Courtwright Andrew M, Goldberg Hilary J, Henske Elizabeth Petri, El-Chemaly Souheil
Division of Pulmonary and Critical Care Division, Brigham and Women's Hospital, Boston, MA, USA.
Division of Pulmonary and Critical Care Division, Brigham and Women's Hospital, Boston, MA, USA
Eur Respir Rev. 2017 Jan 17;26(143). doi: 10.1183/16000617.0004-2016. Print 2017 Jan.
Lymphangioleiomyomatosis (LAM) is a destructive cystic lung disease. Mammalian target of rapamycin (mTOR) inhibitors are the primary treatment for LAM but it is unknown whether these immunosuppressing medications increase the risk for or the severity of respiratory infections in LAM patients.We searched multiple databases for original articles that reported the rate of respiratory infections in LAM patients treated with mTOR inhibitors or placebo. We calculated incidence rates for respiratory infections in these groups and incidence rate ratios for respiratory infections and severe respiratory infections in mTOR inhibitors treated versus placebo treated patients.11 studies were included. There were 294 patients in the treatment groups and 93 patients in the placebo groups. Among subjects in placebo arms, the incidence rate of respiratory infections was 58.8 per 100 patient-years (95% CI 35.3-82.3 per 100 patient-years). The incidence-rate ratio (IRR) for respiratory infection among treated subjects was 0.71 (95% CI 0.50-1.02; p=0.06 compared to placebo subjects). The IRR for severe respiratory infections among treated subjects was 1.56 (95% CI 0.43-8.55; p=0.52).We found that respiratory infections are common in patients with LAM. Importantly, treatment with mTOR inhibitors does not increase the incidence of these infections and may be protective.
淋巴管平滑肌瘤病（LAM）是一种具有破坏性的囊性肺部疾病。雷帕霉素靶蛋白（mTOR）抑制剂是LAM的主要治疗药物，但尚不清楚这些免疫抑制药物是否会增加LAM患者发生呼吸道感染的风险或加重感染的严重程度。我们在多个数据库中检索了报告接受mTOR抑制剂或安慰剂治疗的LAM患者呼吸道感染发生率的原始文章。我们计算了这些组中呼吸道感染的发病率，以及接受mTOR抑制剂治疗与接受安慰剂治疗的患者中呼吸道感染和严重呼吸道感染的发病率比。纳入了11项研究。治疗组有294例患者，安慰剂组有93例患者。在安慰剂组的受试者中，呼吸道感染的发病率为每100患者年58.8例（95%CI为每100患者年35.3 - 82.3例）。治疗组受试者呼吸道感染的发病率比（IRR）为0.71（95%CI为0.50 - 1.02；与安慰剂组受试者相比，p = 0.06）。治疗组受试者严重呼吸道感染的IRR为1.56（95%CI为0.43 - 8.55；p = 0.52）。我们发现呼吸道感染在LAM患者中很常见。重要的是，mTOR抑制剂治疗不会增加这些感染的发生率，可能具有保护作用。
