口服利巴韦林治疗肺移植受者呼吸道合胞病毒感染。
Oral Ribavirin for Treatment of Respiratory Syncytial Virus in Lung Transplantation Recipients.
机构信息
Servicio de Farmacia, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
Servicio de Farmacia, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
出版信息
Transplant Proc. 2021 Nov;53(9):2702-2705. doi: 10.1016/j.transproceed.2021.08.037. Epub 2021 Oct 6.
BACKGROUND
Respiratory syncytial virus (RSV) can cause severe respiratory infection and is a risk factor for development of bronchiolitis obliterans syndrome (BOS) in patients who have undergone lung transplantation (LT). The treatment options are limited in this population. We assessed the efficacy of oral administration for the treatment of RSV infection after LT.
METHODS
A retrospective case-control was conducted in LT patients who documented RSV infection. Demographic, clinical, and efficacy variables (resolution infection, recovery of lung function, incidence of BOS, mortality) was compared between the oral ribavirin (RBV) group and the control group.
RESULTS
Thirty-six LT patients were included (19 RBV group, 17 control group). Significant differences were found for age, sex and coinfections. However, no differences of immunosuppressive level and baseline forced expiratory volume in the first second of expiration (FEV) were found. RSV clearance was evident in 5 patients (26.3%) of the RBV group vs 2 patients (11.8%) in the control group (odds ratio [OR], 0.37; P = .282). At 3 months, FEV remained stable in 12 patients (80%) of the RBV group vs 13 patients (81.3%) of the control group (OR, 0.92; P = .321). At 6 months, FEV remained stable in 11 patients (73.3%) of the RBV group and 12 patients (75%) of the control group (OR, 1.25; P = .779), and BOS appeared in 6 patients (31.6%) vs 4 patients (23.5%) of the control group (OR, 1.50; P = .591). Mortality rates were 26% (5 patients) in the RBV group vs 29.4% (5 patients) in the control group (OR, 1.40; P = .637).
CONCLUSIONS
No significant differences in efficacy parameters were found between groups; however, stabilization without worsening of respiratory function was observed at 3 and 6 months. Because of the variability in the treatment regimen and the heterogeneity of groups, a protocol was developed to standardize and evaluate the use of oral RBV as treatment for RSV in LT.
背景
呼吸道合胞病毒（RSV）可导致严重的呼吸道感染，是肺移植（LT）患者发生细支气管炎闭塞性综合征（BOS）的危险因素。该人群的治疗选择有限。我们评估了 LT 后口服利巴韦林（RBV）治疗 RSV 感染的疗效。
方法
对有记录的 RSV 感染的 LT 患者进行回顾性病例对照研究。比较口服 RBV 组和对照组的人口统计学、临床和疗效变量（感染缓解、肺功能恢复、BOS 发生率、死亡率）。
结果
共纳入 36 例 LT 患者（19 例 RBV 组，17 例对照组）。年龄、性别和合并感染存在显著差异，但免疫抑制水平和基础用力呼气量（FEV）无差异。RBV 组 5 例（26.3%）患者 RSV 清除，对照组 2 例（11.8%）（比值比 [OR]，0.37；P=0.282）。3 个月时，RBV 组 12 例（80%）患者 FEV 稳定，对照组 13 例（81.3%）（OR，0.92；P=0.321）。6 个月时，RBV 组 11 例（73.3%）患者 FEV 稳定，对照组 12 例（75%）（OR，1.25；P=0.779），对照组出现 BOS 6 例（31.6%），对照组 4 例（23.5%）（OR，1.50；P=0.591）。RBV 组死亡率为 26%（5 例），对照组为 29.4%（5 例）（OR，1.40；P=0.637）。
结论
两组间疗效参数无显著差异；然而，3 个月和 6 个月时观察到呼吸功能稳定而无恶化。由于治疗方案的可变性和组间的异质性，制定了一项方案以标准化和评估口服 RBV 作为 LT 中 RSV 治疗的应用。
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