糖皮质激素雾化吸入对呼吸窘迫综合征患者肺纤维化的疗效观察

Therapeutic effect of glucocorticoid inhalation for pulmonary fibrosis in ARDS patients

目的观察经雾化吸入糖皮质激素对成人呼吸窘迫综合征(ARDS)患者临床症状及肺纤维化的影响。方法选择2011年12月-2013年6月入住上海市松江区中心医院ICU的ARDS患者53例,随机分成两组。A组(常规治疗组)给予常规治疗,B组(雾化治疗组)在常规治疗基础上给予糖皮质激素雾化治疗(布地奈德,2mg/次,每12h 1次,应用12d)。比较两组氧合指数、疗效及预后、肺纤维化指标Ⅰ型胶原肽(CoⅠ)、Ⅲ型前胶原肽(PⅢP)及转化生长因子β1(TGF-β1)等的变化,分析常见不良反应的发生率。结果与A组相比,B组患者第15天氧合指数明显改善(P<0.05);ELISA法检测结果显示,两组间CoⅠ、PⅢP、TGF-β1比较差异均有统计学意义(P<0.05);激素治疗并未增加不良反应的发生(P>0.05)。结论小剂量雾化吸入糖皮质激素可改善ARDS患者氧合指数及肺纤维化水平,且常见不良反应并无增加,提示激素雾化治疗ARDS安全有效。

Objective To observe the effect of glucocorticoid inhalation on the clinical symptoms and pulmonary fibrosis index in ARDS patients. Methods Fifty-three ARDS patients admitted to ICU of Songjiang District Center Hospital of Shanghai from Dec. 2011 to Jun. 2013 were randomly divided into two groups. Group A （n=29） received conventional therapy, and group B （n=24） was given glucocorticoid inhalation treatment （budesonide, 2 mg, 1/12 h, for 12 days） on the basis of the conventional therapy. The oxygenation index, time of extubation, changes in pulmonary fibrosis index, including collagen I （Co I ）, Ⅲ procollagen peptide （PⅢ P） and transforming growth factor （TGF-β1） were compared between the two groups, and the incidence of common adverse reactions were analyzed. Results The oxygenation index of patients in group B was significantly improved on the 15th day compared with group A （P〈0.05）. There was a significant difference in the level of Co I, PⅢP and TGF-β1 between two groups as measured with enzyme-linked immunosorbent assay （P〈0.05）. The hormone therapy did not increase adverse effects （P〉0,05）. Conclusion A small dose of glucocorticoids introduced by inhalation can improve the oxygenation index and pulmonary fibrosis level without increasing common adverse reactions, suggesting that the inhalation of corticosteroid may be a clinically safe and effective way in patients with ARDS.