布地奈德联合噻托溴铵雾化吸人治疗老年性肺间质纤维化

目的探讨布地奈德联合噻托溴铵雾化吸入剂治疗老年性肺间质纤维化的临床疗效。方法将72例老年性肺间质纤维化患者随机分为3组，各组24例：A组，普米克令舒2ml（含布地奈德1ms）雾化吸入，6～8h吸入1次，联合吸入噻托溴铵吸入剂18μg/d。B组，只雾化吸入布地奈德1mg，6～8h吸入1次，不吸入噻托溴铵吸入剂。C组，每天口服泼尼松1mg／kg，4周后减半量维持。疗程均为3个月。观察3组患者的临床表现、肺CT、血气分析、肺功能改变及不良反应。结果临床表现缓解率：A组76．8％、B组43．2％、C组51．7％；A组与B、C组比较，差异有统计学意义俨〈0．05）；B组与C组比较，差异无统计学意义（P〉0．05）。肺CT改善率：A组71．7％、B组47．4％、C组47．5％；A组与B、C组比较，差异有统计学意义（P〈0．05）；B组与c组比较，差异无统计学意义（P〉0．05）；A组和C组患者动脉血氧分压（Pa02）、肺活量（Vc）、肺一氧化碳弥散功能（DLCO）与治疗前比较，均有提高（P〈0．05），但两组间比较，差异无统计学意义（P〉0．05）；B组PaO2、VC、DLCO有提高，与治疗前比较，差异有统计学意义（P〈0．05）。不良反应发生率：A组8.3％、B组8.3％、C组58.3％，A组与C组比较，差异有统计学意义（P〈0．05）。结论雾化吸入布地奈德联合吸入噻托溴铵吸入剂较单纯吸入布地奈德或单纯口服泼尼松治疗老年性肺间质纤维化，不良反应少且临床疗效确切。

Effects of budesonide combined with tiotropium bromide inhalation on senile pulmonary interstitial fibrosis

Objective To investigate clinical effects of budesonide combined with tiotropium bromide inhalation on senile pulmonary fibrosis. Methods Seventy-two elderly patients with pulmonary fibrosis were randomly divided into three groups with 24 cases in each group. The group A was treated with pulmicort respules suspension atomization, 1 mg each time, 1/6 - 8 h,combining inhalation with Tiotropium Bromide 18μg/d. The group B was treated with pulmicort respules suspension atomization,1 mg each time, 1/6 - 8 h,without inhalation with Tiotropium Bromide. The group C was treated with prednisone, 1 mg/kg each day. Four weeks later all the dosage were reduced to half for maintenance over 3 month. The clinical manifestation,high-resolution CT of the chest, arterial blood gas analysis,pulmonary function testing and side effects were observed. Results After treatment.the improvement rate of symptoms was 76.8% in group A,43.2% in group B and 51.7% in group C ,with a significant difference between group A and group B,group C （P 〈 0.05）. However no difference between group B and group C （P 〉 0.05）. The improvement rate showed by lung CT was 71.7% in group A,47.4% in group B and 47.5% in group C,with a significant difference between group A and group B,group C （P 〈 0.05）,but no difference between group B and group C （P 〉 0.05）. PaO2,VC% and DLCO% of the patients in group A and group C improved with no difference between two groups （P 〉 0.05）. Those indexes of the group B also improved with significant difference in comparison to the evaluation items before treatment （P 〈 0.05）. The incidence rate of side effect was 8.3% in group A, 8.3% in group B and 58.3% in group C,with a significant difference between group A and group C （P 〈 0.05）. Conclusion Budesonide combined with tiotropium bromide inhalation is effective in the treatment of senile pulmonary fibrosis,in comparison to mono-therapy as inhalation of pulmicort respules suspension atomization or prednisone administration. Also the method had few side effects with good efficacy.