吡非尼酮对重型新型冠状病毒肺炎患者肺纤维化的治疗作用

The therapeutic effect of pirfenidone on pulmonary fibrosis in patients with severe novel coronavirus pneumonia

目的探讨吡非尼酮对重型新型冠状病毒肺炎(简称新冠肺炎)患者肺纤维化的治疗作用。方法选择重型新冠肺炎患者80例,随机分为2组,每组各40例。在患者肺部出现肺间质纤维化时口服乙酰半胱氨酸为对照组;在患者肺部出现肺间质纤维化时口服吡非尼酮为观察组。动态测定2组患者口服抗纤维化药时、2周、1个月、3个月、6个月后血清KL-6、血浆IL-6、TGF-β1和TNF-α、动脉血气,胸部HRCT、肺功能、6 min步行距离、呼吸困难评分,比较2组间的差异。结果口服抗纤维化药时,2组患者血清KL-6、血浆IL-6、TGF-β_(1)、TNF-α、PaO_(2)、氧合指数、胸部HRCT评分、FEV_(1)、FVC、6 min步行距离、呼吸困难评分差异均无统计学意义(P>0.05);2周、1个月、3个月、6个月后,上述各指标两组差异均有统计学意义(P<0.05)。观察组患者进行组内比较,3个月、6个月后与口服抗纤维化药时、2周、1个月后两两比较,上述各指标差异均有统计学意义(P<0.05)。结论吡非尼酮可以抑制重型新冠肺炎患者血中炎症因子、改善氧合、肺功能、延长6 min步行距离、降低呼吸困难评分,对重型新冠肺炎患者肺纤维化具有一定的治疗作用。

Objective To investigate the therapeutic efficacy of pirfenidone on pulmonary fibrosis in patients with severe COVID-19 pneumonia.Methods A total of 80 patients with severe COVID-19 pneumonia were selected as participants.They were divided into 2 groups,with 40 patients in each group.The patients who underwent oral n-acetylcysteine when pulmonary interstitial fibrosis occurred were assigned into the control group,whereas the patients who underwent oral pirfenidone when pulmonary interstitial fibrosis occurred were assigned into the treatment group.The inflammatory cytokines related to pulmonary fibrosis(serum KL-6,plasma IL-6,TGF-β_(1)and TNF-α),arterial blood gas,chest HRCT,lung function,6-minute walking distance and dyspnea score were dynamically measured at the initiation of oral antifibrotic regimen,after 2 weeks,1 month,3 months,and months were compared.Results There were no statistically significant differences in serum KL-6,plasma IL-6,TGF-β_(1),TNF-α,PaO_(2),oxygenation index,chest HRCT score,FEV_(1),FVC,6-minute walking distance or dyspnea score at the initiation of oral antifibrotic treatment between two groups(P>0.05).The differences of the aforementioned variables two weeks,1 month,3 months and 6 months after the antifibrotic treatment were statistically significant between two groups(P<0.05).Pairwise comparison of the abovementioned variables showed statistically significant differences between the patients 3 or 6 months after the antifibrotic treatment and the patients at the initiation of antifibrotic treatment,2 weeks and 1 month after the antifibrotic treatment(P<0.05).Conclusion Pirfenidone can inhibit inflammatory cytokines,improve oxygenation and lung function,prolong 6-minute walking distance,and reduce dyspnea score in patients with severe COVID-19 pneumonia.It has certain therapeutic efficacy on pulmonary fibrosis in patients with severe COVID-19 pneumonia.