Sweiss N J, Barnathan E S, Lo K, Judson M A, Baughman R
University of Chicago, Chicago, IL, USA.
Sarcoidosis Vasc Diffuse Lung Dis. 2010 Jul;27(1):49-56.
This study assessed the value of C-reactive protein as a predictor of disease severity and response to infliximab therapy in patients with chronic pulmonary sarcoidosis.
Sera were collected through week 52 from 138 patients with chronic pulmonary sarcoidosis who received placebo or infliximab in a randomized, double-blind, placebo-controlled study. We evaluated the response to therapy by baseline CRP using a dichotomous cutpoint (0.8 mg/dL) for the change from baseline in percent-predicted forced vital capacity (FVC), Saint George's Respiratory Questionnaire (SGRQ), 6-minute walk distance (6MWD), Borg's CR10 dyspnea score, and Physician Organ Assessment (POA).
CRP was elevated in 36% of patients at baseline, and was significantly reduced by infliximab by week 2. Among patients with elevated baseline CRP, infliximab-treated patients improved significantly compared with placebo-treated patients in percent-predicted FVC (+2.5 versus -2.6%), 6MWD (+8.0 versus -34.1), Borg's CR10 dyspnea score (pre-6MWD -0.8 versus +0.9, post-6MWD -1.1 versus +0.8), and POA (-3.1 versus -0.3). Patients with lower CRP levels at baseline did not show significant differences between the placebo and infliximab groups in most endpoints evaluated.
In chronic sarcoidosis patients, elevated CRP appears to identify a subset with more severe disease who may respond better to treatment with infliximab.
本研究评估了C反应蛋白在预测慢性肺结节病患者疾病严重程度及英夫利昔单抗治疗反应中的价值。
在一项随机、双盲、安慰剂对照研究中，收集了138例接受安慰剂或英夫利昔单抗治疗的慢性肺结节病患者第52周时的血清。我们使用二分切点（0.8mg/dL），根据预测用力肺活量（FVC）、圣乔治呼吸问卷（SGRQ）、6分钟步行距离（6MWD）、博格CR10呼吸困难评分和医生器官评估（POA）从基线的变化，评估治疗反应。
36%的患者基线时CRP升高，英夫利昔单抗治疗至第2周时CRP显著降低。在基线CRP升高的患者中，英夫利昔单抗治疗组在预测FVC百分比（+2.5对-2.6%）、6MWD（+8.0对-34.1）、博格CR10呼吸困难评分（6MWD前-0.8对+0.9，6MWD后-1.1对+0.8）和POA（-3.1对-0.3）方面与安慰剂治疗组相比有显著改善。基线CRP水平较低的患者在大多数评估终点上，安慰剂组和英夫利昔单抗组之间没有显著差异。
在慢性结节病患者中，CRP升高似乎可识别出疾病更严重的亚组，这些患者可能对英夫利昔单抗治疗反应更好。
