尼达尼布对特发性肺纤维化肺功能、肺纤维化程度及PDGF、PGE2、TGF-β1的影响

Influence of nintedanib on pulmonary function,pulmonary fibrosis degree and serum PDGF,PGE2 and TGF⁃β1 levels in patients with idiopathic pulmonary fibrosis

目的分析尼达尼布对特发性肺纤维化(idiopathic pulmonary fibrosis,IPF)患者肺功能、肺纤维化程度及血小板衍生细胞因子(platelet-derived growth factor,PDGF)、血清前列腺素E2(prostaglandin E2,PGE2)、血清转化生长因子-β1(transforming growth factor-β1,TGF-β1)水平的影响。方法选择2019年3月至2023年3月我院收治的IPF患者152例为对象,给予常规+吡非尼酮治疗65例为对照组,常规治疗基础上加用尼达尼布治疗87例为观察组。比较两组治疗后临床疗效和不良反应,比较两组治疗前后的肺功能、血管内皮功能、肺纤维化程度、促纤维化相关因子水平。结果观察组治疗后有效85例(97.70%)高于对照组58例(89.23%)(P<0.05)。两组不良反应差异无统计学意义(P>0.05)。两组治疗后肺功能指标、内皮源性一氧化氮(nitric oxide,NO)较治疗前提高,观察组FEV1[(2.05±0.23)vs.(1.88±0.27)]L,FVC[(2.14±0.21)vs.(1.93±0.27)]L,DLCO[(16.19±1.51)vs.(14.84±1.73)]ml/(min·mmHg),NO[(825.10±98.37)vs.(746.01±77.78)]nmol/L高于对照组(P<0.05);两组肺纤维化程度、血管内皮素-1(endothelin-1,ET-1)、促纤维化相关因子水平较治疗前降低,观察组ⅣC[(89.25±12.23)vs.(95.58±14.54)]ng/ml,HA[(185.44±23.01)vs.(197.23±27.17)]ng/ml,胸部CT影像学评分[(1.56±0.18)vs.(1.70±0.20)]分,ET-1[(57.78±10.05)vs.(70.14±10.53)]ng/L,PDGF[(136.85±61.07)vs.(217.47±67.12)]ng/L、PGE2[(258.57±50.28)vs.(329.28±71.43)]ng/L、TGF-β1[(159.41±115.91)vs.(236.92±137.89)]ng/L低于对照组(P<0.05)。结论尼达尼布能有效治疗IPF,改善肺功能、血管内皮功能指标、肺纤维化程度,降低促纤维化相关因子水平具有意义。

Objective To analyze the influence of nintedanib on pulmonary function,pulmonary fibrosis degree,serum platelet⁃derived growth factor(PDGF),prostaglandin E2(PGE2),and serum transforming growth factor⁃β1(TGF⁃β1)in patients with idiopathic pulmonary fibrosis(IPF).Methods 152 patients with IPF in the hospital were selected as the subjects from March 2019 to March 2023.65 patients who were treated with routine treatment+pirfenidone were included in control group,and 87 patients who received nintedanib based on routine treatment were enrolled as observation group.The clinical efficacy and adverse reactions after treatment and pulmonary function indicators,vascular endothelial function indicators,pulmonary fibrosis degree and pro⁃fibrosis⁃related factors before and after treatment were compared between both groups.Results After treatment,the total effective rate in observation group was higher than that in control group[85 cases(97.7%)vs.58 cases(89.2%)](P<0.05).There were no statistical differences in the adverse reactions between groups(P>0.05).The pulmonary function indicators and endothelial nitric oxide(NO)in both groups were enhanced after treatment than those before treatment,and FEV1[(2.05±0.23)vs.(1.88±0.27)]L,FVC[(2.14±0.21)vs.(1.93±0.27)]L,DLCO[(16.19±1.51)vs.(14.84±1.73)]ml/min·mmHg and NO[(825.10±98.37)vs.(746.01±77.78)]nmol/L were higher in observation group than those in control group(P<0.05).The pulmonary fibrosis degree,endothelin⁃1(ET⁃1)and pro⁃fibrosis⁃related factors were reduced in the two groups compared with those before treatment,andⅣC[(89.25±12.23)vs.(95.58±14.54)]ng/ml,HA[(185.44±23.01)vs.(197.23±27.17)]ng/ml,chest CT imaging score[(1.56±0.18)vs.(1.70±0.20)]points,ET⁃1[(57.78±10.05)vs.(70.14±10.53)]ng/L,PDGF[(136.85±61.07)vs.(217.47±67.12)]ng/L,PGE2[(258.57±50.28)vs.(329.28±71.43)]ng/L and TGF⁃β1[(159.41±115.91)vs.(236.92±137.89)]ng/L in observation group were lower compared to control group(P<0.05).Conclusion Nintedanib can effectively treat IPF,improve pulmonary function,vascular endothelial function indicators and pulmonary fibrosis degree,and reduce the levels of pro⁃fibrosis⁃related factors.