不同剂量激素联合伏立康唑治疗过敏性支气管肺曲霉病的临床疗效

Clinical effects of different doses of hormones combined with voriconazole in the treatment of ABPA

目的探讨不同剂量激素联合伏立康唑治疗过敏性支气管肺曲霉病(ABPA)患者的临床效果及安全性。方法选取2017年7月至2020年12月我院呼吸内科收治的120例ABPA患者为研究对象,依据治疗方法不同分为对照组(常规剂量激素联合伏立康唑治疗,62例)及观察组(低剂量糖皮质激素联合伏立康唑治疗,58例),比较两组疗效,治疗前后两组血清学指标变化(IgE、白细胞计数和嗜酸性粒细胞计数)、肺功能指标[用力肺活量(FVC)、第1秒用力呼吸量(FEV1)、最大自主通气量(MVV)],同时比较两组药物安全性。结果观察组总有效率与对照组比较差异无统计学意义(P>0.05)。与同组治疗前比较,治疗后两组IgE、白细胞计数和嗜酸性粒细胞计数明显降低(P<0.05),但治疗后组间比较差异无统计学意义(P>0.05)。观察组临床症状消失时间与对照组比较差异无统计学意义(P>0.05)。两组治疗后FVC、FEV1、MVV较治疗前明显升高(P<0.05),且观察组明显高于对照组(P<0.05)。观察组不良反应总发生率较对照组明显降低(P<0.05)。结论常规剂量与低剂量激素分别联合伏立康唑治疗ABPA患者的临床效果相当,低剂量激素联合伏立康唑治疗在降低患者IgE水平和保护肺功能方面的效果更优,且后者的药物安全性更高。

Objective To investigate the clinical effects and safety of different doses of hormones combined with voriconazole in the treatment of patients with allergic bronchopulmonary aspergillosis(ABPA).Methods A total of 120 patients with ABPA admitted to the department of respiratory medicine of our hospital between July 2017 and December 2020 were selected as study subjects.They were divided into control group(conventional-dose hormone combined with voriconazole,n=62)and observation group(low-dose hormone combined with voriconazole,n=58)according to the treatment method.Therapeutic effects,changes of serum indexes(IgE,white blood cell count and eosinophil count)and lung function indexes[forced vital capacity(FVC),forced expiratory volume in the first second(FEV1),maximum voluntary ventilation(MVV)]before and after treatment,and drug safety in the two groups were compared.Results There was no statistically significant difference in the total response rate between the two groups(P>0.05).After treatment,IgE,white blood cell count and eosinophil count were significantly reduced in the two groups(P<0.05),but there was no statistically significant difference between the two groups(P>0.05).There was no significant difference in the disappearance time of clinical symptoms between the two groups(P>0.05).After treatment,FVC,FEV1 and MVV in the two groups were significantly increased(P<0.05),and these indicators in the observation group were significantly higher than those in the control group(P<0.05).The total incidence of adverse reactions in the observation group was significantly lower than that in the control group(P<0.05).Conclusion Voriconazole combined with conventional-dose hormone or low-dose hormone can achieve equivalent clinical effects in the treatment of patients with ABPA and low-dose hormone combined with voriconazole is better in reducing IgE level and protecting lung function and has higher safety.