低分子肝素联合乙酰半胱氨酸治疗特发性间质性肺炎的临床疗效评价

摘要

目的：探讨低分子肝素和乙酰半胱氨酸联合治疗特发性间质性肺炎的临床效果和安全性评价。方法将入选的60例特发性间质性肺炎患者随机分为对照组和观察组，每组30例。对照组给予常规治疗，观察组在此基础上给予低分子肝素配合乙酰半胱氨酸进行治疗，两组疗程均为3个月。比较两组患者治疗前后临床症状、肺功能指标[用力肺活量占预计值百分比（FVC％ pred）、单位肺泡容积的一氧化碳弥散量占预计值百分比（DLCO/ VA％ pred）、第1秒用力呼气容积占预计值百分比（FEV1％ pred）、肺活量（VC）、肺总量（TLC）]、动脉血气分析（PO2、PCO2）、血清Ⅲ型胶原、六分钟步行试验和高分辨率 CT（HRCT）影像学改变。结果观察组患者治疗后，咳嗽、咳痰、呼吸困难、肺部 Velcro 音自评分数与治疗前比较显著改善（ P ＜0.05），对照组治疗前后上述评分差异无明显改变。两组治疗后的动脉血气分析指标均明显优于治疗前；观察组治疗后的各项肺功能指标（VC％ pred、FVC％ pred、DLCO/ VA％ pred、FEV1％ pred、TLC％pred）明显高于治疗前；对照组治疗后的肺功能各项指标比治疗前有所改善，但差异无统计学意义（ P ＞0.05）；且观察组治疗后的 VC％ pred、FVC％ pred、DLCO/ VA％ pred 明显高于对照组。观察组治疗后，胸部 HRCT 出现磨玻璃影、网格影和小叶间隔增厚明显少于治疗前，对照组治疗后的胸部 HRCT 各项指标均比治疗前有所改善，但差异无统计学意义（ P＞0.05）。两组治疗后血清Ⅲ型胶原水平、六分钟步行距离均较治疗前改善；但观察组治疗后的血清Ⅲ型胶原水平、六分钟步行距离明显优于对照组（ P ＜0.05）。两组患者治疗后均未发现明显的不良反应。结论低分子肝素和乙酰半胱氨酸联合治疗特发性间质性肺炎临床效果显著，可以更好地改善肺纤维化，提升患者运动能力，短期内未发现明显的不良反应，建议推广。%Objective To study the low molecular heparin and acetylcysteine combined treatment of idiopathic interstitial pneumonia clin-ical effect and safety evaluation. Methods 60 patients with idiopathic interstitial pneumonia were randomly divided into two groups according to throw the dice way,30 cases of control group and observation group of 30 cases. Control group were given conventional treatment,the observation group were given low molecular heparin with acetylcysteine treatment. Total 3 months were considered as a course. The clinical symptoms,pulmo-nary function,arterial blood gas analysis,serum levels of collagen type Ⅲ,6 minutes walk test and HRCT imaging changes were compared be-tween two groups before and after treatment. Results After the observation group patients,cough,sputum,dyspnea,lung sounds Velcro Rating former showed improvement compared with before treatment( P < 0. 05). These scores showed no significant change in the control group. The PO2 in observation group after treatment were significantly higher than before the treatment. PCO2 significantly lower than before treatment. VC %Mr Pred,Mr Pred FVC% ,Mr Pred DLCO/ VA% of observation group after treatment were significantly higher than the control group and before the treatment. FEV1 % ,Mr Pred,TLC Mr Pred of observation group after treatment were significantly higher than before treatment. The chest HRCT in ground glass shadow,shadow grid and interlobular septal thickening of the observation group of patients after treatment were obviously less than before treatment. The serum levels of collagen type Ⅲ,6 minutes walking distance of the observation group after treatment was better than the control group after treatment. The levels of serum collagen type Ⅲ,six minutes walking distance were statistically significant( P < 0. 05). Two groups of patients after treatment were not found obvious adverse reactions. Conclusion Low molecular heparin and acetylcysteine combined treatment of idiopathic interstitial pneumonia clinical effect is remarkable. This method can improve pulmonary fibrosis,improve exercise capacity of patients,did not show obvious adverse reaction in the short term,is worthy of recommended.