Respir Res. 2017;18(1):204.

Factors affecting treatment outcome in patients with idiopathic nonspecific interstitial pneumonia: a nationwide cohort study.

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제1저자 이상훈 · 교신저자 박종선

PMID 29212510 PMC5719588 DOI 10.1186/s12931-017-0686-7 IF 5.7 호흡기내과

소속 (18)

Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.
Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
Department of Internal Medicine, Division of Pulmonology, Severance Hospital, Institute of Chest Diseases, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Department of Internal Medicine and Lung Institute, Division of Pulmonary and Critical Care Medicine, Seoul National University College of Medicine, Seoul, South Korea.
Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Internal Medicine, Division of Allergy and Respiratory Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea.
Department of Internal Medicine, Division of Allergy and Respiratory Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea.
Department of Internal Medicine, Division of Pulmonology, Gachon University Gil Medical Center, Incheon, South Korea.
Department of Internal Medicine, Division of Pulmonary, Allergy & Critical Care Medicine, Kangdong Sacred Heart Hospital, Hallym University, Seoul, South Korea.
Department of Internal Medicine, Pulmonary Division, Inha University Hospital, Incheon, South Korea.
Department of Internal medicine, Division of Pulmonary Medicine, Chung Ang University College of Medicine, Seoul, South Korea.
Department of Internal Medicine, Division of Respiratory and Critical Care Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, South Korea.
Department of Internal Medicine, Division of Pulmonary Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
Department of Internal Medicine, Division of Critical Care and Pulmonary Medicine, Inje University Busan Paik Hospital, Busan, South Korea.
Department of Internal Medicine, Division of Allergy and Pulmonology, Bucheon St. Mary's Hospital, The Catholic University of Korea School of Medicine, Bucheon, South Korea.
Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea. jspark.im@gmail.com.

Abstract

BACKGROUND The effects of corticosteroid-based therapy in patients with idiopathic nonspecific interstitial pneumonia (iNSIP), and factors affecting treatment outcome, are not fully understood. We aimed to investigate the long-term treatment response and factors affecting the treatment outcome in iNSIP patients from a multi-center study in Korea.

METHODS The Korean interstitial lung disease (ILD) Study Group surveyed ILD patients from 2003 to 2007. Patients were divided into two groups to compare the treatment response: response group (forced vital capacity (FVC) improves ≥10% after 1 year) and non-response group (FVC <10%). Factors affecting treatment response were evaluated by multivariate logistic regression analysis.

RESULTS A total of 261 patients with iNSIP were enrolled, and 95 patients were followed-up for more than 1 year. Corticosteroid treatment was performed in 86 patients. The treatment group showed a significant improvement in lung function after 1-year: FVC, 10.0%; forced expiratory volume (FEV₁), 9.8%; diffusing capacity of the lung for carbon monoxide (DLco), 8.4% (p < 0.001). Sero-negative anti-nuclear antibody (ANA) was significantly related with lung function improvement. Sero-positivity ANA was significantly lower in the response group (p = 0.013), compared to that in the non-response group. A shorter duration of respiratory symptoms at diagnosis was significantly associated with a good response to treatment (p = 0.018).

CONCLUSION Treatment with corticosteroids and/or immunosuppressants improved lung function in iNSIP patients, which was more pronounced in sero-negative ANA and shorter symptom duration patients. These findings suggest that early treatment should be considered in iNSIP patients, even in an early disease stage.

Keywords

Non-specific interstitial pneumoniaPulmonary lung functionTreatment

Figures

**Fig. 1** Flow chart of the study population. Initially, 2186 patients with interstitial lung disease (ILD) were enrolled by the Korean study group between January 1, 2003, and December 31, 2007. A total of 261 surgically diagnosed patients with non-specific interstitial pneumonia (NSIP) were analyzed in this study; 1925 patients with a different diagnosis other than NSIP were excluded from this study. One hundred and fifty seven patients were followed-up within 1 year, and 95 patients were followed-up after >1 year. Of these 95 patients, nine were in the conservative care group, and 86 in the treatment group. The treatment group was defined as those prescribed corticosteroid and/or immunosuppressant therapy, and conservative care group was defined as those who were only prescribed medication for symptom control. IPF: idiopathic pulmonary fibrosis, COP: cryptogenic organizing pneumonia, AIP: acute interstitial pneumonia, DIP: desquamative interstitial pneumonia, RB-ILD: respiratory bronchiolitis-associated interstitial lung disease, LIP: lymphocytic interstitial pneumonia

**Fig. 2** Changes in lung function over time between the response group and non-response group. a Change in functional vital capacity (FVC) (%) over time between the two groups (p < 0.001, Mean ± standard error (SE), b Change in the diffusing capacity of the lung for carbon monoxide (DL_CO) (%) over time between the two groups (p = 0.002, Mean ± SE)

그림 출처: PubMed Central 공개 논문 (PMC5719588)

Conflict of interest statement

ETHICS APPROVAL AND CONSENT TO PARTICIPATE: The Institutional Review Board (IRB) of Yonsei University Health Service, Severance Hospital, reviewed and approved the study protocol (Reference number for ethics approval: 4–2009-0372). CONSENT FOR PUBLICATION: Not applicable. COMPETING INTERESTS: The authors declare that they have no competing interests. PUBLISHER’S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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