环孢素联合甲泼尼龙琥珀酸钠冲击对百草枯所致肺纤维化患者血清纤维化指标及尿β_2-MG mALB的影响

Effect of Cyclosporine Combined with Methylprednisolone Sodium Succinate on Serum Fibrosis Index and Urinary Beta 2-MG and mALB in Patients with Paraquat-induced Pulmonary Fibrosis

目的:研究环孢素联合甲泼尼龙琥珀酸钠冲击对百草枯所致肺纤维化患者血清纤维化指标及尿β2-微球蛋白(β2-MG)、微量白蛋白(m ALB)的影响。方法:收集2015年4月至2017年4月我院102例百草枯所致肺纤维化患者。按抽签法分为实验组(n=50)和对照组(n=52)。两组均给予胃肠道灌洗、补充营养、进行镇痛、抗生素、防治感染等常规治疗,实验组在此基础上,采用环孢素联合甲泼尼龙琥珀酸钠冲击治疗,环孢素注射液每次5mg/kg,甲泼尼龙琥珀酸钠每次1000mg,每天一次,治疗4天后减量。两组治疗疗程均为一周。观察两组血清纤维化指标透明质酸(HA)、层粘连蛋白(LN)、Ⅳ型胶原蛋白(CⅣ)及Ⅲ型前胶原,基质金属蛋白酶-9(MMP-9)、基质金属蛋白酶抑制物(T1MP-1)水平,尿β2-MG、m ALB水平,肺部高分辨率CT(HRCT)评分。结果:实验组HA、LN、CⅣ、PCⅢ水平显著低于对照组(P<0.05);MMP-9、T1MP-1水平显著低于对照组(P<0.05);β2-MG、m ALB水平显著低于对照组(P<0.05);HRCT评分显著低于对照组(P<0.05)。结论:环孢素联合甲泼尼龙琥珀酸钠冲击能够显著降低百草枯所致肺纤维化患者血清纤维化指标,缓解肺纤维化进程,可减少尿β2-MG、m ALB水平,减少肾功能损伤。

Objective： To study effect of cyclosporine combined with methylprednisolone on paraquat induced pulmonary fibrosis in patients with serum fibrosis index and its effects on urine Urinary beta 2-microspheres（ beta 2-MG） and microalbuminuria（ m ALB）. Methods： 102 patients of paraquat induced pulmonary fibrosis who received therapy from Apr. 2015 to Apr. 2017 in our hospital were selected as research objects.According to draw method,all the patients were divided into the experimental group（ n = 50） and the control group（ n = 52）. Two groups were given gastrointestinal lavage,nutritional supplements,analgesia,antibiotics,infection prevention and other conventional treatment,while the experimental group was on this basis,treated with cyclosporine combined with methylprednisolone,cyclosporin injection every time 5 mg/kg,methylprednisolone every time 1000 mg,once a day,after 4 days of treatment,decrease. Then serum fibrosis markers Hyaluronic acid（ HA）,laminin（ LN）,type IV collagen（ CIV） and type III procollagen,Matrix metalloproteinase-9（ MMP-9） and matrix metalloproteinase inhibitor（ T1 MP-1） levels,urinary beta 2-MG,m ALB levels,and Pulmonary high-resolution CT（ HRCT） scores were compared. Results： The levels of HA,LN,C,IV and PC III in the experimental group were significantly lower than the control group（ P〈0.05）; MMP-9,T1 MP-1 level were significantly lower than the control group（ P〈0.05）; β2-MG,m ALB level were significantly lower than the control group（ P〈0.05）; HRCT score were significantly lower than the control group（ P〈0.05）. Conclusion： Cyclosporin combined with methylprednisolone sodium succinate can significantly reduce the index of serum fibrosis in patients with paraquat induced pulmonary fibrosis,alleviate the process of pulmonary fibrosis,reduce the level of urinary beta 2-MG and m ALB,and reduce renal function damage.