Respiratory Medicine and Research最新文献_第8页

Anti-Mi-2 positive interstitial lung disease (ILD): A progressive disease comparable to other myositis-ILD 抗mi -2阳性间质性肺病（ILD）：一种与其他肌炎相似的进行性疾病

IF 2.2 4区医学 Q3 RESPIRATORY SYSTEM

Respiratory Medicine and Research

Pub Date : 2025-05-13 DOI: 10.1016/j.resmer.2025.101176

Bess M. Flashner , Ryosuke Imai , Andrew J. Synn , Julia K. Munchel , Lida P. Hariri , Fiona K. Gibbons , Sydney B. Montesi , Barry S. Shea , Mary B. Rice , Rene S. Bermea , Robert W. Hallowell

Background

Evaluation for interstitial lung disease (ILD) often involves sending a myositis panel that includes myositis-associated and myositis-specific antibodies (MAA and MSA respectively) such as anti-Mi-2. Little is known about anti-Mi-2 positive ILD. We sought to determine the typical presentation and prognosis of anti-Mi-2 positive ILD.

Methods

We performed a retrospective chart review of patients in two ILD referral centers in Boston, MA with a positive anti-Mi-2 antibody between 2012 and 2024. Patients were identified by query of the medical record for patients with anti-Mi-2, and we included those with ILD on chest computed tomography (CT). We conducted survival analyses for ILD progression-free and overall survival using Kaplan-Meier curves and log-rank tests. Additionally, a Cox proportional-hazards model was employed, adjusting for age, gender, baseline forced vital capacity, and immunosuppressant use to calculate hazard ratios. The comparator group included patients who were followed longitudinally in the ILD clinic who were anti-Mi-2 negative but positive for other MSAs.

Results

Fifty-eight patients were identified. Half (52 %) were female with mean age 67 years (SD 13 years). The majority had dyspnea and/or cough, and a quarter of patients required oxygen upon presentation. Six (10 %) had PM/DM that pre-dated their ILD diagnosis. Other autoantibody positivity was common; one-third-of patients (n = 19, 33 %) were positive for anti-Mi-2 alone without positivity for other MSAs or MAAs. Clinical follow up data were available for 52 patients for a median follow up of 24 months (range <1 month-10 years). PFT progression was seen in 67 % and radiologic progression was seen in over a third. Half received immunosuppression (55 %), with 19 % requiring multiple immunosuppressives. During follow up, 21 % had acute exacerbation of ILD or death. Progression-free and overall survival were not significantly different among anti-Mi-2 positive ILD versus anti-Mi-2 negative, MSA positive ILD patients regardless of anti-Mi-2 positivity alone or in combination with other autoantibodies.

Conclusions

This series of 58 patients is the largest anti-Mi-2 positive ILD cohort to date. Concurrent positivity with other autoantibodies associated with ILD was common. Anti-Mi-2 positive ILD was associated with similar outcomes to those with other MSAs. Larger studies are needed to better characterize patients with Mi-2 positive ILD.

肺间质性疾病（ILD）的诊断通常包括肌炎检查，包括肌炎相关抗体和肌炎特异性抗体（分别为MAA和MSA），如抗mi -2。对抗mi -2阳性ILD知之甚少。我们试图确定抗mi -2阳性ILD的典型表现和预后。方法：我们对2012年至2024年间在马萨诸塞州波士顿的两家ILD转诊中心抗mi -2抗体阳性的患者进行回顾性图表回顾。通过查询抗mi -2患者的医疗记录来确定患者，并在胸部计算机断层扫描（CT）上纳入ILD患者。我们使用Kaplan-Meier曲线和log-rank检验对ILD无进展和总生存率进行了生存分析。此外，采用Cox比例风险模型，调整年龄、性别、基线强制肺活量和免疫抑制剂使用来计算风险比。比较组包括在ILD诊所纵向随访的抗mi -2阴性但其他msa阳性的患者。结果共鉴定出58例患者。一半（52%）为女性，平均年龄67岁（SD 13岁）。大多数患者有呼吸困难和/或咳嗽，四分之一的患者在就诊时需要吸氧。6例（10%）在ILD诊断之前患有PM/DM。其他自身抗体阳性较为常见；三分之一的患者（n = 19, 33%）单抗mi -2阳性，而其他msa或MAAs阳性。52例患者的临床随访数据为中位随访24个月（范围1个月-10年）。67%的患者出现PFT进展，超过三分之一的患者出现放射学进展。一半接受免疫抑制（55%），19%需要多种免疫抑制剂。在随访期间，21%的患者出现ILD急性加重或死亡。抗mi -2阳性ILD患者的无进展期和总生存率与抗mi -2阴性、MSA阳性ILD患者的无进展期和总生存率无显著差异，无论单独抗mi -2阳性还是联合其他自身抗体。该58例患者是迄今为止最大的抗mi -2阳性ILD队列。与ILD相关的其他自身抗体同时呈阳性是常见的。抗- mi -2阳性ILD与其他msa相关的结果相似。需要更大规模的研究来更好地描述Mi-2阳性ILD患者。

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引用次数: 0

Outcomes of cannabis smoking in patients with lung cancer: findings from KBP-CPHG-2020 肺癌患者吸食大麻的结果：来自KBP-CPHG-2020的研究结果

IF 2.2 4区医学 Q3 RESPIRATORY SYSTEM

Respiratory Medicine and Research

Pub Date : 2025-05-08 DOI: 10.1016/j.resmer.2025.101174

Sébastien Couraud , Olivier Molinier , Marielle Sabatini , Séverine Thomassin , Rym Haouachi , Virginie Levrat , Hannah Ghalloussi-Tebai , Antoine Belle , Laurent Mosser , Sébastien Larive , Alexandra Bedossa , Alexia Letierce , Hugues Morel , Didier Debieuvre , Study Group KBP-2020-CPHG

Introduction

Cannabis smoking is suspected to be a risk factor for lung cancer. The KBP-2020-CPHG study is a prospective study that collected data from all patients with newly diagnosed lung cancer in non-academic hospitals in France in 2020.

Method

We conducted comparative and matched cohort analyses using the dataset, in which cannabis smokers (i.e. participants who self-declared a lifetime intake of ≥20 joints) were compared with tobacco-only smokers. After matching on confounders, we compared age at diagnosis and overall survival.

Results

Among 8999 patients, 314 (3.6%) were cannabis smokers and 7372 were tobacco-only smokers (data missing for 183). Cannabis smokers were younger than tobacco-only smokers at lung cancer diagnosis (mean [± standard deviation] 52.9 [±8.84] versus 67.7 [±9.51] years; p<0.0001), and this difference remained in the paired analysis (matched for histology, sex and cigarette pack-years [±5 pack-years]; n = 298 pairs; median age at diagnosis 53.1 vs 64.8 years; hazard ratio 5.61, 95% CI 4.10–7.68; p<0.0001). Histological type was also different between the two groups, with more cases of adenocarcinoma and large cell neuroendocrine carcinoma among cannabis smokers. Finally, a 1:1 matched analysis controlled for age, sex, stage, histology and cigarette pack-years showed that overall survival was not affected by cannabis smoking (HR 0.90, 95% CI 0.68–1.18; p = 0.44).

Conclusion

We provide a detailed description of lung cancer characteristics among cannabis smokers compared with tobacco-only smokers. Cannabis smoking appeared to be associated with lung cancer diagnosis at an earlier age and was not a prognostic factor for mortality.

吸食大麻被怀疑是肺癌的一个危险因素。KBP-2020-CPHG研究是一项前瞻性研究，收集了2020年法国非学术医院所有新诊断肺癌患者的数据。方法我们使用数据集进行了比较和匹配队列分析，其中大麻吸烟者（即自称终身吸烟≥20支的参与者）与仅吸烟的吸烟者进行了比较。在对混杂因素进行匹配后，我们比较了诊断时的年龄和总生存率。结果8999例患者中，314例（3.6%）为大麻吸烟者，7372例为纯烟草吸烟者（183例数据缺失）。在肺癌诊断时，吸食大麻者比只吸食烟草者年轻(平均[±标准差]52.9[±8.84]比67.7[±9.51]岁；P<0.0001)，这一差异在配对分析中仍然存在(匹配组织学、性别和卷烟包年[±5包年]；N = 298对；诊断时中位年龄53.1 vs 64.8岁；风险比5.61,95% CI 4.10-7.68；术中,0.0001)。两组之间的组织学类型也不同，吸食大麻者中腺癌和大细胞神经内分泌癌的病例较多。最后，一项控制年龄、性别、分期、组织学和卷烟包年的1:1匹配分析显示，吸食大麻不影响总体生存(HR 0.90, 95% CI 0.68-1.18；P = 0.44)。结论：我们提供了大麻吸烟者与纯烟草吸烟者肺癌特征的详细描述。吸食大麻似乎与早期肺癌诊断有关，而不是死亡率的预后因素。

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引用次数: 0

Epidemiology of interstitial lung diseases in a native Afro-Caribbean population of French West Indies 法属西印度群岛土著非裔加勒比人间质性肺病流行病学研究

IF 2.2 4区医学 Q3 RESPIRATORY SYSTEM

Respiratory Medicine and Research

Pub Date : 2025-05-08 DOI: 10.1016/j.resmer.2025.101175

Sylvain Neveu , Milène Chaptal , Elodie Rossigneux , Hilario Nunes , Chantal Raherison-Semjen

Introduction

Data about interstitial lung diseases (ILDs) epidemiology in the Afro-Caribbean population is lacking. Differences in incidence and prevalence compared to European populations have already been reported. The main objective of this study was to estimate ILD incidence in Guadeloupe overall and by etiology. The secondary objective was to determine the clinical, demographic, and environmental characteristics of patients with ILD.

Materials and methods

We conducted a descriptive epidemiological study to estimate the incidence and prevalence of ILD in Guadeloupe between 2013 and 2019 and assess its etiological distribution.

Results

A total of 235 ILD cases in Guadeloupe were included. The incidence of ILD was 6.87 cases per 100,000 population per year, and the prevalence was 32.22 cases per 100,000 population. ILDs associated with connective tissue diseases accounted for 34 % of cases, with an incidence of 2.12 per 100,000 population. Sarcoidosis represented 31 % of cases, with an incidence of 1.72 per 100,000 population. Idiopathic ILDs made up 21 % of cases, with an incidence of 1.72 per 100,000 population. In this cohort, 25 % of patients were smokers, and 29 % of those with idiopathic pulmonary fibrosis (IPF) were farmers or agricultural workers.

Conclusion

We report the first study on ILD epidemiology in a native Afro-Caribbean population. Incidence and prevalence figures are lower than those previously reported in European populations. The main etiologies were connective tissue diseases, sarcoidosis, and idiopathic ILD.

关于非裔加勒比人口间质性肺病（ILDs）流行病学的数据缺乏。与欧洲人群相比，发病率和流行率的差异已经有报道。本研究的主要目的是估计瓜德罗普岛ILD的总体发病率和病因。次要目的是确定ILD患者的临床、人口学和环境特征。材料和方法我们进行了一项描述性流行病学研究，估计2013年至2019年瓜德罗普岛ILD的发病率和患病率，并评估其病因分布。结果在瓜德罗普岛共纳入235例ILD病例。每年ILD的发病率为6.87例/ 10万人，患病率为32.22例/ 10万人。与结缔组织疾病相关的ild占病例的34%，发病率为每10万人2.12例。结节病占31%的病例，发病率为每10万人1.72例。特发性ild占21%，发病率为每10万人1.72例。在这个队列中，25%的患者是吸烟者，29%的特发性肺纤维化（IPF）患者是农民或农业工人。结论本研究首次报道了加勒比非洲土著人群的ILD流行病学研究。发病率和流行率低于以前报道的欧洲人群。主要病因为结缔组织病、结节病和特发性ILD。

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引用次数: 0

Severe respiratory syncytial virus infection in older adults – burden, clinical outcomes and implications for care 老年人严重呼吸道合胞病毒感染——负担、临床结局和护理意义

IF 2.2 4区医学 Q3 RESPIRATORY SYSTEM

Respiratory Medicine and Research

Pub Date : 2025-05-06 DOI: 10.1016/j.resmer.2025.101173

Daniel Guimarães de Oliveira , Ana Grande , Francisco Belchior , Rafaela Costa , Rita Francisco , Natália Oliveira , Maria Calle

Background

Respiratory syncytial virus (RSV) infection in adults remains under-researched. Increased testing is revealing an emerging picture of severe outcomes within the most prevalent lower respiratory tract infections. Understanding risk factors is increasingly important, especially in light of the recent approval of prophylactic vaccination.

Methods

Retrospective evaluation of all real-time polymerase chain reaction-positive RSV cases detected at our institution over three consecutive infection seasons from 2021 to 2024 in adults aged 60 years and older. Subsequent assessment of patients with severe infection requiring hospitalization.

Results

A total of 574 individuals were included, 57 % of whom were female, with a median age of 81,1 years (IQR 74–87 years). The peak number of cases occurred between September and March. We found a hospitalization rate of 51,2 % (representing an incidence of 1 case per 758 inhabitants per year in the elderly population of our region) and an in-hospital mortality rate of 15,6 % (19,1 % if transferred patients are excluded) among older adults with PCR-confirmed RSV infection. Heart failure (p ≤ 0.001), asthma (p = 0005), chronic kidney disease (p = 0006), chronic obstructive pulmonary disease (p = 0,02) and active smoking (p = 0.01) were risk factors for hospitalization. Older age (p = 0.003), residing in long-term care facility (p = 0.003), active cancer (p = 0,01), lower lymphocytes (p ≤ 0,001) and higher creatinine (p = 0,01) were significantly associated with mortality.

Conclusions

This is the first review of health outcomes related to RSV infection in the elderly from a Portuguese hospital. It identifies a high burden of hospitalization and in-hospital mortality in the elderly population. Our findings highlight the need for increased awareness of RSV infection in adults, particularly older adults, and underscore the importance of targeted interventions, such as vaccination programs, to reduce the burden of this disease in vulnerable populations in Portugal.

成人呼吸道合胞病毒（RSV）感染的研究尚不充分。越来越多的检测正在揭示最普遍的下呼吸道感染中出现严重后果的新情况。了解危险因素变得越来越重要，特别是考虑到最近批准预防性疫苗接种。方法回顾性评价我院从2021年至2024年连续三个感染季节检测到的所有实时聚合酶链反应阳性的60岁及以上成人RSV病例。对需要住院治疗的严重感染患者的后续评估。结果共纳入574例，其中女性占57%，中位年龄81.1岁（IQR 74 ~ 87岁）。病例高峰发生在9月至3月。我们发现，在pcr确诊的RSV感染的老年人中，住院率为51.2%（代表我们地区老年人口每年每758名居民中有1例的发病率），住院死亡率为15.6%（如果排除转院患者，则为19.1%）。心衰（p≤0.001）、哮喘（p = 0005）、慢性肾脏疾病（p = 0006）、慢性阻塞性肺疾病（p = 0.02）和主动吸烟（p = 0.01）是住院的危险因素。年龄较大（p = 0.003）、居住在长期护理机构（p = 0.003）、活动性癌症（p = 0.01）、淋巴细胞降低（p≤0.001）和肌酐升高（p = 0.01）与死亡率显著相关。结论：这是对葡萄牙医院老年人RSV感染相关健康结果的首次回顾。它确定了老年人口住院和住院死亡率的高负担。我们的研究结果强调需要提高成年人，特别是老年人对呼吸道合胞病毒感染的认识，并强调有针对性的干预措施的重要性，例如疫苗接种计划，以减轻葡萄牙脆弱人群对这种疾病的负担。

{"title":"Severe respiratory syncytial virus infection in older adults – burden, clinical outcomes and implications for care","authors":"Daniel Guimarães de Oliveira , Ana Grande , Francisco Belchior , Rafaela Costa , Rita Francisco , Natália Oliveira , Maria Calle","doi":"10.1016/j.resmer.2025.101173","DOIUrl":"10.1016/j.resmer.2025.101173","url":null,"abstract":"<div><h3>Background</h3><div>Respiratory syncytial virus (RSV) infection in adults remains under-researched. Increased testing is revealing an emerging picture of severe outcomes within the most prevalent lower respiratory tract infections. Understanding risk factors is increasingly important, especially in light of the recent approval of prophylactic vaccination.</div></div><div><h3>Methods</h3><div>Retrospective evaluation of all real-time polymerase chain reaction-positive RSV cases detected at our institution over three consecutive infection seasons from 2021 to 2024 in adults aged 60 years and older. Subsequent assessment of patients with severe infection requiring hospitalization.</div></div><div><h3>Results</h3><div>A total of 574 individuals were included, 57 % of whom were female, with a median age of 81,1 years (IQR 74–87 years). The peak number of cases occurred between September and March. We found a hospitalization rate of 51,2 % (representing an incidence of 1 case per 758 inhabitants per year in the elderly population of our region) and an in-hospital mortality rate of 15,6 % (19,1 % if transferred patients are excluded) among older adults with PCR-confirmed RSV infection. Heart failure (<em>p</em> ≤ 0.001), asthma (<em>p</em> = 0005), chronic kidney disease (<em>p</em> = 0006), chronic obstructive pulmonary disease (<em>p</em> = 0,02) and active smoking (<em>p</em> = 0.01) were risk factors for hospitalization. Older age (<em>p</em> = 0.003), residing in long-term care facility (<em>p</em> = 0.003), active cancer (<em>p</em> = 0,01), lower lymphocytes (<em>p</em> ≤ 0,001) and higher creatinine (<em>p</em> = 0,01) were significantly associated with mortality.</div></div><div><h3>Conclusions</h3><div>This is the first review of health outcomes related to RSV infection in the elderly from a Portuguese hospital. It identifies a high burden of hospitalization and in-hospital mortality in the elderly population. Our findings highlight the need for increased awareness of RSV infection in adults, particularly older adults, and underscore the importance of targeted interventions, such as vaccination programs, to reduce the burden of this disease in vulnerable populations in Portugal.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"88 ","pages":"Article 101173"},"PeriodicalIF":2.2,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The evolution of management in chronic thromboembolic pulmonary hypertension in a non-surgical / balloon pulmonary angioplasty center 慢性血栓栓塞性肺动脉高压在非手术/球囊肺动脉成形术中心的治疗进展

IF 2.2 4区医学 Q3 RESPIRATORY SYSTEM

Respiratory Medicine and Research

Pub Date : 2025-05-01 DOI: 10.1016/j.resmer.2023.101043

Mitja Jevnikar, David Montani, Elie Fadel, Xavier Jais

引用次数: 0

Impact of inhaled corticosteroids on metabolic dysfunction-associated steatotic liver disease risk in COPD patients 吸入皮质类固醇对COPD患者代谢功能障碍相关脂肪变性肝病风险的影响

IF 2.2 4区医学 Q3 RESPIRATORY SYSTEM

Respiratory Medicine and Research

Pub Date : 2025-05-01 DOI: 10.1016/j.resmer.2025.101171

Jiyu Sun , Hyo Jin Lee , Jung-Kyu Lee , Tae Yeon Park , Eun Young Heo , Deog Kyeom Kim , Hyun Woo Lee

Background

The systemic impact of long-term use of inhaled corticosteroid (ICS) on the liver remains poorly understood in patients with chronic obstructive pulmonary disease (COPD). Our study aimed to identify whether long-term ICS therapy impacts the risk of Metabolic dysfunction-associated steatotic liver disease (MASLD) in patients with COPD.

Methods

A retrospective cohort study was conducted using claims records from a large population-based database. We included COPD patients ≥40 years old who had no previous history of chronic liver disease. Patients were divided into two groups based on their ICS use. The primary outcome was the development of MASLD. Additionally, subgroup analyses were conducted according to the duration of ICS exposure and the various components of ICS.

Results

A total of 442,880 COPD patients were included in the study, with 95,695 in ICS group and 347,185 in non-ICS group. The incidence rate of MASLD was higher in the ICS group compared to the non-ICS group (859.3 vs. 440.4 per 100,000 person-years). After adjusting for potential confounding factors, ICS use was associated with a significantly increased risk of MASLD (hazard ratio [HR]=1.630, 95 % confidence interval [CI]=1.560–1.704). Fluticasone furoate showed a higher risk of MASLD compared to other ICS components, and a longer duration of ICS exposure was associated with an increased MASLD risk.

Conclusions

In COPD patients, long-term use of ICS may be associated with an increased risk of developing MASLD. Further studies are needed to explore strategies to mitigate the potential risk of MASLD in COPD patients requiring ICS therapy.

长期使用吸入性皮质类固醇（ICS）对慢性阻塞性肺疾病（COPD）患者肝脏的全身性影响尚不清楚。我们的研究旨在确定长期ICS治疗是否会影响COPD患者代谢功能障碍相关脂肪变性肝病（MASLD）的风险。方法回顾性队列研究采用基于人口的大型数据库中的索赔记录。我们纳入了年龄≥40岁且无慢性肝病病史的COPD患者。根据ICS的使用情况将患者分为两组。主要成果是MASLD的发展。此外，根据ICS暴露的持续时间和ICS的各种成分进行亚组分析。结果共纳入442,880例COPD患者，其中ICS组95,695例，非ICS组347,185例。与非ICS组相比，ICS组MASLD的发病率更高（859.3 vs 440.4 / 100000人年）。在调整了潜在的混杂因素后，ICS的使用与MASLD的风险显著增加相关（风险比[HR]=1.630, 95%可信区间[CI]= 1.560-1.704）。与其他ICS成分相比，糠酸氟替卡松显示出更高的MASLD风险，并且更长的ICS暴露时间与MASLD风险增加相关。结论慢性阻塞性肺病患者长期使用ICS可能与发生MASLD的风险增加有关。需要进一步的研究来探索降低需要ICS治疗的COPD患者发生MASLD的潜在风险的策略。

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引用次数: 0

Update of guidelines for management of Community Acquired pneumonia in adults by the French Infectious Disease Society (SPILF) and the French-Speaking Society of Respiratory Diseases (SPLF) 法国传染病学会（SPILF）和法语呼吸疾病学会（SPLF）更新成人社区获得性肺炎管理指南：得到法国重症监护学会（SRLF）、法国微生物学会（SFM）、法国放射学学会（SFR）和法国急救学会（SFMU）的认可。

IF 2.2 4区医学 Q3 RESPIRATORY SYSTEM

Respiratory Medicine and Research

Pub Date : 2025-05-01 DOI: 10.1016/j.resmer.2025.101161

Aurélien Dinh , François Barbier , Jean-Pierre Bedos , Mathieu Blot , Vincent Cattoir , Yann-Erick Claessens , Xavier Duval , Pierre Fillâtre , Maxime Gautier , Yann Guegan , Sophie Jarraud , Alban Le Monnier , David Lebeaux , Paul Loubet , Constance de Margerie , Philippe Serayet , Yacine Tandjaoui-Lambotte , Emmanuelle Varon , Yves Welker , Damien Basille

Community-Acquired Pneumonia (CAP) of Presumed Bacterial Origin: Updated Management Guidelines

Community-acquired pneumonia (CAP) of presumed bacterial origin is a common condition with varying severity, requiring either outpatient, hospital, or even critical care management.

The French Infectious Diseases Society (SPILF) and the French Language Pulmonology Society (SPLF), in collaboration with the French Societies of Microbiology (SFM), Emergency Medicine (SFMU), Radiology (SFR), and Intensive Care Medicine (SRLF), along with representatives of general practice, have coordinated an update of the previous management guidelines, which dated back to 2010.

From a therapeutic perspective, the updated recommendations define the choice of initial empiric antibiotic therapy, indications for combination therapy, the use of anti-Pseudomonas beta-lactams, antibiotic treatment duration, and the indications and modalities for prescribing systemic corticosteroids.

On a biological level, indications for biomarkers and microbiological investigations have been refined. Regarding imaging, the role of different modalities in the diagnosis and follow-up of CAP has been reassessed, including chest X-ray, pleuropulmonary ultrasound, and thoracic CT scan

假定细菌来源的社区获得性肺炎（CAP）：更新的管理指南假定细菌来源的社区获得性肺炎（CAP）是一种不同严重程度的常见疾病，需要门诊、医院甚至重症监护管理。法国传染病学会（SPILF）和法语肺脏学学会（SPLF）与法国微生物学会（SFM）、急诊医学学会（SFMU）、放射学学会（SFR）和重症监护医学学会（SRLF）以及全科医生代表合作，协调更新了可追溯到2010年的以前的管理指南。从治疗的角度来看，更新的建议确定了初始经验性抗生素治疗的选择、联合治疗的适应症、抗假单胞菌β -内酰胺类药物的使用、抗生素治疗的持续时间以及开具全身皮质类固醇的适应症和方式。在生物学水平上，生物标志物和微生物学研究的适应症已经得到完善。影像学方面，重新评估了不同方式在CAP诊断和随访中的作用，包括胸部x线、胸膜肺超声和胸部CT扫描。

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引用次数: 0

Pulmonary Arterial Hypertension-approved drugs in Pulmonary Hypertension associated with COPD: A systematic literature review 经批准的肺动脉高压药物治疗COPD相关肺动脉高压：系统文献综述

IF 2.2 4区医学 Q3 RESPIRATORY SYSTEM

Respiratory Medicine and Research

Pub Date : 2025-05-01 DOI: 10.1016/j.resmer.2025.101165

Beatrice Le Bon Chami , Fida Charif , Claude Semaan , Vanessa Bironneau , Elisa Larrieu-Ardilouze , Magali Croquette , Xavier Jaïs , Lucilla Piccari , David Montani , Etienne-Marie Jutant

Introduction

Pulmonary hypertension (PH) is commonly associated with chronic obstructive pulmonary disease (COPD), with an estimated prevalence of 39%. PH reduces functional capacity and exercise tolerance, and increases the risk of COPD exacerbations and hospitalizations. PH associated with COPD (PH–COPD) typically manifests with moderate severity, progressing gradually in tandem with the level of bronchial obstruction. However, a specific subgroup with severe PH displays disproportionately high pulmonary vascular resistance, reduced diffusion capacity, and a severe prognosis.

Methods

This article is a systematic literature review of clinical trials including randomized controlled trials (RCTs), non-RCTs, cohort studies and registry data regarding PAH-approved drugs, in the context of PH–COPD, from January 2003 to January 2025.

Results

There have been three positive and three negative RCTs with phosphodiesterase-5 inhibitors, as well as one positive and one negative RCT with endothelin receptor antagonists. These RCTs suffered from limitations especially in severe PH cases. Additional data came from 16 studies, including non-RCTs, cohort studies and registry data, and the results were conflicting. The most robust study, a large phase 3 RCT using inhaled treprostinil, was terminated early due to an unfavorable benefit-risk ratio.

Conclusion

The evidence does not support PAH-approved drugs for mild-to-moderate PH–COPD, though potential benefits may exist for the severe PH subgroup. Large, multicenter RCTs are necessary to provide robust medical evidence and phase 2 and phase 3 clinical trials are ongoing. In the interim, suspected or confirmed severe PH–COPD should prompt referral to PH centers for personalized care and potential clinical trial participation.

肺动脉高压（PH）通常与慢性阻塞性肺疾病（COPD）相关，估计患病率为39%。PH降低了功能能力和运动耐受性，增加了COPD恶化和住院的风险。PH与COPD相关（PH - COPD）通常表现为中度严重程度，随支气管阻塞程度逐渐进展。然而，严重PH的特定亚组表现出不成比例的高肺血管阻力，扩散能力降低和严重预后。方法：本文对2003年1月至2025年1月在PH-COPD背景下的pah批准药物的临床试验进行了系统的文献综述，包括随机对照试验（rct）、非rct、队列研究和注册数据。结果磷酸二酯酶-5抑制剂组有3个阳性RCT和3个阴性RCT，内皮素受体拮抗剂组有1个阳性RCT和1个阴性RCT。这些随机对照试验存在局限性，特别是在严重的PH病例中。其他数据来自16项研究，包括非随机对照试验、队列研究和登记数据，结果相互矛盾。最有力的研究是一项使用吸入曲前列替尼的大型3期随机对照试验，由于不利的获益-风险比而提前终止。结论：证据不支持pah批准的药物治疗轻至中度PH - copd，尽管对重度PH亚组可能存在潜在的益处。为了提供强有力的医学证据，需要大型多中心随机对照试验，目前正在进行2期和3期临床试验。在此期间，疑似或确诊的严重PH - copd应及时转诊到PH中心进行个性化护理和潜在的临床试验参与。

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引用次数: 0

Progressive course of anti-nuclear matrix protein-2 (NXP-2) positive-interstitial lung disease 抗核基质蛋白-2 （NXP-2）阳性间质性肺疾病的进展过程

IF 2.2 4区医学 Q3 RESPIRATORY SYSTEM

Respiratory Medicine and Research

Pub Date : 2025-04-01 DOI: 10.1016/j.resmer.2025.101170

Bess M. Flashner , Ryosuke Imai , Andrew J. Synn , Julia K. Munchel , Lida P. Hariri , Fiona K. Gibbons , Sydney B. Montesi , Barry S. Shea , Mary B. Rice , Rene S. Bermea , Robert W. Hallowell

Background

Evaluating the etiology of interstitial lung disease (ILD) commonly involves ordering a myositis panel containing myositis-specific antibodies (MSAs), including anti-NXP-2. However, little is known about the presentation of patients with ILD and anti-NXP-2 positivity. We sought to define the course of anti-NXP-2-positive ILD in order to guide prognosis and potential treatment strategies.

Methods

We performed a retrospective chart review of patients with positive anti-NXP-2 antibodies who presented to two ILD referral centers in Boston, MA between 2012 and 2024. Patients were identified by query of the electronic medical record for patients positive for anti-NXP-2. We included those anti-NXP-2 positive patients with ILD on chest computed tomography (CT). Data regarding clinical presentation and disease course were abstracted from the medical record. For patients following longitudinally in the ILD clinic, we conducted survival analyses for ILD progression (composite of PFT progression, hospitalization, or death) using Kaplan-Meier curves and log-rank tests. Additionally, we used a Cox proportional-hazards model, adjusting for age, gender, forced vital capacity (FVC) at baseline, and immunosuppression to calculate hazard ratios. ILD patients with MSA-positive, NXP-2-negative ILD served as the comparator group.

Results

31 patients were identified (mean 70 years, SD 9). Three were diagnosed with dermatomyositis (DM) prior to presentation, but the remaining had ILD as the only manifestation of connective tissue disease. Most (97%) patients were symptomatic with dyspnea and/or cough at presentation. Other autoantibody positivity was common; only 42% were positive for anti-NXP-2 alone without positivity for other autoimmune serologies, including MSAs known to be associated with ILD. Clinical follow up data were available for 28 patients for a median follow up period of 24 months (range <1 month-13 years). A majority (61%) were treated with immunosuppression, antifibrotics, or both. Over one third experienced acute exacerbation of ILD or death (N = 11, 35%). Progression-free survival was similar to that of other MSA-positive ILD patients, regardless of whether anti-NXP-2 was positive alone or co-positive for other autoantibodies.

Conclusions

We present the largest single series of anti-NXP-2-positive ILD. Anti-NXP-2-positive ILD can occur in the absence of DM/PM and can manifest as progressive pulmonary disease that is similar to other MSA-positive ILDs.

背景：评估间质性肺疾病（ILD）的病因通常需要进行肌炎检查，检查中含有肌炎特异性抗体（msa），包括抗恩智浦-2。然而，对于ILD和抗恩智浦-2阳性患者的表现知之甚少。我们试图确定抗nxp -2阳性ILD的病程，以指导预后和潜在的治疗策略。方法：我们对2012年至2024年间在马萨诸塞州波士顿的两个ILD转诊中心就诊的抗nxp -2抗体阳性患者进行了回顾性调查。通过查询抗恩智浦-2阳性患者的电子病历来确定患者。我们纳入了在胸部计算机断层扫描（CT）上显示抗nxp -2阳性的ILD患者。从病历中提取有关临床表现和病程的资料。对于在ILD诊所纵向随访的患者，我们使用Kaplan-Meier曲线和log-rank检验对ILD进展（PFT进展、住院或死亡的组合）进行了生存分析。此外，我们使用了Cox比例风险模型，调整了年龄、性别、基线时的强迫肺活量（FVC）和免疫抑制来计算风险比。以msa阳性、nxp -2阴性的ILD患者为对照组。结果31例患者（平均70岁，SD 9），其中3例在发病前被诊断为皮肌炎（DM），其余为ILD，为结缔组织病的唯一表现。大多数（97%）患者就诊时伴有呼吸困难和/或咳嗽。其他自身抗体阳性较为常见；只有42%的患者单独抗nxp -2阳性，而其他自身免疫性血清学无阳性，包括已知与ILD相关的msa。28例患者的临床随访数据中位随访期为24个月（范围1个月-13年）。大多数（61%）患者接受免疫抑制、抗纤维化药物治疗，或两者兼有。超过三分之一的ILD急性加重或死亡（N = 11,35%）。无进展生存期与其他msa阳性ILD患者相似，无论抗nxp -2是单独阳性还是与其他自身抗体共同阳性。结论：我们提出了最大的抗nxp -2阳性ILD系列。抗nxp -2阳性ILD可在没有DM/PM的情况下发生，并可表现为与其他msa阳性ILD相似的进行性肺部疾病。

{"title":"Progressive course of anti-nuclear matrix protein-2 (NXP-2) positive-interstitial lung disease","authors":"Bess M. Flashner , Ryosuke Imai , Andrew J. Synn , Julia K. Munchel , Lida P. Hariri , Fiona K. Gibbons , Sydney B. Montesi , Barry S. Shea , Mary B. Rice , Rene S. Bermea , Robert W. Hallowell","doi":"10.1016/j.resmer.2025.101170","DOIUrl":"10.1016/j.resmer.2025.101170","url":null,"abstract":"<div><h3>Background</h3><div>Evaluating the etiology of interstitial lung disease (ILD) commonly involves ordering a myositis panel containing myositis-specific antibodies (MSAs), including anti-NXP-2. However, little is known about the presentation of patients with ILD and anti-NXP-2 positivity. We sought to define the course of anti-NXP-2-positive ILD in order to guide prognosis and potential treatment strategies.</div></div><div><h3>Methods</h3><div>We performed a retrospective chart review of patients with positive anti-NXP-2 antibodies who presented to two ILD referral centers in Boston, MA between 2012 and 2024. Patients were identified by query of the electronic medical record for patients positive for anti-NXP-2. We included those anti-NXP-2 positive patients with ILD on chest computed tomography (CT). Data regarding clinical presentation and disease course were abstracted from the medical record. For patients following longitudinally in the ILD clinic, we conducted survival analyses for ILD progression (composite of PFT progression, hospitalization, or death) using Kaplan-Meier curves and log-rank tests. Additionally, we used a Cox proportional-hazards model, adjusting for age, gender, forced vital capacity (FVC) at baseline, and immunosuppression to calculate hazard ratios. ILD patients with MSA-positive, NXP-2-negative ILD served as the comparator group.</div></div><div><h3>Results</h3><div>31 patients were identified (mean 70 years, SD 9). Three were diagnosed with dermatomyositis (DM) prior to presentation, but the remaining had ILD as the only manifestation of connective tissue disease. Most (97%) patients were symptomatic with dyspnea and/or cough at presentation. Other autoantibody positivity was common; only 42% were positive for anti-NXP-2 alone without positivity for other autoimmune serologies, including MSAs known to be associated with ILD. Clinical follow up data were available for 28 patients for a median follow up period of 24 months (range <1 month-13 years). A majority (61%) were treated with immunosuppression, antifibrotics, or both. Over one third experienced acute exacerbation of ILD or death (<em>N</em> = 11, 35%). Progression-free survival was similar to that of other MSA-positive ILD patients, regardless of whether anti-NXP-2 was positive alone or co-positive for other autoantibodies.</div></div><div><h3>Conclusions</h3><div>We present the largest single series of anti-NXP-2-positive ILD. Anti-NXP-2-positive ILD can occur in the absence of DM/PM and can manifest as progressive pulmonary disease that is similar to other MSA-positive ILDs.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101170"},"PeriodicalIF":2.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143839011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Management of non-small cell lung cancer after 2 years of immunotherapy 非小细胞肺癌免疫治疗2年后的处理

IF 2.2 4区医学 Q3 RESPIRATORY SYSTEM

Respiratory Medicine and Research

Pub Date : 2025-03-25 DOI: 10.1016/j.resmer.2025.101169

Cédric Mahiat , Jacques Cadranel , Constance Méteyé , Samy Houari , Lise Rosencher , Christelle Epaud , Jérémy Slomka , Vincent Fallet , Anthony Canellas

Background

The optimal management strategy for metastatic or advanced-stage non-small-cell lung cancer (NSCLC) after 2 years of immune checkpoint inhibitor (ICI) remains unclear.

Methods

We conducted a single-center retrospective observational study to characterize the management of patients who received at least 2 years of ICI in the first-line setting for a metastatic or advanced-stage NSCLC.

Results

Among the 254 patients that received ICI in the first-line setting, 39 (15%) achieved 2 years of treatment (ICI in monotherapy, n = 14; ICI with chemotherapy, n = 25). ICI was discontinued after 2 years (<30 months) in 31 (79%) of the cases. During the first 2 years, 29 patients (74%) had no disease progression (2 complete radiological responses, 25 partial radiological responses, and 2 stable diseases) and 10 patients (26%) experienced at least one oligo-progression, which was treated with local ablative treatment (LAT), allowing continuation of ICI up to 2 years. A positron emission tomography (PET) scan was performed at 2 years for 37 patients (95%), revealing a complete metabolic response (CMR) in 16 individuals (43%). None of these patients progressed subsequently (median follow-up: 13 months). After 2 years of ICI, the 12-month progression-free survival was 100% in case of CMR versus 49% (95% CI, 29–91) in the absence of CMR (p = 0.00037).

Conclusions

A CMR at 2 years of ICI is associated with a favorable prognosis. Further studies are needed to better establish the role of PET scan at 2 years, the relevance of LAT and the optimal duration of ICI.

背景：在使用免疫检查点抑制剂（ICI）治疗2年后，转移性或晚期非小细胞肺癌（NSCLC）的最佳治疗策略尚不清楚。方法：我们进行了一项单中心回顾性观察性研究，以描述在一线接受至少2年ICI治疗的转移性或晚期NSCLC患者的管理情况。结果254例在一线接受ICI治疗的患者中，39例（15%）达到了2年的治疗(单药治疗的ICI， n = 14；ICI合并化疗，n = 25)。31例（79%）患者在2年（30个月）后停止使用ICI。在最初的2年中，29名患者（74%）没有疾病进展（2名完全放射反应，25名部分放射反应，2名疾病稳定），10名患者（26%）经历了至少一次低进展，这些患者接受了局部消融治疗（LAT），允许持续ICI长达2年。37名患者（95%）在2年后进行了正电子发射断层扫描（PET）扫描，显示16名患者（43%）有完全代谢反应（CMR）。这些患者随后均无进展（中位随访：13个月）。ICI治疗2年后，有CMR的患者12个月无进展生存率为100%，无CMR的患者为49% (95% CI, 29-91) （p = 0.00037）。结论ICI 2年CMR与良好的预后相关。需要进一步的研究来更好地确定2岁时PET扫描的作用、LAT的相关性和ICI的最佳持续时间。

{"title":"Management of non-small cell lung cancer after 2 years of immunotherapy","authors":"Cédric Mahiat , Jacques Cadranel , Constance Méteyé , Samy Houari , Lise Rosencher , Christelle Epaud , Jérémy Slomka , Vincent Fallet , Anthony Canellas","doi":"10.1016/j.resmer.2025.101169","DOIUrl":"10.1016/j.resmer.2025.101169","url":null,"abstract":"<div><h3>Background</h3><div>The optimal management strategy for metastatic or advanced-stage non-small-cell lung cancer (NSCLC) after 2 years of immune checkpoint inhibitor (ICI) remains unclear.</div></div><div><h3>Methods</h3><div>We conducted a single-center retrospective observational study to characterize the management of patients who received at least 2 years of ICI in the first-line setting for a metastatic or advanced-stage NSCLC.</div></div><div><h3>Results</h3><div>Among the 254 patients that received ICI in the first-line setting, 39 (15%) achieved 2 years of treatment (ICI in monotherapy, <em>n</em> = 14; ICI with chemotherapy, <em>n</em> = 25). ICI was discontinued after 2 years (<30 months) in 31 (79%) of the cases. During the first 2 years, 29 patients (74%) had no disease progression (2 complete radiological responses, 25 partial radiological responses, and 2 stable diseases) and 10 patients (26%) experienced at least one oligo-progression, which was treated with local ablative treatment (LAT), allowing continuation of ICI up to 2 years. A positron emission tomography (PET) scan was performed at 2 years for 37 patients (95%), revealing a complete metabolic response (CMR) in 16 individuals (43%). None of these patients progressed subsequently (median follow-up: 13 months). After 2 years of ICI, the 12-month progression-free survival was 100% in case of CMR versus 49% (95% CI, 29–91) in the absence of CMR (<em>p</em> = 0.00037).</div></div><div><h3>Conclusions</h3><div>A CMR at 2 years of ICI is associated with a favorable prognosis. Further studies are needed to better establish the role of PET scan at 2 years, the relevance of LAT and the optimal duration of ICI.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101169"},"PeriodicalIF":2.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143808117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0