糖皮质激素治疗对特发性肺纤维化患者预后的影响  

Effect of corticosteroids upon the prognosis of idiopathic pulmonary fibrosis

作　　者：李振华[1] 彭守春[1] 康健[1] 侯显明[1] 于润江[1] 

机构地区：[1]中国医科大学附属第一医院呼吸疾病研究所,沈阳110001

出　　处：《中华医学杂志》2010年第12期804-807,共4页National Medical Journal of China

摘　　要：目的探讨糖皮质激素（激素）对特发性肺纤维化（IPF）的治疗作用和激素治疗对患者生存时间的影响。方法回顾性分析2000至2004年间应用激素治疗的94例（激素治疗组）和没有应用激素治疗的32例（非激素治疗组）IPF患者的临床资料，比较2组的生存率。激素治疗组中有62例随访观察3～6个月，按肺功能指标改善、稳定、恶化分3组进行疗效分析和生存率比较。结果激素治疗组94例中失访6例（6．4％），存活22例（23．4％），死亡66例（70．2％）；非激素治疗组32例中失访1例（3．1％），存活2例（6．3％），死亡29例（90．6％）；2组间生存率差异无统计学意义（P〉0．05）。激素治疗组随访观察3～6个月的62例患者中肺功能改善19例（30．7％），稳定11例（17．7％），恶化32例（51．6％）。改善组19例中生存7例（36．8％），死亡12例（63．2％）；稳定组11例中存活3例（27．3％），死亡8例（72．7％）；恶化组32例中失访3例（9．4％），存活1例（3．1％），死亡28例（87．5％）。改善组和稳定组生存率均明显高于恶化组（均P〈0．01）。结论IPF早期肺泡炎阶段应用激素治疗有一定疗效，治疗的前3—6个月肺功能指标有改善或稳定者预后好于肺功能恶化者。Objective To investigate the therapeutic effect of corticosteroids upon idiopathic pulmonary fibrosis （IPF） and the impact of corticosteroids upon survival time. Methods Clinical data of 94 corticosteroid treatment and 32 non-corticosteroid treatment IPF patients during 2000 - 2004 were retrospectively analyzed and their survival rates compared between two groups. The corticosteroid treatment patients were divided into 3 groups： improved, steady and worsened group according to the pulmonary function data. Therapeutic effects and survival rates were compared between these 3 groups. Results In the treatment group, 6 （6.4%） patients could not be located, 22 （23.4%） patients survived, and 66 （70. 2%） patients died. In the non-corticosteroid treatment group, 1 （3.1%） patients could not be located, 2 （6. 3% ） patients survived and 29 （90. 6% ） patients died. No statistically significant difference existed between the two groups （P 〉 0. 05）. Sixty-two corticosteroid treatment patients were followed up for 3 -6 months. Among them, 19 （30. 7% ） patients improved, 11 （ 17.7% ） patients remained steady and 32 （51.6%） patients worsened in pulmonary function. In 19 improved patients, 7 （36. 8% ） survived and 12 （63.2%） died. In 11 steady patients, 3 （27.2%） survived and 8 （72.7%） died. In 32 worsened patients, 3 （9. 4% ） could not be located, 1（3.1% ） survived and 28 （87. 5% ） died. The survival rate of the improved and steady groups was higher than that of the worsened group （ P 〈 0. 01 ）. Conclusions There is some therapeutic effect of corticosteroids in the early alveolitis stage of IPF. The prognosis of the patients with improved and steady pulmonary function parameters during the first 3 -6 months is better than that of worsened patients.

关 键 词：肺纤维化 糖皮质激素类 存活率 

分 类 号：R563.9[医药卫生—呼吸系统]