不同剂量糖皮质激素联合N-乙酰半胱氨酸治疗特发性肺纤维化的研究

目的 为探讨特发性肺纤维化(idiopathic pulmonary fibrosis,IPF)的治疗新方案,比较静脉推注较大剂量糖皮质激素(80～120 mg/d)联合N-乙酰半胱氨酸与较小剂量糖皮质激素(＜80 mg/d)联合N-乙酰半胱氨酸治疗IPF的临床疗效.方法 根据标准纳入35例受试者,分为治疗组与对照组.观察用药3个月后2组p(O2)、p(CO2)、FVC％ pred、FEV1％ pred、VC％ pred、TLC％ pred、DLCO/VA％ pred、症状体征评分、HRCT上磨玻璃影、网格影、蜂窝影、小叶间隔增厚的变化情况及不良反应.结果 对比各组用药前后的变化,用药3个月后2组肺功能(FVC％ pred、FEV1％ pred、VC％ pred、TLC％ pred、DLCO/VA％ pred)及p(O2)较用药前升高,p(CO2)较用药前降低,症状体征较用药前缓解,差异均具有统计学意义(P＜0.05);而HRCT用药前后变化无显著性差异(P＞0.05).对比2组用药后的变化,治疗组用药后FVC％ pred、VC％ pred、DLCO/VA％ pred改善优于对照组,差异具有统计学意义(P＜0.05).结论 与较小剂量糖皮质激素联合N-乙酰半胱氨酸的治疗方案比较,静脉推注较大剂量糖皮质激素联合N-乙酰半胱氨酸短期治疗特发性肺纤维化更能改善FVC％ pred、VC％ pred及DLCO/VA％ pred,缓解总体症状,且在短期内未表现出明显副作用.

Different doses of glucocorticoids combined with N-acetylcysteine in treatment of idiopathic pulmonary fibrosis

Objective To explore a new approach for the treatment of idiopathic pulmonary fibrosis(IPF),and to compare the clinical effect of intravenous injection of large doses of glucocorticoids(80-120 mg/d) combined with N-acetylcysteine with that of small doses of glucocorticoids(<80 mg/d) combined with N-acetylcysteine.Methods According to the inclusion criteria,35 subjects were enrolled and divided into a treatment group(large doses of glucocorticoids) and a control group(small doses of glucocorticoids).The p(O2),p(CO2),FVC%pred,FEV1%pred,VC%pred,TLC%pred,DLCO/VA%pred,symptom scores,HRCT changes and adverse reactions of the two groups were observed after three-month treatment.Results After the treatment for three months,p(O2) and pulmonary function(FVC%pred,FEV1%pred,VC%pred,TLC%pred,and DLCO/VA%pred) of both groups increased,p(CO2) decreased,and symptom scores increased as compared with those before treatment.The differences were statistically significant(P<0.05).However,HRCT showed no significant difference before and after the treatment(P>0.05).As compared with those of the control group,FVC%pred,VC%pred and DLCO/VA%pred of the treatment group improved significantly(P<0.05).Conclusion Compared with the small doses of glucocorticoid combined with N-acetylcysteine,intravenous injection of large doses glucocorticoid combined with N-acetylcysteine in treatment of idiopathic pulmonary fibrosis can better improve FVC%pred,VC%pred and DLCO/VA%pred,and relieve general symptoms with no obvious side effects in a short term.