O'Driscoll B R, Kalra S, Gattamaneni H R, Woodcock A A
North West Lung Centre, Wythenshawe Hospital, Manchester, England.
Chest. 1995 May;107(5):1355-7. doi: 10.1378/chest.107.5.1355.
Previously, we have reported in 1990 that 35% of carmustine treated patients (6 of 17) who survived childhood brain tumors died of pulmonary fibrosis between 2 and 13 years after treatment. In addition, 8 patients studied in 1989 (13 to 17 years post treatment), had physiologic and biopsy or radiologic evidence of pulmonary fibrosis. We now report 3 more years of follow-up on these patients. Between 1989 and 1992, two more patients have died of pulmonary fibrosis, giving an overall mortality of 47%. Of the eight patients who died of pulmonary fibrosis, the median age at treatment was 2.5 years, whereas the nine long-term survivors had a median age at treatment of 10 years. All five patients treated below the age of 5 years have died of lung fibrosis. Analysis by the standard survival curve method indicated that patients treated at an age less than 6 years were more likely to die than those treated at an age older than 7 years (p = 0.03). Of the nine survivors, seven were observed over 3 more years. There was a gradual decline in mean forced vital capacity from 55% predicted (range, 44 to 81) to 51% predicted (range, 41 to 72) and total lung capacity fell from 65% predicted (range, 51 to 89) to 57% predicted (range, 47 to 77).
此前，我们于1990年报告称，在接受卡莫司汀治疗且存活下来的儿童脑肿瘤患者中，35%（17例中的6例）在治疗后2至13年死于肺纤维化。此外，1989年研究的8例患者（治疗后13至17年）有肺纤维化的生理学及活检或放射学证据。我们现在报告对这些患者进行的另外3年随访情况。在1989年至1992年期间，又有2例患者死于肺纤维化，总死亡率为47%。在死于肺纤维化的8例患者中，治疗时的中位年龄为2.5岁，而9例长期存活者治疗时的中位年龄为10岁。所有5岁以下接受治疗的患者均死于肺纤维化。采用标准生存曲线法分析表明，6岁以下接受治疗的患者比7岁以上接受治疗的患者死亡可能性更大（p = 0.03）。在9名幸存者中，7名又被观察了3年多。平均用力肺活量从预测值的55%（范围为44%至81%）逐渐下降到预测值的51%（范围为41%至72%），肺总量从预测值的65%（范围为51%至89%）下降到预测值的57%（范围为47%至77%）。
