糖皮质激素在缓解博来霉素所致肺毒性的效果观察

目的：探讨糖皮质激素对缓解博来霉素致肺毒性的有效性。方法35例经术后组织病理学确诊为卵巢生殖细胞肿瘤并接受至少4个疗程以上含博来霉素化疗方案的化疗患者，随机分为两组，激素治疗组在化疗的同时静脉给予地塞米松，非激素治疗组不给予地塞米松。检测化疗2个疗程、4个疗程后患者肺弥散功能（DLCO）变化，以评估肺损伤程度。结果化疗过程中随着博来霉素累计剂量增加，DLCO下降，表明对肺的毒性随之增强；化疗4个疗程后，非激素治疗组患者较化疗前DLCO明显下降（P〈0.01），激素治疗组DLCO虽有下降，但与化疗前比较差异无统计学意义（P〉0.05）。结论早期应用适量的地塞米松可有效缓解博来霉素引起的肺毒性作用，有利于预防肺纤维化的发生。

Objective To investigate the therapeutic effect of corticosteroids on bleomycin-induced pulmonary toxicity in human. Methods Thirty-five patients with histopathologically diagnosed malignant ovarian germ cell tumors received Chemotherapy containing bleomycin in department of Obstetrics and Gynecology,union Taihe Hospital of Hubei Medical College.All of them had at least 4 courses of chemotherapy with bleomycin.All patients were randomized into two groups,glucocorticoids group（Group A n=18）were treated with dexamethasone For three days during the chemotherapy,Non-glucocorticoids group（Group B n=17） was for control group and nothing was dealed. Meanwhile,carbon monoxide diffusing capacity（DLCO）of lung were detected after 2 and 4 course of chemotherapy so as to assess injury of the lung. Results With the increasing of doses of bleomycin,DLCO in Non-glucocorticoids group was significantly lower than glucocorticoids group after 4 course of chemotherapy（P〈0.05）.It was also significantly lower compared with the prior to chemotherapy（P〈0.01）. However,The decrease of DLCO was not obvious In glucocorticoids group. Conclusions According to the Results of the study,we propose that an early moderate course treatment with dexamethasone may be useful in alleviating pulmonary toxicity,thus effectively prevent Bleomycin-induced pulmonary fibrosis.