Objective To investigate the therapeutic effect of thalidomide combined with prednisone on idiopathic pulmonary fibrosis ( IPF ), explore the role of tumor necrosis factor α ( TNF-α )and transforming growth factor β ( TGF-β )in pathogenesis of IPF, and observe the influence of thalidomide on TNF-α and TGF-β1 in patients with IPF. Methods 57 IPF patients were randomly divided into hormone group ( n - 20, prednisone )and treatment group ( n -37, prednisone combined with thalidomine ). The curative effect, broncho alveolar lavage fluid( BALF )and serum levels of TNF-α and TGF-β1 inpatients with IPF were detected by ELISA before and after 3-month treatment,meanwhile,the BALF and serum in health volunteer ( n - 20 )were detected as control. Results The total effective rate of treatment group was higher than that of hormone group( P <0. 05 );the BALF and the serum levels of TNF-α and TGF-β1 in patients with IPF were significantly higher than those of control group ( P < 0. 01 ), those in hormone group and treatment group both decreased after treatment ( P < 0. 01 ), and the decrease in treatment group were higher than those in hormone group ( P <0. 01 ). Conclusion Thalidomide combined with prednisone can prevent pulmonary interstitial fibro-sis;TNF-α and TGF-β1 play an important role on pathogenesis of IPF;thalidomide can inhibit the pulmonary fibrosis through lowering the levels of TNF-α and TGF-β1.%目的 探讨沙利度胺联合强的松治疗特发性肺间质纤维化(IPF)的临床疗效;肿瘤坏死因子α(TNF-α)、转化生长因子β(TGF-β)在IPF发病中的作用;沙利度胺对IPF患者TNF-α及TGF-β的影响.方法 IPF患者57例,20例单用强的松治疗(激素组),37例应用沙利度胺联合强的松治疗(联合治疗组),3个月后进行疗效判定;用酶联免疫法(ELISA)分别检测两组患者治疗前后肺泡灌洗液(BALF)及血清中TNF-α、TGF-β1的变化,同时检测20例健康志愿者(对照组)BALF液及血清中TNF-α、TGF-β1,作为对照组.结果 联合治疗组临床总有效率高于激素组(P<0.05);IPF患者的BALF液及血清中TNF-α、TGF-β1均明显高于对照组(P<0.01),治疗后,激素组及联合治疗组BALF液及血清中TNF-α、TGF-β1均较治疗前下降(P<0.05),联合治疗组BALF液及血清中TNF-α、TGF-β1下降幅度明显高于激素组(P<0.01).结论 沙利度胺联合强的松可有效控制IPF发展;TNF-α、TGF-β1在IPF发病中起重要作用,沙利度胺联合强的松对其抑制作用更强;沙利度胺通过降低TNF-α、TGF-β1表达来抑制肺纤维化.
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