Department of Respiratory Medicine and.
Department of Radiology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
Ann Am Thorac Soc. 2021 May;18(5):799-806. doi: 10.1513/AnnalsATS.202008-1002OC.
The natural history of recovery from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains unknown. Because fibrosis with persistent physiological deficit is a previously described feature of patients recovering from similar coronaviruses, treatment represents an early opportunity to modify the disease course, potentially preventing irreversible impairment. Determine the incidence of and describe the progression of persistent inflammatory interstitial lung disease (ILD) following SARS-CoV-2 when treated with prednisolone. A structured assessment protocol screened for sequelae of SARS-CoV-2 pneumonitis. Eight hundred thirty-seven patients were assessed by telephone 4 weeks after discharge. Those with ongoing symptoms had outpatient assessment at 6 weeks. Thirty patients diagnosed with persistent interstitial lung changes at a multidisciplinary team meeting were reviewed in the interstitial lung disease service and offered treatment. These patients had persistent, nonimproving symptoms. At 4 weeks after discharge, 39% of patients reported ongoing symptoms (325/837) and were assessed. Interstitial lung disease, predominantly organizing pneumonia, with significant functional deficit was observed in 35/837 survivors (4.8%). Thirty of these patients received steroid treatment, resulting in a mean relative increase in transfer factor following treatment of 31.6% (standard deviation [SD] ± 27.6, < 0.001), and forced vital capacity of 9.6% (SD ± 13.0, = 0.014), with significant symptomatic and radiological improvement. Following SARS-CoV-2 pneumonitis, a cohort of patients are left with both radiological inflammatory lung disease and persistent physiological and functional deficit. Early treatment with corticosteroids was well tolerated and associated with rapid and significant improvement. These preliminary data should inform further study into the natural history and potential treatment for patients with persistent inflammatory ILD following SARS-CoV-2 infection.
严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 康复的自然史尚不清楚。由于纤维化伴持续生理缺陷是先前描述的从类似冠状病毒中康复的患者的特征，因此治疗代表了改变疾病进程的早期机会，可能预防不可逆的损害。确定皮质类固醇治疗后 SARS-CoV-2 患者持续性炎症性间质性肺病 (ILD) 的发生率并描述其进展情况。采用结构化评估方案筛查 SARS-CoV-2 肺炎的后遗症。出院后 4 周通过电话对 837 例患者进行评估。有持续症状的患者在 6 周时进行门诊评估。在多学科团队会议上诊断为持续性间质性肺改变的 30 例患者在间质性肺病服务中进行了回顾，并提供了治疗。这些患者有持续性、无改善的症状。出院后 4 周，39%的患者（325/837）报告有持续症状并接受了评估。在 837 例幸存者中观察到间质性肺疾病，主要为机化性肺炎，伴有明显的功能缺陷，占 4.8%（35/837）。这 30 例患者接受了类固醇治疗，治疗后转移因子的平均相对增加率为 31.6%（标准偏差 [SD] ± 27.6， < 0.001），用力肺活量增加 9.6%（SD ± 13.0， = 0.014），症状和影像学均有显著改善。SARS-CoV-2 肺炎后，一组患者遗留放射性炎症性肺病和持续的生理和功能缺陷。皮质类固醇的早期治疗耐受性良好，与快速显著改善相关。这些初步数据应进一步研究 SARS-CoV-2 感染后持续性炎症性 ILD 患者的自然史和潜在治疗方法。
