Ogawa Kazumasa, Takahashi Yui, Murase Kyoko, Hanada Shigeo, Uruga Hironori, Takaya Hisashi, Miyamoto Atsushi, Morokawa Nasa, Kurosaki Atsuko, Kishi Kazuma
Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo, Japan.
Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo, Japan.
Respir Investig. 2018 Sep;56(5):410-417. doi: 10.1016/j.resinv.2018.05.003. Epub 2018 Jun 11.
Pneumothorax occasionally develops in patients with interstitial pneumonia (IP) and is often intractable. As there exists no well-established treatment for pneumothorax with IP, we evaluated the efficacy and safety of pleurodesis with OK-432, a lyophilized preparation of Streptococcus pyogenes Su strain that has been inactivated by benzylpenicillin.
We retrospectively evaluated the efficacy and safety of pleurodesis using OK-432 in 39 patients treated for IP-related pneumothorax between January 2006 and May 2017. Five to 10 Klinische Einheit (KE) of OK-432 was injected through the chest tube of each patient. Pleurodesis was considered successful if 1) the chest tube was removed without air leaks and 2) there was no recurrence of pneumothorax within 4 weeks after tube removal, and no additional treatment was required.
OK-432 pleurodesis was performed 46 times in 39 patients. The median number of OK-432 intrapleural injections received was 1 (range, 1-6), and median dose was 10 KE (range, 5-55 KE). The success rate was 63% (29/46) and recurrence rate was 17.4% (8/46). Grade 5 adverse events were observed in eight patients, including two patients who developed acute exacerbation of IP. Patients in whom the first OK-432 pleurodesis was successful had a significantly longer median survival time than patients in whom it was unsuccessful (322 days vs. 70 days, p = 0.036).
Our results show that OK-432 pleurodesis is an effective treatment for pneumothorax associated with IP; however, clinicians should be aware of the possibility of adverse events, especially in patients who are critically ill.
气胸偶尔会在间质性肺炎（IP）患者中发生，且往往难以治疗。由于目前尚无针对IP合并气胸的成熟治疗方法，我们评估了使用OK-432进行胸膜固定术的疗效和安全性，OK-432是一种经苄青霉素灭活的化脓性链球菌Su株冻干制剂。
我们回顾性评估了2006年1月至2017年5月期间39例接受IP相关性气胸治疗的患者使用OK-432进行胸膜固定术的疗效和安全性。通过每位患者的胸管注入5至10 Klinische Einheit（KE）的OK-432。如果满足以下条件，则认为胸膜固定术成功：1）胸管在无漏气的情况下拔除；2）拔管后4周内气胸无复发，且无需额外治疗。
39例患者共进行了46次OK-432胸膜固定术。接受OK-432胸膜腔内注射的中位数为1次（范围为1至6次），中位数剂量为10 KE（范围为5至55 KE）。成功率为63%（29/46），复发率为17.4%（8/46）。8例患者出现5级不良事件，其中2例患者发生IP急性加重。首次OK-432胸膜固定术成功的患者的中位生存时间明显长于未成功的患者（322天对70天，p = 0.036）。
我们的结果表明，OK-432胸膜固定术是治疗IP相关性气胸的有效方法；然而，临床医生应意识到不良事件的可能性，尤其是在重症患者中。
