射频激活次数能否预测支气管热成形术后的严重不良事件？一项回顾性病例对照研究。
Can the Number of Radiofrequency Activations Predict Serious Adverse Events after Bronchial Thermoplasty? A Retrospective Case-Control Study.
作者信息
Yamamoto Shota, Iikura Motoyasu, Kakuwa Tamaki, Tsujimoto Yoshie, Matsubayashi Sachi, Nagano Naoko, Suzuki Tomoyuki, Sakamoto Keita, Kobayashi Konomi, Shiozawa Ayako, Hashimoto Masao, Ishii Satoru, Suzuki Manabu, Izumi Shinyu, Hojo Masayuki, Hasebe Terumitsu, Sugiyama Haruhito
机构信息
Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
Department of Radiology, Tokai University Hachioji Hospital, Tokai University School of Medicine, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan.
出版信息
Pulm Ther. 2019 Dec;5(2):221-233. doi: 10.1007/s41030-019-00103-7. Epub 2019 Nov 7.
INTRODUCTION
Bronchial thermoplasty (BT) is a bronchoscopic procedure that involves the delivery of thermal radiofrequency energy to the bronchial wall for treating severe asthma. It has been suggested that too many radiofrequency activations could induce serious adverse events (SAEs) at an early stage. We aimed to examine the number of radiofrequency activations at each session and early lung function changes from baseline to determine whether these are related to SAEs.
METHODS
We retrospectively investigated 13 consecutive patients who underwent three sessions each of BT for severe asthma from February 2015 to January 2016. Lung function tests were performed on the day before and after each BT procedure. Since we compared the number of activations and lung function changes from baseline after each session, a total of 39 sessions were reviewed. The relationship between the number of radiofrequency activations and each lung function change from baseline was also examined by linear regression analysis.
RESULTS
A total of 10 SAEs (4 of pneumonia, 3 of atelectasis, 2 of bronchial asthma exacerbation and 1 of hemoptysis) were observed following the 39 BT sessions. When we compared sessions with and without SAEs, there were no differences in the number of activations (mean ± SD, 71.5 ± 28.6 times in sessions with SAEs; 66.5 ± 25.1 times in sessions without SAEs; p = 0.772) and lung function changes (mean changes in FVC/%FVC/FEV/%FEV/%PEF from baseline; - 0.49 l/- 14.2%/- 0.36 l/- 11.7%/- 9.6% in sessions with SAEs; - 0.43 l/- 13.3%/- 0.34 l/- 12.1%/- 9.4% in sessions without SAEs; p > 0.05 for all the above). Increase in the number of activations correlated with decreased FEV (R = 0.17, p = 0.0088) and %FEV (R = 0.11, p = 0.0357).
CONCLUSIONS
Increase in the number of radiofrequency activations during BT is related to a decrease in FEV and %FEV from baseline. The number of radiofrequency activations, however, is not associated with SAEs after BT.
引言
支气管热成形术（BT）是一种支气管镜检查程序，通过向支气管壁输送热射频能量来治疗重度哮喘。有人提出，过多的射频激活可能在早期引发严重不良事件（SAE）。我们旨在检查每次治疗时的射频激活次数以及从基线开始的早期肺功能变化，以确定这些是否与SAE相关。
方法
我们回顾性研究了2015年2月至2016年1月期间连续接受三次BT治疗重度哮喘的13例患者。在每次BT治疗前后当天进行肺功能测试。由于我们比较了每次治疗后与基线相比的激活次数和肺功能变化，共审查了39次治疗。还通过线性回归分析检查了射频激活次数与每次肺功能相对于基线变化之间的关系。
结果
在39次BT治疗后共观察到10例SAE（4例肺炎、3例肺不张、2例支气管哮喘加重和1例咯血）。当我们比较有和没有SAE的治疗时，激活次数（平均值±标准差，有SAE的治疗中为71.5±28.6次；无SAE的治疗中为66.5±25.1次；p = 0.772）和肺功能变化（FVC/%FVC/FEV/%FEV/%PEF相对于基线的平均变化；有SAE的治疗中为-0.49升/-14.2%/-0.36升/-11.7%/-9.6%；无SAE的治疗中为-0.43升/-13.3%/-0.34升/-12.1%/-9.4%；上述所有p>0.05）均无差异。激活次数增加与FEV降低（R = 0.17，p = 0.0088）和%FEV降低（R = 0.11，p = 0.0357）相关。
结论
BT期间射频激活次数增加与基线时FEV和%FEV降低有关。然而，射频激活次数与BT后的SAE无关。
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