小剂量糖皮质激素,N-乙酰半胱氨酸联合治疗特发性肺纤维化的前瞻性随机对照研究[J].docVIP

小剂量糖皮质激素、N-乙酰半胱氨酸联合治疗特发性肺纤维化的前瞻性随机对照研究 杨雪梅 王兴胜 魏燕 崔社怀* （400042重庆，第三军医大学大坪医院野战外科研究所呼吸内科） 地址：重庆市渝中区长江支路10号呼吸内科； 邮编：400042） 【摘要】目的 比较小剂量糖皮质激素+N乙酰半胱氨酸（NAC）与NAC单药治疗特发性肺纤维化（IPF）的疗效和安全性。方法 选择2008.3-2010.9在我院就诊符合诊断标准的HRCT显示肺部有磨玻璃样病变的IPF病例随机分为治疗组与对照组。观察12月内两组PO2、FVC%pred、Dlco/VA%pred、MVV%pred、症状自我评估、HRCT变化情况及副反应。结果 参与统计分析者25例，治疗组14例，对照组11例。两组患者PO2、FVC%pred、Dlco/VA%pred、MVV%pred均逐步下降，HRCT显示病灶进展。治疗组12个月后 PO2下降6.93%，对照组下降约9.71%，差异具统计学意义（P0.05）。Dlco/VA%pred治疗组下降6.23%，对照组下降13.66%，，差异具统计学意义（P0.05）。与治疗前比较，治疗组总体症状评分改善，对照组总体症状评分无明显变化，两组间差异具统计学意义（P0.05），而治疗后12月与治疗前比较，差异不具统计学意义（P0.05）。而两组在FVC%pred、MVV%pred、HRCT变化情况及副反应方法差异不具统计学意义（P0.05）。结论 与NAC单药的治疗方案比较，小剂量糖皮质激素与NAC联合治疗肺部有磨玻璃样病变的IPF可降低PO2及肺弥散功能下降速度，改善症状，且未表现出明显副作用。是对IPF特定亚群有改善作用且相对安全的治疗方案。 【关键词】 肺纤维化；N-乙酰半胱氨酸；糖皮质激素；肺功能 基金项目：第三军医大学临床科研基金（2008xg181）；国家自然科学基金 通信作者：崔社怀，电话：（023E-mail：renew_y@ A prospective randomized trial of Low-dose methylprednisolone combined with N-acetylcysteine for treatment of idiopathic pulmonary fibrosis Yang Xuemei, Wang Xingsheng, Wei Yan, Cui Shehuai*（Department of Respiratory Diseases,Institute of Surgery Research,Dapin Hospital,Third military Medical University,Chongqing,400042,China） [Abstact] Objective To compare the clinical effect and safety of low-dose methylprenisolone+ N-acetylcysteine(NAC) and NAC alone in the treatment of idiopathic pulmonary fibrosis(IPF). Methods In this prospective,randomized clinical trial,patients with IPF and ground glass like opacity in HRCT scan in Dapin hospital from Mar 2008 to Sept 2010 were ranmdomly allocated to receive either low-dose methylprenisolone+NAC or NAC alone.Statistical analyses were performed at 12 months postoperatively to compare the PO2、FVC%pred、Dlco/VA%pred、MVV%pred、self-assessment symptom score and adverse reactions between the two groups. Results A total of 25 patients were involved in the statistical analysis,14 patients achieved loe-dose methylprenisolone+NAC,and 11 achieved NAC.Significant differences were found in the PO2、Dl