甲泼尼龙联合环孢素A冲击治疗对口服百草枯中毒致肺纤维化的早期干预研究

A study of early medical intervention on paraquat-induced pulmonary fibrosis by high-dose methylprednisolone pulse therapy combined with cyclosporine A

目的通过回顾性对照研究，观察采用大剂量甲泼尼龙联合环孢素A早期冲击治疗对百草枯中毒患者肺纤维化发生率及病死率的影响。方法将2004年1月～2007年11月收治的151例口服百草枯中毒患者分为对照组（50例）和试验组（101例）；所有患者均给予常规洗胃、血液灌流及补液等对症支持治疗；对照组中氧合下降、胸部CT提示肺纤维化者采用甲泼尼龙（15mg／kg）＋环磷酰胺（15mg／kg）冲击治疗；试验组患者来诊后立即使用甲泼尼龙（15mg／kg）＋环孢霉素A（5mg／kg）冲击治疗；比较2组患者的病死率、肺纤维化发生率及因肺纤维化而死亡者占各组患者总数的百分比。结果2组患者的年龄、服毒量、重度中毒患者占各组患者总数的百分比三项指标比较差异无统计学意义；对照组和试验组的病死率分别为52．00％（26／50）和43．56％（44／101），差异无统计学意义（P=0．328）；肺纤维化发生率分别为20．0％（10／50）和6．93％（7／101），差异显著（P=0．027）；因肺纤维化而死亡者占各组患者总数的百分比分别为18．00％（9／50）和4．95％（5／101），差异显著（P=0．015）。结论采用大剂量甲泼尼龙联合环孢素A早期冲击治疗可显著降低百草枯中毒致肺纤维化的发生率及病死率，但其确切效果尚需通过大样本的多中心临床随机、对照研究进一步明确。

Objective To study the effect of high-dose methylprednisolone pulse therapy combined with cyclosporine A on the mortality and incidence of pulmonary fibrosis in patients with oral paraquat （PQ） poisoning. Methods A retrospective analysis of 151 PQ-poisoned patients was performed between January 2004 and November 2007 in the 307 Hospital of PLA. All patients treated conventional PQ given gastric lavage, blood perfusion. The patients in control group （n=50） received initial pulse therapy with methylprednisolone （15 mg/kg） and cyclophosphamide （15 mg/kg）, when decrease of oxygenation index and pulmonary fibrosis showed by thoracic computed tomography had appeared. The patients in experimental group （n=101） received initial pulse therapy with methylprednisolone （15 mg/kg） and cyclosporine A （5 mg/kg） immediately after admission. Incidence of pulmonary fibrosis and mortality were compared between the two groups. Results There was no statistical significant difference between the two groups in age, quantity of paraquat ingested orally and percentage of severely poisoned patients. The mortality in control group and experiment group were 52.00% （26/50） and 43.56% （44/101）, respectively （P=0.328）. The incidence of pulmonary fibrosis was 20.0% （10/50） and 6.93% （7/101）, respectively （P=0.027）. The percentage of the patients died of pulmonary fibrosis was 18.00% （9/ 50） and 4.95% （5/101）, respectively （P=0.015）. Conclusion The early high-dose methylprednisolone pulse therapy combined with cyelosporine A can s!gnificantly reduce the mortality and incidence of pulmonary fibrosis in patients with PQ poisoning. A large sample with randomized and case-control study is needed in order to further evaluate the clinical outcomes.