小剂量糖皮质激素、N-乙酰半胱氨酸联合有氧抗阻肺康复疗法治疗特发性肺纤维化的临床疗效及对相关炎症介质表达的影响

Clinical observation of idiopathic pulmonary fibross treating with pulmonary rehabilitation combined with N⁃acetyl cysteine

目的探讨小剂量糖皮质激素、N-乙酰半胱氨酸(Nac)联合有氧抗阻肺康复治疗对特发性肺纤维化(IPF)患者临床疗效及对相关炎症介质表达的影响。方法将72例IPF患者随机分为治疗组与对照组各36例,在进行肺康复治疗的同时,治疗组给予小剂量糖皮质激素泼尼松片、Nac持续口服6个月。对两组患者的临床疗效、肺功能变化情况、生活质量评估(MMRC、CAT)以及炎症介质表达差异进行分析比较。结果治疗前两组患者第1秒用力呼气容积(FEV1)、MMRC、CAT评分以及炎症介质表达均无显著差异,治疗6个月后比较发现,治疗组临床有效率明显高于对照组(P <0.05),MMRC、CAT评分均优于对照组(P <0.05)。治疗后两组患者白细胞介素-8(IL-8)、肿瘤坏死因子(TNF-α)差异明显(P <0.05)。结论 IPF患者,应用小剂量糖皮质激素、Nac联合有氧抗阻肺康复治疗效果显著,可降低炎症因子释放,提高患者生活质量,临床上值得推广。

Objective Observing clinical efficacy and the changes in inflammatory response mediators with idiopathic pulmonary fibross(IPF)after treating with pulmonary rehabilitation combined with N⁃acetyl cysteine(Nac)and low dose of glucocorticoid.Methods 72 IPF patients were randomly divided into two groups.36 patients in conventional therapy group was given symbicort turbuhaler combined with low dose of glucocorticoid and Nac as the basic treatment.36 patients in treating group was treated with pulmonary rehabilitation on the basis of conventional therapy.The clinical efficacy,the influence on pulmonary function and quality of life,and the inflammatory response mediators of these two groups were observed.Results The clinic effective rates of conventional therapy group,treating group were 77.8%and 94.4%individually,which had a statistical significance(P<0.05).Symptom scor⁃ing,quality of living evaluation,pulmonary function index(FEV1、FVC)and changes of inflammatory factors were improved in treating group compared with that in conventional therapy group(P<0.05).Conclusion IPF patients treating with pulmonary rehabilitation combined with Nac showed significantly improvement in clinical effi⁃cacy,pulmonary function and quality of life,which also decreasing inflammatory factors expression and restores corticosteroid responses in IPF.