血必净联合糖皮质激素治疗特发性肺纤维化急性加重的临床观察

摘要

目的：观察血必净联合糖皮质激素治疗特发性肺纤维化急性加重（AE-IPF）的临床疗效。方法38例AE-IPF患者随机分为联合组和激素组，分别给予血必净联合糖皮质激素及单药糖皮质激素治疗，观察3个月，比较两组临床治疗结果、氧合指数及CT评分等方面的差异。结果38例AE-IPF患者的总体死亡率为44.74％，且联合组的死亡率和机械通气发生率明显低于激素组，差异均有统计学意义（χ2分别=5.17、4.86，P均＜0.05）。联合组二次AE发生率虽低于激素组，但差异无统计学意义（χ2=2.39，P＞0.05）。联合组第14天和第28天氧合指数均较第一天明显提高，差异均有统计学意义（t分别=3.59、2.87，P均＜0.05），但第28天较第14天无明显进一步改善，差异无统计学意义（t=1.03，P＞0.05）。激素组与联合组类似，但两组之间比较，联合组在第14天及第28天均较激素组改善明显，差异均有统计学意义（t分别=2.74、3.11，P均＜0.05）。联合组和激素组治疗1月后的CT评分均较治疗前有所降低，差异均有统计学意义（t分别=3.48、3.92，P均＜0.05），但两组治疗1月后之间差异无统计学意义（t=0.86，P＞0.05）。结论血必净联合糖皮质激素较单用糖皮质激素治疗AE-IPF能够减少再次急性加重，改善氧合，利于预后。%Objective To evaluated the efficacy of combination therapy of xubijing and corticosteroid for acute exacer-bation of idiopathic pulmonary fibrosis (AE-IPF). Methods A total of 38 cases of AE-IPF were divided into combination group and corticosteroid group which were given corticosteroid whether combined with xuebijing or not. The partial pressure of arterial oxygen/fraction of inspired oxygen ratio and computed tomography score were also assessed. Results The overall mortality of 38 patients with AE-IPF was 44.74%. The mortality rate and incidence of mechanical ventilation of combina-tion group were significantly lower than that of corticosteroid group (χ2=5.17,4.86,P<0.05). The AE reoccurrence rate of combination group was lower than that of corticosteroid group, but the difference was no statistically significant (χ2=2.39, P>0.05). The P/F ratio of combination group on 28th day and 14th day were significantly higher than that of the 1st day (t=3.59,2.87,P<0.05), but there was no further improvement on 28th day compared with 14th day(t=1.03,P>0.05). The P/F ratio of combination group was significantly improved on 14th day and 28th day compared to corticosteroid group, the difference was statistically significant(t=2.74,3.11,P<0.05). CT scores of combination group and corticosteroid group were both reduced after treatment for 1 month, the differences were statistically significant (t=3.48,3.92,P<0.05) while the CT scores after treatment for 1 month between the two groups was not statistically different (t=0.86,P>0.05). Conclusion The combination therapy of xuebijing and corticosteroid for AE-IPF can prevent re-acute exacerbation, improve P/F ratio and contribute to a better prognosis.