PDF(Pubmed)
Abstract：
Cryptogenic organizing pneumonia (COP) is an idiopathic interstitial pneumonia generally requiring steroid therapy, and spontaneous resolution has been reported in patients with mild disease. However, evidence supporting the need for COP treatment is poor. Therefore, we investigated the characteristics of patients with spontaneous resolution. We retrospectively collected data from 40 adult patients who were diagnosed with COP through bronchoscopic examination at Fukujuji Hospital from May 2016 to June 2022. Sixteen patients who improved without steroid therapy (the spontaneous resolution group) and 24 patients who required steroid therapy (the steroid therapy group) were compared. Patients in the spontaneous resolution group showed a lower C-reactive protein (CRP) concentration (median 0.93 mg/dL [interquartile range [IQR] 0.46-1.91] vs median 10.42 mg/dL [4.82-16.7], P < .001), a higher lymphocyte ratio (median 21.7% [18.2-25.2] vs median 13.3% [8.8-19.8], P = .002), and a longer duration from symptom onset to diagnosis of COP (median 51.5 days [24.5-65.3] vs 23.0 days [17.3-31.8], P = .009) than those in the steroid therapy group. Within 2 weeks, all patients in the spontaneous resolution group showed relief of symptoms and alleviated radiographic findings. The area under the receiver operating characteristic (ROC) curve was 0.859 (95% confidence interval [CI]: 0.741-0.978) in CRP. When we arbitrarily determined the cutoff values, including CRP levels of ≤3.79 mg/dL, the sensitivity, specificity, and odds ratio were 73.9%, 93.8%, and 39.8 (95% confidence interval: 4.51-1968.9), respectively. Only 1 patient in the spontaneous resolution group showed recurrence but did not require steroid therapy. Conversely, 4 patients in the steroid therapy group showed recurrence and were treated by an additional course of steroids. The characteristics of COP with spontaneous resolution and factors that determine the patients in whom steroid therapy might be avoided is detailed in this study.
摘要：
隐源性机化性肺炎（COP）是一种特发性间质性肺炎，通常需要类固醇治疗，据报道，轻度疾病患者自发消退。然而,支持需要COP治疗的证据很少。因此,我们调查了自发消退患者的特征。我们回顾性收集了2016年5月至2022年6月在福居医院通过支气管镜检查诊断为COP的40例成年患者的数据。比较了16例未经类固醇治疗改善的患者（自发消退组）和24例需要类固醇治疗的患者（类固醇治疗组）。自发消退组患者的C反应蛋白（CRP）浓度较低（中位数0.93mg/dL[四分位距[IQR]0.46-1.91]与中位数10.42mg/dL[4.82-16.7]，P<.001),较高的淋巴细胞比率（中位数为21.7％[18.2-25.2]，中位数为13.3％[8.8-19.8]，P=.002)，从症状发作到诊断COP的持续时间更长（中位数为51.5天[24.5-65.3]vs23.0天[17.3-31.8]，P=.009）比类固醇治疗组。2周内,自发消退组的所有患者均表现出症状缓解和影像学表现缓解.CRP的受试者工作特征（ROC）曲线下面积为0.859（95％置信区间[CI]：0.741-0.978）。当我们任意确定截止值时，包括CRP水平≤3.79mg/dL，灵敏度,特异性，赔率比为73.9%，93.8%,和39.8（95%置信区间：4.51-1968.9），分别。自发消退组中只有1例患者出现复发，但不需要类固醇治疗。相反，类固醇治疗组中有4例患者出现复发，并接受了额外的类固醇治疗。本研究详细介绍了具有自发消退的COP的特征以及决定可以避免使用类固醇治疗的患者的因素。
