N-乙酰半胱氨酸辅治特发性肺纤维化的临床疗效观察

摘要

目的：探讨N-乙酰半胱氨酸( NAC)辅治特发性肺纤维化( IPF)的临床疗效。方法采用按入院顺序随机、对照的方法,将42例IPF患者分为观察组和对照组,每组21例,观察组在糖皮质激素口服常规治疗基础上加用NAC,对照组糖皮质激素口服常规治疗。2组其余基础治疗相同,疗程均为6个月。评价比较2组临床疗效,观察2组治疗前后、肺功能[肺活量(VC)、一氧化碳弥散量(DLco)]、动脉血气分析[pH 值、氧分压(PaO2)、血氧饱和度(SaO2)、二氧化碳分压(PaCO2)]等指标及不良反应等。结果观察组总有效率为80.95%高于对照组的52.38%(χ2=3.857, P <0.05)。与治疗前比较,2组治疗后VC、DLco均降低,对照组差异有统计学意义( t =2.151, t =2.093, P均<0.05),观察组差异均无统计学意义( t =0.419, t =0.376, P均>0.05),观察组治疗后VC、DLco下降幅度小于对照组,差异均有统计学意义( t =-2.147, t =-2.083, P均<0.05)。与治疗前比较,2组治疗后pH、PaCO2,差异均无统计学意义( t =0.861/1.724, t =-1.624/-1.983, P均>0.05),PaO2、SaO2均降低,且对照组差异有统计学意义( t =2.375, t =2.459, P均<0.05),观察组差异均无统计学意义( t =0.507, t =0.381, P均>0.05),治疗后观察组PaO2、SaO2下降幅度小于对照组,差异均有统计学意义( t =-2.117, t =-3.426, P 均<0.05)。2组均未发生严重不良反应。结论对于IPF患者,常规糖皮质激素治疗基础上加用NAC能有效改善IPF的症状,且延缓其肺功能、PaO2、SaO2的下降。%Objective To investigate the effect of N-acetylcysteine ( NAC) as adjuvant treatment on idiopathic pul-monary fibrosis ( IPF) . Methods Applying randomized control method, 42 cases of patients with IPF were divided into obser-vation group and control group according toadmission sequence with 21 cases in each group, the observation group based on the conventional treatment of oral glucocorticoid, patients were used of NAC, the control group were received glucocorticoid oral conventional treatment. The rest basic treatment was the same in the two groups, treated for 6 months. The therapeutic effect of the 2 groups after treatment was evaluated,the pulmonary function[ ( vital capacity,VC) , diffusion capacity for carbon mon-oxide ( DLco) ] , arterial blood gas analysis [ pH value, oxygen partial pressure ( PaO2 ) , oxygen saturation ( SaO2 ) , partial pressure of carbon dioxide ( PaCO2 ) ] index and adverse reaction were observed before and ofter. Results After treatment, in observation group, the total clinical effective rate was 80. 95%,which was higher than that of the control group 52. 38%(χ2 =3.857,P <0.05).Compared with before treatment, the 2 groups after treatment’s VC, DLco decreased, the difference in control group was significant( t =2. 151, t =2. 093, P <0. 05),but no significance was found in observation group( t =0. 419, t =0. 376, P >0. 05). After treatment decrease of VC,DLco in observation group was less than those of control group, there were significant difference (t = -2. 147, t = -2. 083, P <0. 05). Compared with before treatment, pH, PaCO2 has no significant difference( t =0. 861/1. 724, t = -1. 624/ -1. 983, P >0. 05), PaO2,SaO2 were decreased, and the differences in control group were statistically significant ( t =2. 375, t =2. 459, P <0. 05);no significant difference was found in observation group ( t =0.507, t =0.381, P >0.05),after treatment the decrease of PaO2, SaO2 in observation group was less than observation group ( t = -2. 117, t = -3. 426, P <0. 05). No serious adverse reaction was found in the 2 groups. Conclusion For patients with IPF, the conventional corticosteroid therapy added with NAC can effectively improve the symptoms of IPF, and slow down the decrease of pulmonary function, PaO2 , SaO2 .