大剂量谷胱甘肽加维生素C对特发性肺纤维化的疗效观察

A study of curative effects of big dose GSH and vitamin C to idiopathic pulmonary fibrosis

目的 观察大剂量还原型谷胱甘肽（GSH）和维生素C对特发性肺纤维化（IPF）的疗效．探讨其可能的作用机制和治疗价值。方法 18例临床诊断IPF患者以GSH2．4g和维生素C4．0g静注，1次／d．1个月后，以GSH0．3g维生素C0．5g，每日2次雾化吸入维持治疗．统计1个月内的症状改变情况．1个月前后1min步行距离及步行1minPaO，、SaO，值的变化及4年内患者生存情况。结果（1）患者在治疗第2、4周末总体症状好转率分别为89％和94％，两者差异无统计学意义（P〉0．05）。（2）治疗前轻症组和重症组1min步行距离分别为（40．5±5．8）m和（25．8±3．8）m，治疗1个月分别为（58．5±4．2）m和（42．5±4．1）m，两组前后比较差异均有统计学意义（P〈0．01）。（3）轻症组治疗前．步行1minPaO2和SaO2值分别为（65．3±4．9）mmHg和（90．5±6．1）％，1个月后分别为（75．2±5．2）mmHg、（95．0±3．2）％，前后对比差异有统计学意义（P〈O．01）。重症组治疗前步行1minPa02和Sa（）’值分别为（48．2±4．8）mmHg和（75．5±5．2）％，治疗1个月后分别为（51．5±5．3）mmHg和（78．3±5．1）％．前后对比差异无统计学意义（均P〉0．05）。（4）4年内18例患者生存情况显示，轻症组预后较好。重症组预后不良．死亡6例，占总数60％，中位死亡时间为2．2年。结论 大剂量GSH和维生素C治疗IPF有效，雾化吸入法可维持疗效；对早期渗出性病变疗效好，但不能阻止重症患者肺纤维化的进程。

Objective To study the curative effects of big dose GSH and vitamin C to idiopathic pulmonary fibrosis（1PF）. Methods Big dose GSH and vitamin C intravenous were injected to 18 cases IPF who were of no effects to corticoid for a month,pulverization inhale GSH and vitamin C in the following days for constant therapy. The improvement of patients＇ syndromes,record distance of one minute walking,and PaO2,SaO2 after a minute walking were recorded, the datas before-and-after one month treatment were compared, these patients survive state in 4 years were recorded and the computation datas by statistics methods were compared,the validity of this method was primarily evaluated. Results （1）There were 89 % and 94 % of patients＇ common syndromes had been improved in 2 and 4 weeks,cough was the first improved syndrome. Postpone this treatment did not promote the rate of improvement. This method could improve the syndromes of IPF rapidly and notably. （2）Before the treatment, one minute walking distance of the slightly group and heavy group was （40.5 ± 5.8） meters and （25.8 ± 3.8） meters each. One month later after the treatment,the distance was （58.5 ± 4.2） and （42.5 ± 4.2） meters for each group. The data of before and after the treatment had significant difference by pared t test, P 〈 0.01, pulmonary function and kinematical function had been notably improved. （3）Before treatment, the slightly groups PaO2 and SaO2 after one minute walking was （51.3 ± 4.9） mmHg and （70.5 ± 6.1 ） % ,later after 30 days therapy, data become （48.5 ± 5.3） mmHg and （65.3 ± 5. 1 ） % , and there was significant difference between these two data, P 〈 0.01. For heavy group, PaO2 and SaO2 after one minute walking before and after treatment was respectively （45.2 ± 4.8）mmHg, （60.5 ± 5.2）96 ,and （48.5 ± 5.3）mmHg and （65.3 ± 5.1 ） % . the data before and after treatment had no significant difference（P 〉 0.05）. It showed that this method could improve syndromes and kinematical function of slight group, and it could only improve common syndromes of heavy illness group, but did not improve PaO2 and SaO2 of heavy group. （4）Survival state of 18 IPF patients in 4 years： the statistics showed that the slightly group had good predication by the GSH and vitamin C treatment, but for the heavy group the prediction was still worse. It refered to hint that it was very important to diagnose and cure IPF early. Conclusions Big dose GSH and vitamin C have good effects to IPF patiects,eapecially to the early stage IPF. Although GSH and vitamin C may eliminate the effusion in- flammation, but may not prevent the process of lung fibrosis.