治疗时间长短对慢性肺曲霉病复发的影响。

Impact of treatment duration on recurrence of chronic pulmonary aspergillosis.

机构信息

Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea.

Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.

出版信息

J Infect. 2021 Oct;83(4):490-495. doi: 10.1016/j.jinf.2021.07.030. Epub 2021 Jul 28.

DOI:10.1016/j.jinf.2021.07.030

PMID:34332020

Abstract

OBJECTIVES

Limited data exist on the optimal treatment duration for chronic pulmonary aspergillosis (CPA). We investigated the treatment outcome and recurrence rate according to treatment duration in CPA patients.

METHODS

A total of 196 patients who completed at least 6 months of antifungal therapy (99% oral itraconazole) and achieved favorable treatment responses were analyzed. A Cox's proportional hazards regression model was used to adjust for potential confounding factors in the association between the duration of antifungal therapy (6-12 months vs. ≥ 12 months) and recurrence.

RESULTS

All patients were treated with antifungal agents for at least 6 months (median: 12.5, interquartile range: 8.5-18.4 months) and categorized into 6-12 months group (79/196, 40%) and ≥ 12 months group (117/196, 60%). The 6-12 months group had significantly higher recurrence rates owing to CPA aggravation after the completion of treatment compared with the ≥ 12 months group (51% vs. 25%, P = 0.003). In a Cox's proportional hazards regression model, treatment duration ≥ 12 months was independently associated with a lower risk of recurrence (adjusted hazard ratio: 0.48, 95% confidence interval: 0.28-0.80).

CONCLUSIONS

Our data suggest that prolonging antifungal therapy beyond 12 months could reduce the recurrence rate in CPA patients.

摘要

目的

慢性肺曲霉病（CPA）的最佳治疗持续时间的数据有限。我们研究了 CPA 患者根据治疗持续时间的治疗结果和复发率。

方法

共分析了 196 例完成至少 6 个月抗真菌治疗（99%口服伊曲康唑）并获得良好治疗反应的患者。使用 Cox 比例风险回归模型调整了抗真菌治疗持续时间（6-12 个月与≥12 个月）与复发之间关联的潜在混杂因素。

结果

所有患者均接受抗真菌药物治疗至少 6 个月（中位数：12.5，四分位距：8.5-18.4 个月），并分为 6-12 个月组（79/196，40%）和≥12 个月组（117/196，60%）。由于治疗完成后 CPA 加重，6-12 个月组的复发率明显高于≥12 个月组（51%比 25%，P=0.003）。在 Cox 比例风险回归模型中，治疗持续时间≥12 个月与复发风险降低独立相关（调整后的危险比：0.48，95%置信区间：0.28-0.80）。