丹红注射液联合乙酰半胱氨酸治疗特发性肺纤维化疗效评价

Therapeutic effect of Danhong injection combined with acetylcysteine on idiopathic pulmonary fibrosis

目的:观察丹红注射液联合乙酰半胱氨酸治疗特发性肺纤维化(idiopathic pulmonary fibrosis,IPF)的疗效及其对血清转化生长因子-β1(transforming growth factor-β1,TGF-β1)、血清超氧化物歧化酶(superoxide dismutase,SOD)、低氧诱导因子-1α(hypoxia-inducible factor-1α,HIF-1α)、丙二醛(malondialdehyde,MDA)的影响。方法:将120例IPF患者随机分为治疗组(n=60)和对照组(n=60)。对照组给予乙酰半胱氨酸口服,600mg/次,3/d;治疗组在对照组基础上联合丹红注射液30ml静脉滴注,1/d,疗程12周。观察两组治疗前后动脉血气、肺功能、肺纤维化指标变化情况。检测两组治疗前后血清TGF-β1、HIF-1α、SOD、MDA水平。结果:两组治疗后用力肺活量(forced vital capacity,FVC)、肺总量(total lung capacity,TLC)、第1秒率占预计值的百分比(forced expiratory volume in one second prediction,FEV1pred)、肺一氧化碳弥散量(lung diffusion capacity for carbon monoxide,DLCO)均较治疗前升高(P<0.05),且治疗组改善情况优于对照组(P<0.05);两组治疗后动脉血氧分压(arterial oxygen partial pressure,PaO2)、动脉血氧饱和度(arterial oxygen saturation,SaO2)均较治疗前升高,动脉血二氧化碳分压(arterial carbon dioxide partial pressure,PaCO2)较治疗前降低(P<0.05),且治疗组改善情况优于对照组(P<0.05);两组治疗后透明质酸(hyaluronic acid,HA)、层粘连蛋白(laminin,LN)、Ⅲ型前胶原(type Ⅲ procollagen,PCⅢ)和Ⅳ型胶原(type Ⅳ collagen,CⅣ)均较治疗前下降(P<0.05),且治疗组改善情况优于对照组(P<0.05);两组治疗后血清TGF-β1、HIF-1α、MDA含量均下降(P<0.05),SOD含量均升高,且治疗组改善情况优于对照组(P<0.05)。结论:丹红注射液联合乙酰半胱氨酸通过抑制炎症反应,纠正氧化(抗氧化)失衡,可延缓IPF患者肺纤维化进程。

Objective:To observe the efficacy of Danhong injection combined with acetylcysteine in the treatment of idiopathic pulmonary fibrosis(IPF)and the expression of transforming growth factor-β1(TGF-β1),serum superoxide dismutase(SOD),hypoxiainducible factor-1α(HIF-1α),malondialdehyde(MDA).Methods:A total of 120 patients with IPF were randomly divided into treatment group(n=60)and control group(n=60).The control group was given acetylcysteine orally,600 mg/time,3/d.The treatment group was given acetylcysteine combined with Danhong injection,30 ml intravenous drip,1/d,the course of treatment was 12 weeks.The changes of blood gas analysis,lung function and lung fiber index before and after treatment were observed.The levels of serum TGF-β1,HIF-1α,SOD and MDA before and after treatment were measured.Results:Forced vital capacity(FVC),total lung capacity(TLC),forced expiratory volume in one second prediction(FEV1 pred),lung diffusion capacity for carbon monoxide(DLCO)were increased after treatment in both groups,and the improvement of the treatment group was better than that of the control group(P <0.05).Arterial oxygen partial pressure(PaO2)and arterial oxygen saturation(SaO2)were increased,and arterial carbon dioxide partial pressure(PaCO2)was decreased after treatment in both groups,and improvement of the treatment group was better than that of the control group after treatment(P<0.05).Hyaluronic acid(HA),laminin(LN),type Ⅲ procollagen(PC Ⅲ)and type Ⅳ collagen(C Ⅳ)were decreased after treatment in both groups,and the improvement of the treatment group was better than that of the control group(P<0.05).The serum levels of TGF-β1,HIF-1αand MDA were decreased after treatment,and the SOD content was increased after treatment in both groups,the improvement of the treatment group was better than those of the control group(P <0.05).Conclusion:Danhong injection combined with acetylcysteine can inhibit the oxidative reaction,correct the oxidation/antioxidation imbalance,and delay the progression of pulmonary fibrosis in patients with IPF.