摘要
目的观察环磷酰胺联合不同剂量肾上腺皮质激素(激素)治疗间质性肺疾病的临床效果。方法选择90例间质性肺疾病患者分为A、B、C组各30例,均予常规治疗及口服环磷酰胺。在此基础上A组予以高剂量泼尼松1.0 mg/(kg·d),B组予中等剂量泼尼松0.75 mg/(kg·d),C组予以低剂量泼尼松0.5 mg/(kg·d)。治疗3个月后行肺功能检测,包括FVC、用力肺活量占预计值百分比(FVC%)、FEV1、一氧化碳弥散量(DLCO)、DLCO占预计值百分比(DLCO%),比较3组的血清IL-6水平及胸部高分辨率CT(HRCT)评分,观察不良反应发生状况。结果治疗前,3组ILD患者的FVC、FVC%、FEV1、DLCO、DLCO%等肺功能指标及血清IL-6水平比较差异均无统计学意义(P均>0.05)。治疗后,3组患者的肺功能指标均高于治疗前、IL-6水平低于治疗前(P均<0.05),且A组肺功能指标高于B、C组,而IL-6水平低于B、C组(P均<0.05),B组治疗后肺功能指标高于C组,而IL-6水平低于C组(P均<0.05)。治疗前后3组组内及治疗后组间HRCT评分比较差异均无统计学意义(P均>0.05)。A、B、C组的不良反应发生率分别为10%、13%、7%,组间比较差异无统计学意义(P>0.05)。结论环磷酰胺联合高剂量激素治疗间质性肺疾病短期内疗效明显。与低、中等剂量激素比较,高剂量激素更能缓解机体炎症反应,改善肺功能,安全性好。
Objective To observe the clinical efficacy of cyclophosphamide combined with different doses of hormone in the treatment of interstitial lung disease. Metllods Ninety patients with interstitial hmg disease were enrolled and evenly divided into the A, B and C groups. All patients were treated with conventional treatment combined with oral intake of cyclophosphamide tablets. Besides, glucocorticoid prednisone at a dose of 1.0 mg/（kg·d） was administered in the A group, 0.75 mg/（kg·d） of glucocorticoid prednisone in the B group, and 0. 5 mg/（kg·d） of glucocorticoid prednisone in the C group. At 3 months after continuous treatment, lung function tests including forced vital capacity （FVC） , FVC% , forced expiratory volume in the first second （FEV,） , carbon monoxide diffusing capacity （DLCO）, DLCO% were measured. The sermn level of interleukins-6 （IL-6） and thoracic high-resolution CT （HRCT） score were statistically compared among three groups. The incidence of adverse reactions was observed. Results Prior to corresponding treatment, FVC, FVC%, FEV1, DLCO, DLCO% and sermn level of IL-6 did not significantly differ among three groups （all P 〉 0. 05）. After treatment, ptdmonat7 function indexes were significantly improved and the sermn level of IL-6 was considerably decreased in all groups （all P 〈 0. 05）. in the A group, the above indexes were signifi- cantly higher, whereas the sermn level of IL-6 was dramatically lower than those in the B and C groups （all P 〈0. 05）. in the B group, the lung function indexes were significantly higher, whereas the sermn level of IL-6 was considerably lower than those in the C group （all P 〈 0. 05）. After corresponding treatment, the HRCT scores did not significantly differ within each group and among different groups （all P 〉0. 05）. The incidence rate of adverse reactions was 10% in the A group, 13% in the B group and 7% in the C group with no statistical significance （ all P 〉 0. 05） . Conclusions Cyclophosphamide combined with high-dose glucocorticald yields high short-term efficacy in the treatment of interstitial lung disease. Compared with low- and moderatedose hormone, high-dose glucocorticoid therapy can more effectively alleviate the inflammatory response, improve lung function and provoke less adverse events.
作者
何毅珺
张平
刘慧欣
陈景顺
He Yijun, Zhang Ping, Liu Huixin, Chen Jingshun(Department of Respiratory, Dongguan People＇s Hospital, Dongguan 523059, Chin)
出处
《新医学》
2018年第8期606-610,共5页
Journal of New Medicine
