缬沙坦联合泼尼松治疗特发性肺间质纤维化的临床观察

Clinical Observation of Valsartan Combined with Prednisone in the Treatment of Idiopathic Pulmonary Fibrosis

目的：观察缬沙坦联合泼尼松对特发性肺间质纤维化的疗效和安全性。方法：50例特发性肺间质纤维化患者随机均分为对照组和观察组。对照组患者给予醋酸泼尼松片1~4周0.5 mg/（kg·d）,5~12周0.25 mg/（kg·d）,后以0.125 mg/（kg·d）维持治疗,每日2~3次;观察组患者在对照组治疗的基础上给予缬沙坦胶囊80 mg,口服,每日1次。两组患者疗程均为6个月。观察两组患者的临床疗效,治疗前后肺功能指标[用力肺活量（FVC）、最大呼气峰流速（PEFR）、第一秒用力呼气容积（FEV1）]、血清炎症因子指标[白细胞介素（IL）-13、IL-18、转化生长因子（TGF）-β1]水平,基质金属蛋白酶（MMP）-9、MMP-2含量及不良反应发生情况。结果：观察组患者总有效率显著高于对照组,差异有统计学意义（P〈0.05）。治疗前,两者患者肺功能指标、血清炎症因子指标、MMP-9、MMP-2含量比较,差异均无统计学意义（P〉0.05）;治疗后,两组患者肺功能指标均显著高于同组治疗前,且观察组高于对照组,血清炎症因子水平和MMP-9、MMP-2含量均显著低于同组治疗前,且观察组低于对照组,差异均有统计学意义（P〈0.05）。两组患者不良反应发生率比较,差异均无统计学意义（P〉0.05）。结论：缬沙坦联合泼尼松可显著改善特发性肺间质纤维化患者肺功能,降低血清炎性因子及基质金属蛋白酶的含量,疗效显著,安全性较好。

OBJECTIVE：To observe the efficacy and safety of valsartan combined with prednisone in the treatment of idiopathic pulmonary fibrosis. METHODS：50 patients with idiopathic pulmonary fibrosis were randomly divided into control group and observation group. Control group was orally given 0.5 mg/（kg·d）Prednisone acetate tablet in 1-4 weeks,then maintained with 0.125mg/（kg·d）in 5-12 neeks,2-3 times a day;observation group was additionally given 80 mg Valsartan capsule,orally,once a day.The treatment course for both groups was 6 months. Pulmonary function indicators [forced vital capacity（FVC）,peak expiratory flow rate（PEFR）,and forced expiratory volume in one second（FEV1）],serum inflammatory factor indicators [interleukin-13（IL-13）,IL-18,transforming growth factor-β1（TGF-β1）] level,matrix metalloproteinase-9（MMP-9）,MMP-2 contents and the incidence of adverse reactions in 2 groups were observed. RESULTS：The total effective rate in observation group was significantly higher than control group,the difference was statistically significant（P〈0.05）. Before treatment,there were no significant differences in the pulmonary function indicators,serum inflammatory factor indicators,MMP-9 and MMP-2 contents between 2 groups（P〈0.05）;after treatment,pulmonary function indicators in 2 groups were significantly higher than before,and observation group was higher than control group,MMP-9 and MMP-2 contents were significantly lower than before,and observation group was lower than control group（P〈0.05）. And there was no significant difference in the incidence of adverse reactions between 2 groups（P〉0.05）.CONCLUSIONS：Valsartan combined with prednisone can significantly improve the pulmonary function of patients with idiopathic pulmonary fibrosis,and reduce the contents of serum inflammatory cytokines and matrix metalloproteinases,with good safety.