Mankikian J, Favelle O, Guillon A, Guilleminault L, Cormier B, Jonville-Béra A P, Perrotin D, Diot P, Marchand-Adam S
CHRU Tours, Service de Pneumologie, Tours, France.
CHRU Tours, Service de Radiologie, Tours, France.
Respir Med. 2014 Apr;108(4):638-46. doi: 10.1016/j.rmed.2014.01.014. Epub 2014 Feb 10.
Amiodarone-induced pulmonary toxicity (APT) is a serious adverse event that can lead to death. The aims of our study are to determine factors associated with mortality and to describe outcome and sequelae of patients with APT.
Forty-six patients with APT were divided into two groups according to survival at day 90 for a clinical, functional, biological and radiological comparaison. We then evaluated the evolution of 15 survivors at a median of three months [1-6 months] and/or 12 months [8-36 months].
Mortality of APT at day 90 was 37% (17 patients) and was linked to the speed of onset of symptoms and a high HRCT alveolar score. Angiotensin system antagonist treatment was prescribed significantly more in the survival group (p = 0.042, HR 0.34 (95% CI 0.12-0.96)). In surviving patients, dyspnea, vital capacity and HRCT alveolar score improved significantly while HRCT fibrosis score deteriorated gradually during the first six months. At the end of the study, all the surviving patients presented functional and/or radiological sequelae.
Severity of APT is linked to the extent and speed of onset of pulmonary damage. After the initial episode, the patients who survived improved slowly but with persistent sequelae.
胺碘酮所致肺毒性（APT）是一种可导致死亡的严重不良事件。我们研究的目的是确定与死亡率相关的因素，并描述APT患者的结局和后遗症。
46例APT患者根据90天时的生存情况分为两组，进行临床、功能、生物学和影像学比较。然后我们评估了15例幸存者在中位时间3个月[1 - 6个月]和/或12个月[8 - 36个月]时的病情演变。
90天时APT的死亡率为37%（17例患者），与症状出现的速度和高HRCT肺泡评分有关。生存组中血管紧张素系统拮抗剂治疗的处方明显更多（p = 0.042，HR 0.34（95% CI 0.12 - 0.96））。在存活患者中，呼吸困难、肺活量和HRCT肺泡评分显著改善，而HRCT纤维化评分在前六个月逐渐恶化。在研究结束时，所有存活患者均出现功能和/或影像学后遗症。
APT的严重程度与肺损伤的程度和发作速度有关。在最初发作后，存活的患者恢复缓慢但仍有持续的后遗症。
