低分子肝素联合环磷酰胺治疗特发性间质性肺炎的临床研究

Clinical study on low molecular heparin combined with cyclophosphamide in treatment of idiopathic interstitial pneumonia

目的探讨低分子肝素联合环磷酰胺治疗特发性间质性肺炎的临床疗效。方法选取天津市海河医院2014年10月—2015年10月收治的特发性间质性肺炎患者60例,随机分为对照组(30例)和治疗组(30例)。对照组患者口服环磷酰胺片,25 mg/次,1次/d,每周增加25 mg,最大量150 mg/d,每治疗2周休息2周;治疗组治疗组在对照组的基础上皮下注射低分子肝素钙注射液,5 000 U/次,2次/d,每个月注射前两周,两组均治疗4个月。治疗后,观察两组临床–影像–生理评分(CRP)评分、动脉血氧分压(pO_2)和肺活量(VC)、血浆白介素-6(IL-6)和血清肿瘤坏死因子-α(TNF-α)水平以及治疗中不良反应发生情况。结果治疗后,两组的临床评分和生理评分均比治疗前显著降低(P<0.05),且治疗组降低的更为明显,两组比较差异具有统计学意义(P<0.05)。两组患者pO_2和VC均有所提高,同组治疗前后比较差异具有统计学意义(P<0.05)。且治疗后治疗组的pO_2和VC明显高于对照组,两组比较差异具有统计学意义(P<0.05)。两组的IL-6和TNF-α均较治疗前显著降低(P<0.05),且治疗组较对照组降低更为明显,两组比较差异具有统计学意义(P<0.05)。治疗组和对照组不良反应率分别为3.33%、16.67%,两组比较差异具有统计学意义(P<0.05)。结论低分子肝素联合环磷酰胺治疗特发性间质性肺炎患者临床效果显著,且不良反应少,具有一定的临床推广应用价值。

Objective To observe the clinical effect of low molecular heparin combined with cyclophosphamide in treatment of idiopathic interstitial pneumonia. Methods Patients（60 cases） with idiopathic interstitial pneumonia in Tianjin Haihe Hospital from October 2014 to October 2015 were randomly divided into control（30 cases） and treatment（30 cases） groups. Patients in control groupwere po administrated with Cyclophosphamide Tablets, 25 mg/time, once daily, increasing 25 mg every week, and the maximum dosage was 150 mg/d. They were treaed for 2 weeks and another 2 weeks for rest. Patients in the treatment groupwere sc administrated with Low Molecular Weight Heparin Calcium Injection on the basis of control group, 5 000 U/time, twice daily, and injection in the first two weeks of each month. The patients in two groups were treated for 4 months. After treatment, CRP scores, pO2 and VC, IL-6 and TNF-α, and adverse reaction between two groups were compared. Results After treatment, clinical and physiological scores in two groups were diminished more than those before treatment（P〈0.05）, and the two scores in the treatment groupdecreased more obviously than those in the control group, with significant difference between two groups（P〈0.05）. pO2 and VC in two groups were higher than those before treatment, and the differences were statistically significant in the same group（P〈0.05）. And pO2 and VC in the treatment groupwere higher than those in control groupwith significant difference between two groups（P〈0.05）. The levels of IL-6 and TNF-α in two groups were lower than those before treatment（P〈0.05）, and the observational indexes in the treatment groupdecreased more obviously than those in the control groupwith significant difference（P〈0.05）. The adverse reaction rates in the treatment and control groups were 3.33% and 16.67%, respectively, and there were significant difference between two groups（P〈0.05）. Conclusion Low molecular heparin combined with cyclophosphamide has a significant clinical effect in treatment of idiopathic interstitial pneumonia with little adverse reaction, which has a certain clinical application value.