序贯式糖皮质激素治疗急性汞中毒并发间质性肺炎的临床研究

Clinical study of sequential glucocorticoids in the treatment of acute mercury poisoning complicated with interstitial pneumonia

目的:研究应用序贯式糖皮质激素治疗急性汞中毒并发间质性肺炎的临床疗效。方法:分析2009年1月至2019年4月收治的37例急性汞中毒并发间质性肺炎患者,分为序贯治疗组(15例)和常规治疗组(22例)。所有患者均给予二巯基丙磺酸钠驱汞治疗,并给予抗炎、保肝护胃等药物对症治疗;给予常规治疗组患者甲强龙(甲基强的松龙)1 mg/kg 1次/d,连用5~7 d后停药;序贯治疗组先给予甲强龙1 mg/kg 1次/d,连用5~7 d后逐渐减量至20 mg停药,总疗程14~21 d。比较两组患者治疗前后临床症状、体征、肺功能[用力肺活量(FVC)、第一秒用力呼气容积(FEV 1)、第一秒用力呼气容积占用力肺活量比值(FEV 1/FVC)]及胸部CT指标的变化。结果:两组患者的临床症状和体征均较治疗前明显改善,且两组治疗显效率和总有效率差异均无统计学意义(P>0.05);两组患者治疗后FVC、FEV 1、FEV 1/FVC均较治疗前明显升高,且序贯治疗组治疗后各指标明显高于常规治疗组,差异均有统计学意义(P<0.05);序贯治疗组胸部CT病灶吸收显效率(93.3%,14/15)明显高于常规治疗组(59.1%,13/22),差异有统计学意义(P<0.05)。结论:序贯式糖皮质激素治疗急性汞中毒并发间质性肺炎在临床症状和体征的改善上等同于常规治疗,但可以更好地促进肺功能的恢复及肺部病灶的吸收。

Objective To study the clinical efficacy of sequential glucocorticoids in the treatment of acute mercury poisoning complicated with interstitial pneumonia.Methods Retrospective analysis of 37 patients with acute mercury poisoning complicated with interstitial pneumonia admitted from January 2009 to April 2019,including the sequential treatment group(15 cases)and the conventional treatment group(22 cases),all patients were treated with sodium dimercaptopropane sulfonate,and given anti-inflammatory,liver-protecting and other drugs for symptomatic treatment.The conventional treatment group was given methylprednisolone 1mg/kg once a day for 5-7 days.The sequential treatment group was given 1 mg/kg of methylprednisolone once a day for 5-7 days,then gradually reduced to 20 mg,and the total course of treatment was 14-21 days.To observe the changes of clinical symptoms,signs,lung function including forced vital capacity(FVC),forced expiratory volume in the first second(FEV1)and ratio of forced expiratory volume in the first second to forced vital capacity(FEV1/FVC),and chest CT indexes before and after treatment in the two groups.Results The clinical symptoms and signs of the two groups were significantly improved compared with those before treatment,and there was no significant difference between the apparent efficiency and the total effective rate of the two groups(P>0.05).The FVC,FEV1,and FEV1/FVC of the two groups were significantly higher than those before treatment.After treatment,the indexes of the sequential treatment group were significantly higher than that of the conventional treatment group,and the difference was statistically significant(P<0.05).The apparent efficiency(93.3%,14/15)of CT lesions in the sequential treatment group was significantly higher than those of the conventional treatment group(59.1%,13/22),and the difference was statistically significant(P<0.05).Conclusion Sequential glucocorticoid treatment of acute mercury poisoning complicated with interstitial pneumonia could improve the effect of clinical signs and symptoms which is equal to conventional treatment,but it could better promote the recovery of lung function and the absorption of lung lesions.