Respiratory investigation最新文献_第7页

Prognostic significance of oxygen saturation/fraction of inspired oxygen 3 days after initiation of tocilizumab treatment in patients with COVID-19 COVID-19 患者开始接受托珠单抗治疗 3 天后血氧饱和度/吸入氧比例的预后意义

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-10-16 DOI: 10.1016/j.resinv.2024.10.005

Yusuke Kurosawa , Yutaka Kozu , Kaori Soda , Yasunori Itoda , Yusuke Jinno , Shun Yokota , Mamiko Hoshi , Tsukasa Nishizawa , Hisato Hiranuma , Kenji Mizumura , Tetsuo Shimizu , Tadateru Takayama , Kazuo Chin , Yasuhiro Gon

Background

Tocilizumab is effective in treating severe coronavirus disease 2019 (COVID-19). However, the specific time point it acts as a valid indicator of treatment efficacy remains unclear. This study aimed to determine the optimal day for assessing the prognostic value of the oxygen saturation/fraction of inspired oxygen (SpO₂/FiO₂) and ratio of respiratory rate-oxygenation (ROX) index in patients receiving tocilizumab for COVID-19.

Methods

All patients admitted to our hospital from March 2020 to July 2021 who received tocilizumab for COVID-19 were retrospectively identified from hospital charts. Biodata, medical history, and laboratory tests results were obtained from medical records. The prognostic values of the SpO₂/FiO₂ and ROX index for predicting mortality were assessed. Cox proportional hazard and receiver operating characteristic curve models were utilized.

Results

Of the 84 included patients, 34 died within 7 days after discharge. The patients who recovered had a mean age of 65 years and were younger than those who died. The multivariate analysis indicated that multiple comorbidities, cancer history, CURB-65 score, neutrophil and lymphocyte counts, neutrophil/lymphocyte ratio, and lactate dehydrogenase levels were higher in those who died compared with those who survived. No significant differences were found in dyspnea or total bilirubin levels between the two groups. The SpO₂/FiO₂ at 3 days post-tocilizumab initiation was strongly associated with survival.

Conclusions

The SpO₂/FiO₂ on day 3 post-tocilizumab initiation was a predictor of COVID-19 prognosis, which could be employed in determining clinical decisions. Prompt alternative interventions should be considered when this ratio does not improve.

背景托昔单抗能有效治疗 2019 年严重冠状病毒病（COVID-19）。然而，其作为疗效有效指标的具体时间点仍不明确。本研究旨在确定在接受托珠单抗治疗COVID-19的患者中，评估血氧饱和度/吸入氧分量（SpO2/FiO2）和呼吸速率-氧合指数（ROX）比值预后价值的最佳日期。方法从医院病历中回顾性地找出2020年3月至2021年7月期间本院收治的所有接受托珠单抗治疗COVID-19的患者。从病历中获取生物数据、病史和实验室检查结果。评估了SpO2/FiO2和ROX指数预测死亡率的预后价值。结果 84 名患者中有 34 人在出院后 7 天内死亡。康复患者的平均年龄为 65 岁，比死亡患者年轻。多变量分析表明，与存活者相比，死亡者的多种并发症、癌症病史、CURB-65 评分、中性粒细胞和淋巴细胞计数、中性粒细胞/淋巴细胞比率以及乳酸脱氢酶水平均较高。两组患者在呼吸困难或总胆红素水平方面无明显差异。结论使用托珠单抗后第 3 天的 SpO2/FiO2 是 COVID-19 预后的预测指标，可用于确定临床决策。当该比值没有改善时，应考虑及时采取其他干预措施。

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引用次数: 0

Efficacy and safety of mucolytics in patients with stable chronic obstructive pulmonary disease: A systematic review and meta-analysis 粘液溶解剂对稳定期慢性阻塞性肺病患者的疗效和安全性：系统回顾与荟萃分析

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-10-15 DOI: 10.1016/j.resinv.2024.10.004

Hiroshi Ohnishi , Takuya Tanimoto , Ryunosuke Inaba , Masamitsu Eitoku

Background

The efficacy and safety of mucolytics in patients with chronic obstructive pulmonary disease (COPD) and chronic bronchitis or exacerbations of COPD have been reported. We conducted a systematic review and meta-analysis of mucolytics in patients with stable COPD.

Methods

Reports from randomized controlled trials to evaluate the efficacy and safety of mucolytics, including ambroxol, bromhexine, carbocisteine, erdosteine, fudosteine, l-methylcysteine, and N-acetylcysteine used in patients with stable COPD were searched for in PubMed, Scopus, Embase, Web of Science, the Cochrane Library, and the Igaku Cyuo Zasshi database.

Results

Twenty-three reports with ambroxol, carbocisteine, erdosteine, l-methylcysteine, or N-acetylcysteine were included in the review. Mucolytics significantly reduced the rates of exacerbation and hospitalization, shortened the duration of antibiotic use and exacerbations, prolonged the time to first exacerbation, and had a tendency to reduce the occurrence of two or more exacerbations in patients with stable COPD compared to placebo. Mucolytics did not improve mortality, number of lost workdays, scores on St. George's respiratory questionnaire, forced expiratory volume in 1 s, or forced vital capacity. The safety profile of mucolytics was comparable to that of placebo.

Conclusions

Mucolytics reduce exacerbations and hospitalizations in patients with stable COPD and have a safety profile comparable to that of placebo.

背景据报道，粘液溶解剂对慢性阻塞性肺疾病（COPD）、慢性支气管炎或慢性阻塞性肺疾病加重患者具有疗效和安全性。我们对慢性阻塞性肺疾病稳定期患者使用粘液溶解剂的情况进行了系统回顾和荟萃分析。方法在 PubMed、Scopus、Embase、Web of Science、Cochrane Library 和 Igaku Cyuo Zasshi 数据库中检索了用于评估慢性阻塞性肺病稳定期患者使用的粘液溶解剂（包括氨溴索、溴己新、卡波司坦、厄多司坦、夫多司坦、l-甲基半胱氨酸和 N-乙酰半胱氨酸）的疗效和安全性的随机对照试验报告。结果23篇关于氨溴索、卡波司汀、厄多司汀、l-甲基半胱氨酸或N-乙酰半胱氨酸的报告被纳入综述。与安慰剂相比，氨甲环酸能明显降低慢性阻塞性肺病患者的病情加重率和住院率，缩短抗生素使用时间和病情加重时间，延长首次病情加重时间，并有减少两次或两次以上病情加重的趋势。粘多糖并未改善死亡率、损失工作日数、圣乔治呼吸问卷评分、1 秒内用力呼气量或用力肺活量。结论粘液溶解剂可减少慢性阻塞性肺疾病稳定期患者的病情加重和住院次数，其安全性与安慰剂相当。

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引用次数: 0

Pulmonary fibrosis in pulmonary alveolar proteinosis evaluated by transbronchial lung cryobiopsy: A single-center retrospective study 通过经支气管肺冷冻活检评估肺泡蛋白沉着症的肺纤维化：一项单中心回顾性研究

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-10-13 DOI: 10.1016/j.resinv.2024.10.002

Kensuke Kanaoka , Toru Arai , Takayuki Takimoto , Mitsuhiro Moda , Ryota Shintani , Misaki Ryuge , Naoko Takeuchi , Tomoko Kagawa , Kazunobu Tachibana , Yoshikazu Inoue , Hiromitsu Sumikawa , Maiko Takeda , Shigeki Shimizu

Background

Approximately 20% of patients with pulmonary alveolar proteinosis (PAP) present with pulmonary fibrosis on high-resolution computed tomography (HRCT). Although transbronchial lung cryobiopsy (TBLC) has recently been used to diagnose fibrotic interstitial lung disease, no studies have investigated whether TBLC is useful for the histopathological detection of pulmonary fibrosis coexisting with PAP. Therefore, the present study aimed to investigate the utility of TBLC for evaluating pulmonary fibrosis in patients with PAP.

Methods

We retrospectively reviewed patients diagnosed with PAP who underwent TBLC at our hospital between May 2021 and March 2023. We collected data including patient background, HRCT findings, and histopathological findings of the TBLC samples.

Results

Seven patients met the inclusion criteria, with a median age was 69 years; 5 patients were male. Six patients were diagnosed with autoimmune PAP, and one was diagnosed with unclassified PAP. Periodic acid-Schiff staining-positive materials in the alveoli were observed in six out of seven patients. Pulmonary fibrosis, defined as fibrosis with architectural distortion, was found in two patients. Fibroblastic foci and airway-centered fibrosis were presented in two and one patient, respectively. As a result of a multidisciplinary discussion, we diagnosed one each with fibrotic HP coexisting with PAP and PAP-associated fibrosis.

Conclusion

Two of the seven patients with PAP presented histopathologically with pulmonary fibrosis in samples obtained through TBLC. Thus, TBLC should be considered when the coexistence of pulmonary fibrosis is suspected.

背景约 20% 的肺泡蛋白沉积症（PAP）患者在高分辨率计算机断层扫描（HRCT）中表现为肺纤维化。虽然经支气管肺冷冻活检（TBLC）最近已被用于诊断纤维化间质性肺病，但还没有研究探讨 TBLC 是否有助于组织病理学检测与肺泡蛋白沉积症并存的肺纤维化。因此，本研究旨在探讨 TBLC 在评估 PAP 患者肺纤维化方面的实用性。方法我们回顾性分析了 2021 年 5 月至 2023 年 3 月期间在我院接受 TBLC 检查并确诊为 PAP 的患者。结果7名患者符合纳入标准，中位年龄为69岁；5名患者为男性。六名患者被诊断为自身免疫性 PAP，一名患者被诊断为未分类 PAP。在七名患者中，有六名患者的肺泡中观察到周期性酸-希夫染色阳性物质。在两名患者中发现了肺纤维化，即伴有结构变形的纤维化。分别有两名和一名患者出现成纤维细胞灶和以气道为中心的纤维化。经过多学科讨论，我们诊断出与 PAP 和 PAP 相关纤维化并存的纤维化 HP 各一名。因此，当怀疑同时存在肺纤维化时，应考虑使用 TBLC。

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引用次数: 0

Therapeutic effects of an ALK inhibitor, brigatinib, on lung large cell neuroendocrine carcinoma with EML4-ALK fusion ALK抑制剂布加替尼对伴有EML4-ALK融合的肺大细胞神经内分泌癌的治疗效果

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-10-11 DOI: 10.1016/j.resinv.2024.09.013

Takayuki Suetsugu , Yutaka Masada , Tomoki Kozono , Kahoru Morita , Hajime Yonezawa , Kazuhiro Tabata , Naohiko Seki , Keiko Mizuno , Kentaro Tanaka , Hiromasa Inoue

A 64-year-old light-smoking woman was clinically diagnosed with lung large-cell neuroendocrine carcinoma (LCNEC) with a metastatic brain tumor. An Oncomine Dx Targeted Test using metastatic brain tissue revealed that the patient's lung cancer cells had an EML4-ALK rearrangement. Patients with LCNEC and anaplastic lymphoma kinase (ALK) gene rearrangements are rare, and there is currently no standard treatment. Based on the genomic analysis, we treated the patient with brigatinib, an ALK inhibitor. We describe here a patient with LCNEC who responded significantly to brigatinib without serious adverse events.

一名 64 岁的轻度吸烟妇女被临床诊断为肺大细胞神经内分泌癌 (LCNEC)，并伴有转移性脑肿瘤。使用转移性脑组织进行的 Oncomine Dx 靶向检测发现，患者的肺癌细胞存在 EML4-ALK 重排。LCNEC和无性淋巴瘤激酶（ALK）基因重排的患者非常罕见，目前还没有标准治疗方法。根据基因组分析，我们用 ALK 抑制剂布加替尼治疗该患者。我们在此描述了一位对利加替尼治疗反应明显、且无严重不良反应的 LCNEC 患者。

引用次数: 0

Reclassification of items in the Leicester Cough Questionnaire: Correlation analysis 莱斯特咳嗽问卷项目的重新分类：相关性分析

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-10-10 DOI: 10.1016/j.resinv.2024.09.017

Jieun Kang , Ji-Yong Moon , Deog Kyeom Kim , Jin Woo Kim , Seung Hun Jang , Jae-Woo Kwon , Byung-Jae Lee , Hyeon-Kyoung Koo

Background

The Leicester Cough Questionnaire (LCQ) is a validated tool for assessing cough that has three domains (physical, psychological, and social), with eight, seven, and four items, respectively. However, the assigned domain may not accurately reflect the characteristics of an item. This study aimed to reclassify the items in the Korean version of the LCQ (K-LCQ) to improve the coherence in each domain.

Methods

Data of patients with chronic cough from 16 centers who completed the K-LCQ were retrospectively analyzed. Spearman’s rank correlation analysis was used to assess the correlations between items and their domains. Principal component analysis was performed to recategorize the K-LCQ items.

Results

The correlation analysis of the data from 255 patients demonstrated that certain items such as tiredness, embarrassment, and interference with daily work or overall life enjoyment showed strong or very strong correlations with all three domains. Cough bout frequency showed the weakest correlation with the physical domain, despite being included in that domain, and had stronger correlations with the psychological and social domain. The principal component analysis led to the reclassification of six items: one from the physical to psychological, two from the social to psychological, and three from the psychological to social domain. The within-domain correlation coherence was higher in the new classification than in the original. Validation using an independent cohort of 203 patients yielded similar results.

Conclusions

The new classification of the K-LCQ items showed improved within-domain correlation coherence.

背景：莱斯特咳嗽问卷（LCQ莱斯特咳嗽问卷（LCQ）是一种经过验证的评估咳嗽的工具，它有三个领域（生理、心理和社会），分别有 8 个、7 个和 4 个项目。然而，指定的领域可能无法准确反映项目的特征。本研究旨在对韩国版 LCQ（K-LCQ）中的项目进行重新分类，以提高各领域的一致性：方法：回顾性分析了 16 个中心完成 K-LCQ 的慢性咳嗽患者数据。斯皮尔曼等级相关分析用于评估项目及其领域之间的相关性。对K-LCQ项目进行主成分分析以重新分类：对 255 名患者的数据进行的相关性分析表明，某些项目，如疲倦、尴尬、对日常工作或整体生活享受的干扰，与所有三个领域都有很强或非常强的相关性。咳嗽发作频率与生理领域的相关性最弱，尽管它也包含在生理领域中，但与心理和社会领域的相关性较强。通过主成分分析，对六个项目进行了重新分类：一个项目从生理领域归入心理领域，两个项目从社会领域归入心理领域，三个项目从心理领域归入社会领域。与原来的分类相比，新分类的域内相关一致性更高。使用独立的203名患者进行验证也得出了类似的结果：结论：K-LCQ项目的新分类显示出更高的域内相关一致性。

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引用次数: 0

Corrigendum to Baseline lung allograft dysfunction after bilateral deceased-donor lung transplantation: A single-center experience in Japan [Respir Investig 62 (2024) 838–842] 双侧已故供体肺移植术后肺异体移植基线功能障碍的更正：日本单中心经验 [Respir Investig 62 (2024) 838-842]。

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-10-09 DOI: 10.1016/j.resinv.2024.10.001

Miho Yamaguchi , Mitsuaki Kawashima , Tatsuya Muraoka , Takafumi Yamaya , Yue Cong , Keita Nakao , Masaaki Nagano , Chihiro Konoeda , Hidenori Kage , Masaaki Sato

引用次数: 0

Reassessment of the relevance between microbiological macrolide-induced resistance and diagnosis and treatment outcome of Mycobacterium abscessus-related pulmonary disease 重新评估微生物诱导的大环内酯耐药性与脓肿分枝杆菌相关肺病的诊断和治疗结果之间的相关性。

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-10-04 DOI: 10.1016/j.resinv.2024.09.012

Shiomi Yoshida , Kazunari Tsuyuguchi , Takehiko Kobayashi , Yu Kurahara , Yasuaki Shimatani , Toru Arai

Background

Treatment outcomes for Mycobacterium abscessus species–related pulmonary disease (MABS-PD) are generally poor because of inducible clarithromycin resistance (IR). The clinical management of patients with MABS with different genotypic and phenotypic susceptibility results is also not definitive. Here, we aimed to reassess the characteristics of patients with variant MABS and their association with diagnosis, treatment intervention, and sputum culture conversion.

Methods

We retrospectively analyzed 119 patients with MABS infection. Clinical characteristics and medical history were obtained via medical chart review. Isolates were tested for clarithromycin susceptibility and classified into erm(41) sequevars.

Results

In the IR, non-IR, and acquired resistance groups, the sputum culture conversion rates were 22% (5/23), 80% (40/50), and 8% (1/12), respectively. In contrast, in MAB, MAB T28, MAB C28, and M. abscessus subsp. massiliense (MAM), sputum culture conversion rates were 33% (12/36), 29% (22/31), 60% (3/5), and 70.8% (34/48), respectively. The proportion of patients with non-IR MAB T28 diagnosed and treated for MABS-PD was lower than those of patients with IR or acquired resistant T28 [35.7% (5/14), 80.7% (21/26), 100% (5/5); P < 0.05], whereas the sputum culture conversion rate was high in patients with non-IR MAB T28 [80.0%(4/5), 23.8%(5/21), 0%(0/5); P < 0.01)]. The sputum culture conversion rate in treated patients with MABS-PD with IR MAB C28 or acquired resistant MAM was low [0.0% (0/1) and 14.3% (1/7)].

Conclusions

Patients with MABS-PD and non-IR were likely to have sputum culture conversion. Our results indicated that phenotypical properties were associated with MABS-PD diagnosis and treatment.

背景：由于克拉霉素的诱导耐药性（IR），脓肿分枝杆菌相关肺病（MABS-PD）的治疗效果普遍不佳。对于基因型和表型药敏结果不同的 MABS 患者，临床治疗方法也不确定。在此，我们旨在重新评估变异型 MABS 患者的特征及其与诊断、治疗干预和痰培养转换的关系：我们对 119 例 MABS 感染患者进行了回顾性分析。方法：我们对 119 例 MABS 感染患者进行了回顾性分析，通过病历审查获得了患者的临床特征和病史。对分离菌进行克拉霉素敏感性检测，并将其分为erm(41)序列：结果：在IR、非IR和获得性耐药组中，痰培养转换率分别为22%（5/23）、80%（40/50）和8%（1/12）。相比之下，MAB、MAB T28、MAB C28 和大规模脓肿亚种（MAM）的痰培养转化率分别为 33%（12/36）、29%（22/31）、60%（3/5）和 70.8%（34/48）。因 MABS-PD 而确诊和治疗的非 IR MAB T28 患者的比例低于 IR 或获得性耐药 T28 患者[35.7%（5/14）、80.7%（21/26）、100%（5/5）；P 结论：MABS-PD和非IR患者很可能出现痰培养转换。我们的研究结果表明，表型特征与 MABS-PD 的诊断和治疗有关。

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引用次数: 0

Combined use of serum ferritin and KL-6 levels as biomarkers for predicting COVID-19 severity 联合使用血清铁蛋白和 KL-6 水平作为预测 COVID-19 严重程度的生物标志物。

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-10-03 DOI: 10.1016/j.resinv.2024.09.011

Hiromu Tanaka , Erika Toya , Shotaro Chubachi , Ho Namkoong , Takanori Asakura , Shuhei Azekawa , Shiro Otake , Kensuke Nakagawara , Takahiro Fukushima , Mayuko Watase , Kaori Sakurai , Katsunori Masaki , Hirofumi Kamata , Makoto Ishii , Naoki Hasegawa , Yukinori Okada , Ryuji Koike , Yuko Kitagawa , Akinori Kimura , Seiya Imoto , Koichi Fukunaga

Objectives

To assess the value of serum ferritin and Krebs von den Lungen-6 (KL-6) levels for predicting severe COVID-19 (death or requirement for invasive mechanical ventilation [IMV]/high-flow oxygen).

Methods

Data were analyzed on 2495 patients with COVID-19 from February 2020 to November 2022 using data from a nationwide COVID-19 database.

Results

Patients with high KL-6 and low ferritin levels were older with more comorbidities and higher mortality rates, whereas those with high ferritin and low KL-6 levels were younger, predominantly male, and more likely to need IMV. A high level of both markers was strongly associated with critical outcomes (adjusted odds ratio: 13.6, 95% confidence interval: 8.58–21.5). The combination of both markers had higher predictive value than either marker alone (area under the curve: 0.709, 0.745, and 0.781 for KL-6, ferritin, and KL-6 + ferritin, respectively).

Conclusions

The combination of both markers accurately predicted COVID-19 severity.

目的：评估血清铁蛋白和 Krebs von den Lungen-6 (KL-6)评估血清铁蛋白和Krebs von den Lungen-6 (KL-6)水平预测严重COVID-19（死亡或需要有创机械通气[IMV]/高流量供氧）的价值：利用全国COVID-19数据库中的数据，分析了2020年2月至2022年11月期间2495名COVID-19患者的数据：结果：KL-6水平高、铁蛋白水平低的患者年龄较大，合并症较多，死亡率较高；而铁蛋白水平高、KL-6水平低的患者年龄较轻，男性居多，更有可能需要IMV。两种指标的高水平与危重结果密切相关（调整后的几率比：13.6，95% 置信区间：8.58-21.5）。这两种标记物的组合比单独使用其中一种标记物具有更高的预测价值（曲线下面积：0.709，0.7% 置信区间：0.7%）：结论：KL-6、铁蛋白和 KL-6 + 铁蛋白的曲线下面积分别为 0.709、0.745 和 0.781：结论：两种标记物的组合可准确预测 COVID-19 的严重程度。

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引用次数: 0

Comparison of efficacy of gefitinib and osimertinib for untreated EGFR mutation-positive non-small-cell lung cancer in patients with poor performance status 比较吉非替尼和奥希替尼对表现状态不佳的未经治疗的表皮生长因子受体突变阳性非小细胞肺癌患者的疗效。

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-10-03 DOI: 10.1016/j.resinv.2024.09.010

Kazuhisa Nakashima , Hiroaki Kodama , Haruyasu Murakami , Toshiaki Takahashi , Keita Kawakado , Takashi Yanagawa , Kashu Kitani , Takamasa Hottta , Masaaki Abe , Kosuke Hamai , Takuya Tanimoto , Nobuhisa Ishikawa , Tomoki Tamura , Shoichi Kuyama , Takeshi Isobe , Yukari Tsubata

Background

There is a dearth of studies on the efficacy and safety of the tyrosine kinase inhibitors osimertinib (OSI) and gefitinib (GEF) in treating epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer (NSCLC), even in patients with poor performance status (PS).

Methods

We retrospectively reviewed and compared data of 113 patients with EGFR mutation-positive NSCLC with Eastern Cooperative Oncology Group PS 2–4 who were administered OSI 80 mg/day or GEF 250 mg/day from May 2016 to March 2022.

Results

The GEF group (39 patients; median age: 74 years) included 20 patients with a PS of 2, 17 with a PS of 3, and 2 with a PS of 4. The OSI group (74 patients; median age: 76 years) included 48 patients with a PS of 2, 24 with a PS of 3, and 2 with a PS of 4. The overall response rates were 69% and 66% in the GEF and OSI groups, respectively. The disease control and PS improvement rates were 89% and 51% in both groups, respectively. The median progression-free survival in the GEF and OSI groups was 6.9 and 9.2 months, respectively (p = 0.15). The OSI group experienced better overall survival than the GEF group (median: 20.9 vs. 13.0 months, p = 0.0031). The incidence of pneumonitis was 10% and 11% in the GEF and OSI groups, respectively. One treatment-related death owing to pneumonitis occurred in the GEF group.

Conclusions

OSI may be a useful treatment for untreated EGFR mutation-positive NSCLC with poor PS.

背景：关于酪氨酸激酶抑制剂osimertinib（OSI）和吉非替尼（GEF）治疗表皮生长因子受体（EGFR）突变阳性非小细胞肺癌（NSCLC）的疗效和安全性的研究很少，即使是对表现状态（PS）较差的患者也是如此：我们回顾并比较了东部合作肿瘤学组 PS 2-4 的 113 例 EGFR 突变阳性 NSCLC 患者的数据，这些患者在 2016 年 5 月至 2022 年 3 月期间接受了 OSI 80 毫克/天或 GEF 250 毫克/天的治疗：GEF组（39名患者；中位年龄：74岁）包括20名PS为2的患者、17名PS为3的患者和2名PS为4的患者；OSI组（74名患者；中位年龄：76岁）包括48名PS为2的患者、24名PS为3的患者和2名PS为4的患者。两组的疾病控制率和PS改善率分别为89%和51%。GEF组和OSI组的中位无进展生存期分别为6.9个月和9.2个月（P = 0.15）。OSI 组的总生存期优于 GEF 组（中位数：20.9 个月对 13.0 个月，p = 0.0031）。GEF组和OSI组的肺炎发生率分别为10%和11%。GEF组出现了一起因肺炎导致的治疗相关死亡病例：OSI可能是一种有效的治疗方法，适用于未经治疗且PS较差的表皮生长因子受体突变阳性NSCLC。

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引用次数: 0

Prevalence and characteristics of minimal pleural fluid on screening chest MRI 胸部磁共振成像筛查中最小胸腔积液的发生率和特征。

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation

Pub Date : 2024-10-02 DOI: 10.1016/j.resinv.2024.09.014

Kensuke Fukuda , Hirotaka Matsuzaki , Takuya Kawahara , Toshihiro Yamaguchi , Akira Saito , Nobutake Yamamichi , Hidenori Kage , Takeharu Yoshikawa

Background

Minimal pleural fluid is often seen incidentally on chest MRI. However, its prevalence and clinical characteristics remain unknown.

Methods

This retrospective observational study included 2726 participants who underwent comprehensive medical check-ups for screening, including chest CT and MRI, and transthoracic echocardiography between March 2018 and February 2019. Pleural fluid on MRI was manually measured for maximum thickness. Its distribution, change over time, and relevance to participant characteristics were analyzed. The pulmonary function data of 82 participants and their associations with fluid were also analyzed.

Results

Of the 2726 participants (mean age ± standard deviation, 59 ± 11 years), 2009 (73.7%) had minimal pleural fluid (thickness, 1–9 mm) on either side, with right-sided fluid being more frequent than left-sided fluid (P < 0.001). Negligible changes in fluid thickness were observed one year later. The following parameters were associated with less fluid: age, ≥65 years (P < 0.001); male sex (P = 0.006); current smoking (P < 0.001); body mass index, ≥25 kg/m² (P < 0.001); and mean arterial pressure, ≥100 mmHg (P = 0.01), whereas a ratio between early mitral inflow velocity and mitral annular early diastolic velocity>14 was associated with more fluid (P = 0.01). The presence of fluid was an independent explanatory variable for a higher percentage of predicted vital capacity (P = 0.048).

Conclusions

MRI was highly sensitive in detecting minimal pleural fluid. Pleural fluid found on MRI for health screening was assumed to be physiological and fluid thickness at the steady state might be variable among participants depending on age, sex, smoking habits, body shape, blood pressure, and cardiac diastolic capacity.

背景：胸部磁共振成像经常会偶然发现少量胸腔积液。然而，其发病率和临床特征仍然未知：这项回顾性观察研究纳入了 2018 年 3 月至 2019 年 2 月期间接受全面体检筛查（包括胸部 CT 和 MRI 以及经胸超声心动图）的 2726 名参与者。核磁共振成像上的胸腔积液由人工测量最大厚度。对其分布、随时间的变化以及与参与者特征的相关性进行了分析。此外，还分析了 82 名参与者的肺功能数据及其与积液的关联：在 2726 名参与者（平均年龄 ± 标准差，59 ± 11 岁）中，有 2009 人（73.7%）两侧胸腔积液极少（厚度为 1-9 毫米），右侧积液比左侧积液更常见（P 2），P 14 与更多积液相关（P = 0.01）。积液的存在是预测生命容量百分比较高的一个独立解释变量（P = 0.048）：结论：磁共振成像在检测极少量胸腔积液方面具有高度敏感性。在健康检查中通过磁共振成像发现的胸腔积液被假定为生理性胸腔积液，参与者在稳定状态下的积液厚度可能会因年龄、性别、吸烟习惯、体型、血压和心脏舒张能力的不同而不同。

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引用次数: 0