摘要
目的:观察小剂量阿奇霉素联合吸入布地奈德和N-乙酰半胱氨酸对特发性肺纤维化(IPF)患者肺功能及支气管肺泡灌洗液炎症因子表达的影响。方法:随机将56例确诊为IPF的住院患者分为对照组和治疗组,对照组给予常规治疗,吸氧,戒烟,吸入布地奈德及乙酰半胱氨酸;治疗组在常规治疗基础上加服小剂量阿奇霉素片。动态观察两组患者治疗3、6个月的疗效及肺功能的改善情况;完成2个疗程(6个月)治疗后,检测和比较两组支气管肺泡灌洗液相关炎症因子水平的变化。结果:治疗3个月时,两组患者的动脉血氧分压(PO2)、肺活量(VC)、1秒钟用力呼气容积占预计值百分比(FEV1%pred)、最大通气量占预计值百分比(MVV%pred)、单位肺泡容积的一氧化碳弥散量占预计值百分比(DLCO/VA%pred)均较治疗前显著增加(P<0.05);治疗6个月时,治疗组的有效率(20/26,76.9%)明显高于对照组(14/30,46.7%),且PO2、VC、FEV1%pred、MVV%pred及DLCO/VA%pred等肺功能指标均显著高于对照组(P<0.05);对照组支气管肺泡灌洗液TNF-α、IL-8浓度均较治疗前降低(P<0.05),IL-4、IL-10、IFN-γ浓度较治疗前无明显变化;而治疗组支气管肺泡灌洗液TNF-α、IL-8、IL-4、IL-10浓度均较治疗前降低,IFN-γ浓度较治疗前明显增加(P<0.05)。结论:阿奇霉素联合吸入布地奈德和N-乙酰半胱氨酸可能通过改变支气管肺泡灌洗液IFN-γ等炎症因子浓度有效改善IPF患者的肺功能。
Objective: To observe the clinical effects of small dose azithromycin combined with inhalation of Budesonide and N-acetylcysteine on cytokines of bronchoalveolar lavage fluid and lung function of patients with idiopathic pulmonary fibrosis (IPF). Methods: 56 patients with IPF were randomly divided into two groups. The control group was only treated with general treatment, includ- ing oxygen uptaking, quitting smoking and inhaling Budesonide(2 mL/time,Tid) and N-acetylcysteine(3 mL/time, Tid), while the treatment group was given azithromycin (250 mg, oral, qd) based on general treatment for 60 days. The curative effect and pulmonary function pa- rameters such as PO2, forced vital capacity(VC), FEVl%pred, MVV% pred and DLCONA% pred of patients in the two groups were dy- namically observed before and 3, 6 months after treatment, the related inflammatory cytokines concentration in bronchoalveolar lavage fluid were deteced and compared before and 6 months after treatment. Results: After three months' treatment, the PO2, VC, FEVI% pred, MVV% pred and DLCONA% pred of patients in both groups increased compared to those before treatment (P〈0.05). 6 months after treatment, the efficiency of treatment group (20/26, 76.9%) was obviously higher than that of the control group (14/30, 46.7%). The PO2, VC, FEVI% pred, MVV% pred and DLCONA% pred of patients in the treatment group were higher than those in the control group (P〈0.05). The concentration of TNF-α and IL-8 in bronchoalveoiar lavage fluid of patients in control group were significantly lower (P〈0.05), but IL-4, IL -10, IFN-γ had no obvious changes compared to those before treatment, respectively. And the concentration of TNF-α, IL -8, IL-4, IL-10 in the treatment group were reduced, the concentration of IFN-γincreased significantly compared to those be- fore treatment (P〈0.05). Conclusion: Small dose Azithromycin combined with inhalation of Budesonide and N-acetylcysteine could im- prove the lung function of patients with IPF by changing the concentrations of related inflammatory cytokines such as TNF-α, IL -8, IL-4, IL-10 and IFN-γinbronchoalveolar lavage fluid.
出处
《现代生物医学进展》
CAS
2015年第5期905-908,共4页
Progress in Modern Biomedicine