Survival from acute exacerbation of idiopathic pulmonary fibrosis with or without direct hemoperfusion with polymyxin B-immobilized fiber column: A retrospective analysis
Survival from acute exacerbation of idiopathic pulmonary fibrosis with or without direct hemoperfusion with polymyxin B-immobilized fiber column: A retrospective analysis
复制标题
使用或不使用多粘菌素 B 固定纤维柱直接血液灌流的特发性肺纤维化急性加重后的生存率：回顾性分析
DOI：
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
M. Yano
中科院分区：
文献类型：
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作者：
K. Oishi;K. Aoe;Y. Mimura;Y. Murata;K. Sakamoto;Wataru Koutoku;Tsuneo Matsumoto;H. Ueoka;Kazuto Mastunaga;M. Yano
背景：特发性肺纤维化急性加重（AE-IPF）是病因不明的急性呼吸系统恶化的致命发作。先前对急性呼吸窘迫综合征的研究表明，多粘菌素b固定化纤维柱（PMX-DHP）直接血液灌注有利于影响呼吸状态。目的：探讨AE-IPF患者行PMX-DHP后的预后和生存结局。方法：对我院收治的50例AE-IPF患者进行回顾性分析。所有患者均接受皮质类固醇脉冲治疗。我们比较了27例接受PMX- dhp治疗的患者（PMX组）和23例未接受PMX治疗的患者（非PMX组）的疾病结局。通过Cox比例风险分析确定独立的生存预测因子。结果：对所有患者的多因素分析显示，PMX-DHP治疗是生存率的重要预测因子（HR=0.442, p=0.019）。在42.0天（1-1656天）的中位观察期内，38例（76.0%）患者死亡。PMX组的总生存期明显长于非PMX组：PMX组的中位生存期为192天，而非PMX组为29天（p=0.040，对数秩检验）。PMX组的12个月生存率也明显优于非PMX组（41.7%比9.8%）。在PMX组的亚分析中，从AE-IPF发病到PMX- dhp的时间是生存的重要预测因子（HR=1.080, p=0.049）。结论：PMX-DHP可改善AE-IPF的预后。从AE-IPF发病到PMX-DHP的时间可能是预测预后的信息。
Background: Acute exacerbations of idiopathic pulmonary fibrosis (AE-IPF) are fatal episodes of acute respiratory worsening of unknown etiology. Previous studies on acute respiratory distress syndrome have shown that direct hemoperfusion with polymyxin B-immobilized fiber column (PMX-DHP) beneficially impact respiratory status. Aimes: To investigate the prognosis and survival outcome of patients with AE-IPF who underwent PMX-DHP. Methods: We examined records of 50 patients with AE-IPF treated in our hospital. All patients received corticosteroid pulse therapy. We compared the disease outcome between 27 patients who underwent PMX-DHP (PMX group) and 23 patients who did not (non-PMX group). Independent predictors of survival were determined with Cox proportional hazards analyses. Results: A multivariate analysis of all patients revealed that PMX-DHP therapy was a significant predictor of survival (HR=0.442, p=0.019). Throughout the median observational period of 42.0 days (range, 1-1656 days) 38 patients (76.0%) died. Overall survival was significantly longer in the PMX group than the non-PMX group: median survival time, 192 days in the PMX vs. 29 days in the non-PMX (p=0.040, log rank test). The 12-month survival rate was also significantly better in the PMX group than the non-PMX group (41.7% vs. 9.8%). In a subanalysis of the PMX group, time from AE-IPF onset to PMX-DHP was a significant predictor of survival (HR=1.080, p=0.049). Conclusions: PMX-DHP improved the prognosis of AE-IPF. Time from AE-IPF onset to PMX-DHP may be informative for outcome prediction.