Department of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, Missouri 63110, USA.
J Heart Lung Transplant. 2010 May;29(5):531-7. doi: 10.1016/j.healun.2009.12.003. Epub 2010 Feb 4.
Previous studies have suggested that azithromycin improves lung function in lung transplant recipients with bronchiolitis obliterans syndrome (BOS). However, these studies did not include a non-treated BOS control cohort or perform survival analysis. This study was undertaken to estimate the effect of azithromycin treatment on survival in lung transplant recipients with BOS.
We conducted a retrospective cohort study of consecutive lung transplant recipients who developed BOS between 1999 and 2007. An association between azithromycin treatment and death was assessed using univariate and multivariate time-dependent Cox regression analysis.
Of the 178 recipients who developed BOS in our study, 78 did so after 2003 and were treated with azithromycin. The azithromycin-treated and untreated cohorts had similar baseline characteristics. Univariate analysis demonstrated that azithromycin treatment was associated with a survival advantage and this beneficial treatment effect was more pronounced when treatment was initiated during BOS Stage 1. Multivariate analysis demonstrated azithromycin treatment during BOS Stage 1 (adjusted hazard ratio = 0.23, p = 0.01) and absolute forced expiratory volume in 1 second (FEV(1)) at the time of BOS Stage 1 (adjusted hazard ratio = 0.52, p = 0.003) were both associated with a decreased risk of death.
In lung transplant recipients with BOS Stage 1, azithromycin treatment initiated before BOS Stage 2 was independently associated with a significant reduction in the risk of death. This finding supports the need for a randomized, controlled trial to confirm the impact of azithromycin on survival in lung transplant recipients.
先前的研究表明，阿奇霉素可改善闭塞性细支气管炎综合征（BOS）肺移植受者的肺功能。然而，这些研究未纳入未经治疗的 BOS 对照组或进行生存分析。本研究旨在评估阿奇霉素治疗对 BOS 肺移植受者生存的影响。
我们进行了一项回顾性队列研究，纳入了 1999 年至 2007 年间发生 BOS 的连续肺移植受者。采用单变量和多变量时依 Cox 回归分析评估阿奇霉素治疗与死亡的相关性。
在本研究中，178 例发生 BOS 的受者中，78 例发生于 2003 年后，接受了阿奇霉素治疗。阿奇霉素治疗组和未治疗组的基线特征相似。单变量分析显示，阿奇霉素治疗与生存获益相关，且当在 BOS 1 期开始治疗时，这种有益的治疗效果更为显著。多变量分析显示，在 BOS 1 期开始阿奇霉素治疗（校正风险比=0.23，p=0.01）和 BOS 1 期时的绝对 1 秒用力呼气量（FEV1）（校正风险比=0.52，p=0.003）均与死亡风险降低相关。
在 BOS 1 期的肺移植受者中，在 BOS 2 期前开始的阿奇霉素治疗与死亡风险的显著降低独立相关。这一发现支持需要进行一项随机对照试验来证实阿奇霉素对肺移植受者生存的影响。
