糖皮质激素治疗隐源性机化性肺炎的临床疗效研究

摘要

Objective To investigate the effectiveness of glucocorticosteroid (GC) in treating patients with cryptogenic organizing pneumonia (COP) . Methods Nine cases (group A) were treated first with Methylprednisolone Sodium Succinate for Injection, 160 mg/d, 80 mg/d and 40 rag/d, each dose for three days, then with Prednisone Acetate Tablets 50 mg/d. Then the dose was gradually reduced to 5 mg/d and maintained. Seven cases ( group B) were treated with prednisone 30 mg/d for 14 days, then the dose was gradually reduced to 5 mg/d. Course of treatment for all cases ranged from 8 to 12 months. The clinical manifestations, lung function and imaging results of COP patients were analyzed. Results The clinical manifestations of the 16 COP patients treated was significantly improved within 48 hours after treatment. The imaging lesions were greatly absorbed within 3-7 days. After treatment with glucocorticosteroid, 7 cases recovered and 2 cases improved in group A, and 4 cases recovered, 2 cases improved, 1 case relapsed in group B. The case that relapsed was treated with higher dose and improved. All patients were followed up for 12 - 24 months, and no patients suffered a relapse during that period. Conclusion The treatment for group A is characterized by high initial dose and rapid reduction, while the treatment for group B is characterized by low initial dose and gradual reduction. Both therapies receive positive response from the patients except for one relapse in group B. Therefore , early, appropriate and adequate use of glucocorticosteroid to treat COP will be effective and Lead to optimistic prognosis.%目的 研究隐源性机化性肺炎(COP)患者对糖皮质激素治疗的反应性.方法 16例患者均经糖皮质激素治疗.其中大剂量短程冲击,再按快速减量、小剂量激素维持治疗9例(A组),甲强龙160 mg/d、80 mg/d、40mg/d.分别应用3d,分两次静脉滴注,而后改为口服泼尼松50 mg/d,并逐渐减量至维持剂量5 mg/d,总疗程8～ 12个月.另7例(B组)最初口服强的松30 mg/d,时间为14 d,然后逐渐减量至维持剂量5 mg/d治疗,总疗程8 ～12个月.从临床表现、肺功能、影像学等方面分析COP患者对糖皮质激素治疗的反应性.结果 临床症状在应用糖皮质激素48 h内得到明显改善,3～7天内复查肺CT示多发片状影、条索影、斑片实变影及磨玻璃影明显吸收,经激素及对症治疗痊愈11例,好转4例,复发1例再给予激素加量治疗反应良好.所有病例预后随访12 ～ 24个月,停药后无复发病例.结论 糖皮质激素治疗COP具有临床效果好、不良反应少、不易复发的特点,采用甲强龙大剂量短程冲击,再按快速减量、小剂量口服泼尼松维持治疗的方法可能效果更好.