于具有持续生理缺陷的纤维化是先前描述的从类似冠状病毒中恢复的患者的特征，因此治疗代表了改变疾病进程的早期机会，可能防止不可逆的损害。目的：确定使用泼尼松龙治疗SARS-CoV-2后持续性炎性间质性肺病（ILD）的发生率并描述其进展。方法：一个结构化的评估方案筛选SARS-CoV-2肺炎的后遗症。837例患者在出院后4周通过电话进行评估。症状持续的患者在6周时进行门诊评估。在多学科小组会议上诊断为持续性间质性肺改变的30例患者在间质性肺疾病服务中接受了审查并提供了治疗。这些患者有持续的、无改善的症状。结果：在出院后4周，39%的患者报告了持续的症状（325/837）并进行了评估。在35/837名幸存者（4.8%）中观察到间质性肺病，主要是机化性肺炎，伴有显著的功能缺陷。其中30例患者接受类固醇治疗，治疗后转移因子平均相对增加31.6%（标准差[SD] ± 27.6，P < 0.001），用力肺活量增加9.6%（SD ± 13.0，P = 0.014），症状和放射学显著改善。结论：在SARS-CoV-2肺炎之后，一组患者留下了放射性炎性肺病和持续的生理和功能缺陷。早期皮质类固醇治疗耐受性良好，并与快速和显着的改善。这些初步的数据应该为进一步研究SARS-CoV-2感染后持续性炎症性ILD患者的自然史和潜在治疗提供信息。
Rationale: The natural history of recovery from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains unknown. Because fibrosis with persistent physiological deficit is a previously described feature of patients recovering from similar coronaviruses, treatment represents an early opportunity to modify the disease course, potentially preventing irreversible impairment. Objectives: Determine the incidence of and describe the progression of persistent inflammatory interstitial lung disease (ILD) following SARS-CoV-2 when treated with prednisolone. Methods: A structured assessment protocol screened for sequelae of SARS-CoV-2 pneumonitis. Eight hundred thirty-seven patients were assessed by telephone 4 weeks after discharge. Those with ongoing symptoms had outpatient assessment at 6 weeks. Thirty patients diagnosed with persistent interstitial lung changes at a multidisciplinary team meeting were reviewed in the interstitial lung disease service and offered treatment. These patients had persistent, nonimproving symptoms. Results: At 4 weeks after discharge, 39% of patients reported ongoing symptoms (325/837) and were assessed. Interstitial lung disease, predominantly organizing pneumonia, with significant functional deficit was observed in 35/837 survivors (4.8%). Thirty of these patients received steroid treatment, resulting in a mean relative increase in transfer factor following treatment of 31.6% (standard deviation [SD] ± 27.6, P < 0.001), and forced vital capacity of 9.6% (SD ± 13.0, P = 0.014), with significant symptomatic and radiological improvement. Conclusions: Following SARS-CoV-2 pneumonitis, a cohort of patients are left with both radiological inflammatory lung disease and persistent physiological and functional deficit. Early treatment with corticosteroids was well tolerated and associated with rapid and significant improvement. These preliminary data should inform further study into the natural history and potential treatment for patients with persistent inflammatory ILD following SARS-CoV-2 infection.