Radzikowska Elżbieta, Wiatr Elżbieta, Langfort Renata, Bestry Iwona, Skoczylas Agnieszka, Szczepulska-Wójcik Ewa, Gawryluk Dariusz, Rudziński Piotr, Chorostowska-Wynimko Joanna, Roszkowski-Śliż Kazimierz
III Department of Lung Disease National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland.
Pathology Department National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland.
PLoS One. 2017 Sep 25;12(9):e0184739. doi: 10.1371/journal.pone.0184739. eCollection 2017.
Cryptogenic organizing pneumonia (COP) is a clinicopathological syndrome of unknown origin. Corticosteroids are the standard treatment, but clarithromycin (CAM) is also effective. The aim of this observational retrospective study was to compare the results of CAM versus prednisone (PRE) treatment in patients with biopsy-proven OP without respiratory insufficiency.
In a 15-year period, 40 patients were treated with CAM (500 mg twice daily orally for 3 months) and 22 with PRE (mean initial dose of 0.67 ± 0.24 mg/kg/d for a mean of 8.59 ± 3.05 months).
The clinical presentation, laboratory, and radiological findings did not differ markedly between patients treated with CAM and PRE, with the exception of a higher frequency of sweats (55% vs. 23%; p < 0.015), ground glass opacities (95% vs. 50%; p <0.0001) and nodular lesions (45% vs. 18%; p = 0.036) in the CAM group. A complete response was achieved in 35(88%) patients treated with CAM and in all treated with PRE. Patients treated with PRE relapsed more frequently than those treated with CAM (54.5% vs. 10%; p < 0.0001). Corticosteroid-related adverse events were noticed in 8(6.5%) patients (with one death), but CAM caused only one (2.5%) allergic reaction. A FVC >80% identified patients who might be successfully treated with CAM with a sensitivity of 60% and a specificity of 88.57% (AUC 0.869; 95% CI 0.684-1; p = 0.008); the figures for the FEV1 were >70%, a sensitivity of 60%, and a specificity of 91.43% (AUC 0.809; 95%CI 0.609-1; p = 0.027).
CAM can be used to treat COP patients in whom the pulmonary function parameters are within normal limits. Such therapy is shorter, better tolerated, and associated with fewer adverse events and relapses than is PRE. However, the therapy is ineffective in some patients.
隐源性机化性肺炎（COP）是一种病因不明的临床病理综合征。皮质类固醇是标准治疗方法，但克拉霉素（CAM）也有效。这项观察性回顾性研究的目的是比较CAM与泼尼松（PRE）治疗活检证实为OP且无呼吸功能不全患者的结果。
在15年期间，40例患者接受CAM治疗（口服500mg，每日两次，共3个月），22例接受PRE治疗（平均初始剂量为0.67±0.24mg/kg/d，平均治疗8.59±3.05个月）。
接受CAM和PRE治疗的患者临床表现、实验室检查和影像学表现无明显差异，但CAM组出汗频率更高（55%对23%；p<0.015）、磨玻璃影更多见（95%对50%；p<0.0001）以及结节性病变更多（45%对18%；p=0.036）。接受CAM治疗的35例（88%）患者和所有接受PRE治疗的患者均实现了完全缓解。接受PRE治疗的患者比接受CAM治疗的患者复发更频繁（54.5%对10%；p<0.0001）。8例（6.5%）患者出现了与皮质类固醇相关的不良事件（1例死亡），但CAM仅引起1例（2.5%）过敏反应。用力肺活量（FVC）>80%可识别出可能用CAM成功治疗的患者，敏感性为60%，特异性为88.57%（曲线下面积[AUC]0.869；95%置信区间[CI]0.684 - 1；p = 0.008）；第1秒用力呼气容积（FEV1）的相应数据为>70%，敏感性为60%，特异性为91.43%（AUC 0.809；95%CI 0.609 - 1；p = 0.027）。
CAM可用于治疗肺功能参数在正常范围内的COP患者。与PRE相比，这种治疗疗程更短、耐受性更好，不良事件和复发更少。然而，该治疗对部分患者无效。
