尼达尼布治疗特发性肺纤维化92例对肺功能和肺纤维化指标的影响及不良反应分析

Effect of Nidanib on pulmonary function and fibrotic indicators in 92 patients with idiopathic pulmonary fibrosis and analysis of adverse reactions

目的观察尼达尼布治疗特发性肺纤维化(IPF)的临床疗效及不良反应。方法收集2019年11月至2021年1月在南阳市第二人民医院呼吸内科接受治疗的IPF病人144例,年龄(67.8±7.2)岁,男性103例,女性41例,根据临床治疗情况病人分为对照组52例,治疗组92例。收集病人入院时的一般临床资料、肺功能指标和肺纤维化指标。比较治疗12周后和治疗24周后,两组病人的肺功能指标、肺纤维化指标和不良反应率。结果治疗前,对照组和观察组病人的年龄、性别、吸烟情况、病程、肺功能指标和肺纤维化指标之间均差异无统计学意义(P>0.05)。对照组治疗24周后最大肺活量占预计值百分比(FVC%)(61.5±4.8)%低于治疗前(65.9±6.0)%,一氧化碳弥散量占预计值百分比(DLCO%)(70.5±5.9)%低于治疗前(75.9±5.7)%,均P<0.05。观察组治疗24周后FVC%(54.7±3.8)%、FEV1%(50.7±3.9)%和DLCO%(59.6±6.0)%低于治疗前[(67.1±3.4)%、(66.8±4.6)%、(76.3±4.3)%],P<0.05。对照组治疗24周后Ⅳ型胶原(Ⅳ-C)(129.3±7.8)μg/L水平高于治疗前(124.3±5.6)μg/L,P<0.05。观察组治疗24周后Ⅲ型胶原(Ⅲ-C)(138.5±6.3)μg/L、Ⅳ-C(146.2±4.1)μg/L和透明质酸(HA)(164.3±8.0)μg/L的水平高于治疗前[(127.3±7.3)μg/L、(126.5±6.0)μg/L、(142.8±10.2)μg/L],均P<0.05。两组病人治疗后的不良反应发生率之间差异无统计学意义。结论尼达尼布可延缓特发性肺纤维化病人肺功能和肺纤维化的恶化,且治疗期间未增加不良反应率。

Objective To observe the clinical efficacy and adverse reactions of Nidanib in the treatment of idiopathic pulmonary fibrosis(IPF).Methods A total of 144 patients with IPF,aged(67.8±7.2)years,103 males and 41 females,treated in the Department of Respiratory Medicine in Nanyang Second People's Hospital from November 2019 to January 2021 were collected,and the patients were divided into 52 cases in the control group and 92 cases in the treatment group according to clinical treatment.The general clinical data,pulmonary function and fibrotic indicators of the patients at the time of admission were enrolled.Pulmonary function and fibrosis indicators as well as the rate of adverse reactions were compared between the two groups of patients after 12 weeks of treatment and after 24 weeks of treatment.Results Before treatment,there was no statistically significant difference between age,sex,smoking status,duration of disease,pulmonary function and fibrotic indicators between patients in the control and observation groups(P>0.05).In the control group,the maximum vital capacity as a percentage of the predicted value(FVC%)(61.5±4.8)%was lower than that before treatment(65.9±6.0)%,and the diffusion of carbon monoxide as a percentage of the predicted value(DLCO%)(70.5±5.9)%was lower than that before treatment(75.9±5.7)%after 24 weeks of treatment,P<0.05.After 24 weeks of treatment,the FVC%(54.7±3.8)%,FEV1%(50.7±3.9)%and DLCO%(59.6±6.0)%in the observation group were lower than before treatment[(67.1±3.4)%,(66.8±4.6)%,(76.3±4.3)%],P<0.05.The level of typeⅣcollagen(Ⅳ-C)(129.3±7.8)μg/L was higher in the control group after 24 weeks of treatment than before treatment(124.3±5.6μg/L,P<0.05).The levels of typeⅢcollagen(Ⅲ-C)(138.5±6.3)μg/L,IV-C(146.2±4.1)μg/L and hyaluronic acid(HA)(164.3±8.0)μg/L were higher than those before treatment[(127.3±7.3)μg/L,(126.5±6.0)μg/L,(142.8±10.2)μg/L],all at P<0.05.There was no significant difference between the incidence of adverse reactions after treatment in the two groups of patients.Conclusion Nedanib delayed the deterioration of lung function and pulmonary fibrosis in patients with IPF and did not increase the rate of adverse reactions during treatment.