Addition of inhaled corticosteroids to systemic immunosuppression after lung transplantation: a double-blind, placebo-controlled trial1
Addition of inhaled corticosteroids to systemic immunosuppression after lung transplantation: a double-blind, placebo-controlled trial1
复制标题
肺移植后在全身免疫抑制中添加吸入皮质类固醇：一项双盲、安慰剂对照试验1
作者：
H. Whitford;E. Walters;B. Levvey;T. Kotsimbos;B. Orsida;C. Ward;M. Pais;S. Reid;T. Williams;G. Snell
背景据推测，闭塞性细支气管炎综合征（BOS）之前的气道炎症，已被描述，即使在稳定的肺移植受者。已知在其他慢性炎性肺病中，气道炎症被吸入类固醇抑制，例如，哮喘和慢性阻塞性肺病。BOS是肺移植术后发病和死亡的主要原因。Objective.研究吸入皮质类固醇对肺移植受者BOS发生的影响。方法. 30例患者被招募并以双盲方式随机接受750 g丙酸氟替卡松（FP）或相同外观的安慰剂，每日两次，持续3个月;该组中的20例持续到移植后2年。在整个研究期间定期进行详细的肺量测定。结果在短期研究中，未发现任何检查参数存在差异。在研究的长期部分中，未发现BOS和生存率的发展存在差异。支气管肺泡灌洗（BAL）淋巴细胞百分比存在微小差异。结论. FP对肺移植后BOS的预防无效，尽管气道炎症是这种情况的特征。局部给药不足、相对于移植的治疗时机和这种疾病的固有类固醇耐药性可能解释了本研究的阴性结果。
Background. It is postulated that bronchiolitis obliterans syndrome (BOS) is preceded by airway inflammation that has been described even in stable lung transplant recipients. Airway inflammation is known to be suppressed by inhaled steroids in other chronic inflammatory lung diseases, e.g., asthma and chronic obstructive pulmonary disease. BOS is the major cause of morbidity and mortality after lung transplantation. Objective. To examine the effect of inhaled corticosteroids on the development of BOS in lung transplant recipients. Methods. Thirty patients were recruited and randomized in a double-blind fashion to receive either 750 &mgr;g of fluticasone propionate (FP) or an identical-appearing placebo twice daily for 3 months; 20 of this group continued until 2 years posttransplantation. Detailed spirometry was performed regularly throughout the study. Results. In the short-term study no differences were found in any examined parameters. In the long-term component of the study no differences were found in the development of neither BOS nor survival. There were minor differences in bronchoalveolar lavage (BAL) lymphocyte percentages. Conclusions. FP is ineffective for the prevention of BOS after lung transplantation despite the airway inflammation that characterizes this condition. Inadequate local delivery, timing of the therapy relative to transplantation and inherent steroid resistance of this condition may explain the negative finding of this study.
急性排斥反应的特征会增加慢性排斥反应的风险。
影响因子：
6.2
作者：
Humar,A;Kerr,S;Gillingham,KJ;Matas,AJ
通讯作者：
Matas,AJ