吡非尼酮胶囊联合糖皮质激素治疗特发性肺间质纤维化的效果

Efficacy of Pirfenidone Capsules Combined with Glucocorticoid in the Treatment of Idiopathic Pulmonary Fibrosis

目的观察特发性肺间质纤维化(IPF)患者接受吡非尼酮胶囊联合糖皮质激素治疗的临床效果。方法选取2018年1月至2020年10月于信阳市中心医院呼吸与危重症医学科接受治疗的92例IPF患者为研究对象,根据交替分组法将其分为对照组和研究组,每组46例。两组均接受常规对症治疗,对照组接受糖皮质激素治疗,研究组接受吡非尼酮联合糖皮质激素治疗,两组均治疗12周。观察两组临床疗效,比较两组治疗前及治疗12周后纤维化指标[血清Ⅳ型胶原(CⅣ)、Ⅲ型前胶原(PCⅢ)、透明质酸(HA)、层粘连蛋白(LN)]、肺功能[用力肺活量(FVC)、第1秒用力呼气量(FEV1)及一氧化碳弥散量(DLCO)]、炎症因子[肿瘤坏死因子-α(TNF-α)及白细胞介素-1β(IL-1β)]、生活质量[采用圣乔治呼吸问卷(SGRQ)],并统计两组不良反应情况。结果观察组临床总有效率高于对照组(P<0.05);治疗12周后,两组血清CⅣ、PCⅢ、HA、LN、TNF-α、IL-1β水平均低于治疗前,且研究组低于对照组,FVC、FEV1、DLCO高于治疗前,且研究组高于对照组(P<0.05);治疗12周后,两组症状、活动、对日常生活的影响评分均低于治疗前,且研究组低于对照组(P<0.05);两治疗期间不良反应发生率比较,差异无统计学意义(P>0.05)。结论吡非尼酮胶囊联合糖皮质激素治疗IPF具有良好临床效果,可降低炎症因子水平,减轻气道纤维化,利于肺功能改善,改善临床症状,提高患者生活质量,且联合治疗安全性较高。

Objective To observe the clinical effect of pirfenidone capsules combined with glucocorticoid in the treatment of patients with idiopathic pulmonary fibrosis(IPF).Methods A total of 92 patients with IPF treated in the Department of Respiratory and Critical Care Medicine,Xinyang Central Hospital from January 2018 to October 2020 were selected as the research subjects.According to the alternating grouping method,they were divided into control group and study group,with 46 cases in each group.Both groups received routine symptomatic treatment,the control group was treated with glucocorticoid,and the study group was treated with pirfenidone and glucocorticoid,both groups were treated for 12 weeks.The clinical efficacy of the two groups was observed.The fibrosis indexes[serum typeⅣcollagen(CⅣ),typeⅢprocollagen(PCⅢ),hyaluronic acid(HA),laminin(LN)],pulmonary function[forced vital capacity(FVC),forced expiratory volume in the first second(FEV1)and carbon monoxide diffusion volume(DLCO)],inflammatory factors[tumor necrosis factor-α(TNF-α)and interleukin-1β(IL-1β)],quality of life[St.George’s respiratory questionnaire(SGRQ)was used]between the two groups were compared before treatment and 12 weeks after treatment,and adverse reactions between the two groups were counted.Results The total effective rate of the study group was higher than that of the control group(P<0.05).After 12 weeks of treatment,the levels of serum CⅣ,PCⅢ,HA,LN,TNF-αand IL-1βin both groups were lower than those before treatment,and the study group were lower than the control group,the FVC,FEV1 and DLCO were higher than those before treatment,and the study group were higher than the control group(P<0.05).After 12 weeks of treatment,the scores of symptoms,activities and impact on daily life in both groups were lower than those before treatment,and the study group were lower than the control group(P<0.05).There was no statistical difference in the incidence of adverse reactions of both groups during treatment(P>0.05).Conclusion Pirfenidone capsules combined with glucocorticoid in the treatment of IPF has good clinical effect,which can reduce the level of inflammatory factors,reduce the airway fibrosis.It is beneficial to improve lung function,improve clinical symptoms,enhance patients’quality of life,and the safety of combined treatment is high.