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  

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

作　　者：沈叶[1] 崔社怀[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所呼吸内科,重庆400042

出　　处：《第三军医大学学报》2012年第6期551-554,共4页Journal of Third Military Medical University

基　　金：第三军医大学科研基金(2008XG181)~~

摘　　要：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。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（P0.05）.However,HRCT showed no significant difference before and after the treatment（P0.05）.As compared with those of the control group,FVC%pred,VC%pred and DLCO/VA%pred of the treatment group improved significantly（P0.05）.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.

关 键 词：糖皮质激素 N-乙酰半胱氨酸 特发性肺纤维化 

分 类 号：R563.13[医药卫生—呼吸系统] R977.11[医药卫生—内科学]