“天龙竭”论治方案对晚期特发性肺间质纤维化患者肺功能及血清涎液化糖链抗原-6、趋化因子18的影响

Effect of “Tianlongjie” treatment scheme on pulmonary function and serum krebs von den lungen-6 and chemokine cc-motif ligand 18 in patients with advanced idiopathic pulmonary fibrosis

目的 探讨“天龙竭”论治方案对特发性肺间质纤维化(IPF)晚期患者肺功能及血清涎液化糖链抗原-6(KL-6)、血清趋化因子18(CCL18)的影响。方法 采用随机双盲双模拟对照临床研究方法,将2020年1月至2021年1月云南中医药大学第三附属医院呼吸病学危重症医学专科36例晚期IPF患者,采用随机数字表法分为试验组和对照组,各18例。试验组采用“天龙竭”分期治疗方案,对照组采用吡非尼酮,疗程为3个月。观察治疗前后肺功能参数肺总量(TLC)、潮气量(TV)、单次呼吸法一氧化碳弥散(DLCO)及血清KL-6、CCL18水平,进行高分辨率CT(HRCT)治疗前后评分,并观察安全性指标。结果 治疗后,两组TLC、TV与治疗前比较及组间比较,差异无统计学意义(P>0.05),两组DLCO较治疗前升高,且试验组高于对照组,差异有统计学意义(P<0.05)。治疗后,两组HRCT评分与治疗前比较及组间比较,差异无统计学意义(P>0.05)。治疗后,两组治疗血清KL-6、CCL18水平较治疗前降低,差异有统计学意义(P<0.05)。两组治疗前后血清KL-6、CCL18水平比较,差异无统计学意义(P>0.05)。在治疗过程中,两组均未出现明显不良反应。结论 运用“天龙竭”方案可一定程度改善晚期IPF患者肺功能,并通过调控炎症反应稳定病情,临床应用安全有效。

Objective To evaluate the effect of “Tianlongjie”treatment scheme on pulmonary function and serum krebs von den lungen-6(KL-6) and chemokine cc-motif ligand 18(CCL18) in patients with advanced idiopathic pulmonary fibrosis(IPF).Methods A randomized,double-blind,double-dummy controlled clinical trial was conducted,a total of 36 patients with advanced IPF,which were all from the Department of Pulmonary Critical Care Medicine,the Third Affiliated Hospital of Yunnan University of Chinese Medicine were divided into the experimental group and the control group with the method of simple randomization,with 18 cases in each group.The experimental group was treated with Tianlongjie,while the control group was treated with Pirfenidone,the course of treatment was three months.Pulmonary function index,including total lung capacity(TLC),tidal volume(TV),and diffusion capacity of carbon monoxide(DLCO),serum KL-6 and CCL18 level were observed before and after treatment.Before and after treatment patients were scored by high resolution CT.Safety indexes were observed.Results After treatment,there was no statistical significance in TLC and TV between the two groups compared with before treatment and between the two groups(P>0.05),DLCO between the two groups was higher than those before treatment,and the experiment group was higher than the control group,the differences were statistically significant(P<0.05).After treatment,there was no significant difference in HRCT score in the two groups compared with before treatment and between the two groups(P>0.05).After treatment,the levels of serum KL-6 and CCL18 in the two groups were lower than those before treatment,and the differences were statistically significant(P<0.05).There were no significant differences in serum KL-6 and CCL18 levels between the two groups before and after treatment(P >0.05).In the course of treatment,there were no adverse reactions in both groups.Conclusion“Tianlongjie”treatment scheme improved lung function to some extent in advanced IPF.And the scheme stabilized the condition by regulating inflammatory response.The scheme is safe and reliable in the treatment of IPF.