泼尼松治疗特发性肺纤维化患者的预后分析

Analysis of Prognosis of Prednisone Treatment Idiopathic Pulmonary Fibrosis

目的分析泼尼松治疗特发性肺纤维化患者的疗效及其预后。方法回顾性分析泼尼松治疗的107例[年龄48～70(60.1±5.3)岁,治疗组]和同期非激素治疗的42例[年龄50～71(61.2±5.1)岁,对照组]IPF患者的临床资料,比较两组患者的5年生存率有无差异;治疗6个月时评定治疗组患者疗效,据疗效分成改善组、稳定组、恶化组三个亚组比较不同疗效组患者的长期生存率及治疗前BALF细胞学检查结果。结果治疗组5年生存率为28.97%,与对照组(16.67%)相比无统计学意义(P>0.05)。治疗6个月疗效评定,改善35例(35/107),稳定19例(19/107),恶化53例(53/107),改善组和稳定组患者细胞总数和淋巴细胞比例显著高于恶化组,而中性粒细胞比例显著低于恶化组(P<0.05);改善组和稳定组患者5年生存率分别为54.29%和42.11%,显著高于恶化组(7.55%,P<0.05)。结论泼尼松并不能改善IPF患者的预后,但治疗前期阶段肺功能改善和稳定患者的预后相对较好。

Objective To evaluate the effect and prognosis of prednisone treatmant idiopathic pulmonary fibrosis（IPF）.Methods Clinical data of 107 prednisone treatmant patients[48～70（60.1±5.3）yearsold,treatment group] and 42 non-prednisone treatmant patients[50～71（61.2±5.1）years,control group] were retrospectively analysed.The 5-year survival rate were compared between two groups.According to the pulmonary function,the treatment group patients were divided into 3 groups：improved,steady and worsened after 6-month treatment.The 5-year survival rate and result of BALF cytology before treatment were compared between 3 groups.Results The 5-year survival rate were 28.97% in treatment group,no significant difference compared with control group（16.67%,P0.05）.After 6-month treatment,35（32.71%） patients were improved,19（17.76%） patients steady and 53（49.53%） patients worsened.In improved and steady groups,the 5-year survival rate,the total cell number and rate of lymphocyte were higher,and the rate of neutrophil was lower compared with those in worsened group（P0.05）.Conclusion The 5-year survival rate of IPF can not be increased by treatment of prednisone.The prognosis of the patients with improved and steady pulmonary function during the first 6-month is better than that of worsened patients.