吡非尼酮对新冠后肺纤维患者的抗纤维化作用研究

Study on the antifibrotic effect of pirfenidone on patients with post-COVID-19 pulmonary fibrosis

目的探讨吡非尼酮对新冠后肺纤维患者抗纤维化作用。方法选择2023年1—6月在本院呼吸与危重症医学科住院及门诊的60例新冠后肺纤维患者为研究对象,按照药物的不同分为观察组和对照组两组,每组各30例。口服吡非尼酮组患者作为观察组;口服乙酰半胱氨酸患者作为对照组。比较两组患者入院时、1个月后、3个月后、6个月后外周血与肺纤维化形成有关的细胞因子(血清KL-6、TGF-β1和TNF-α)、动脉血气,胸部HRCT评分、肺功能指标差异。结果(1)两组患者KL-6、TGF-β1和TNF-α在1个月后、3个月后、6个月后均呈下降趋势,同一时间段观察,与对照组相比,观察组上述指标下降更明显,均具有统计学差异(P<0.05);(2)观察组患者的PaO_(2)、用力肺活量占(FVC)、一氧化碳弥散量占预计值百分比(DLCO%pred)呈逐渐升高趋势,对照组患者的上述指标呈轻微下降趋势,同一时间点,两组比较均具有统计学差异(P<0.05);(3)不同时间点的胸部HRCT评分有差异,从入院1个月开始,两组胸部HRCT评分逐渐下降,两两比较均有统计学差异(P<0.05);两组胸部HRCT评分有差异,观察组组在1个月、3个月及6个月后胸部HRCT评分均明显高于对照组(P<0.05)。结论吡非尼酮可以抑制新冠后肺纤维化患者血中促纤维化因子、改善患者的氧合、肺功能,对新冠后肺纤维化患者具有抗纤维化作用。

Objective To investigate the anti-fibrosis effect of pirfenidone on patients with post-COVID-19 pulmonary fibrosis.Methods A total of 60 patients with post-COVID-19 pulmonary fibrosis from the Department of Respiration and Critical Care Medicine at the First Affiliated Hospital of Bengbu Medical University from January 2023 to June 2023 were selected.They were divided into an observation group and a control group,each with 30 cases.The observation group received pirfenidone orally,while the control group received oral acetylcysteine.Cytokines related to pulmonary fibrosis formation in peripheral blood(serum KL-6,TGF-β1,and TNF-α),arterial blood gas,chest HRCT scores,and pulmonary function indices were compared at admission and at 1,3,and 6 months post-admission.Results KL-6,TGF-β1 and TNF-αof patients in both groups showed a decreasing trend after 1 month,3 months and 6 months,and the above indexes in the observation group decreased more significantly compared with the control group in the same time period,with statistical differences(P<0.05).PaO_(2),forced vital capacity(FVC),and CO diffusion capacity(DLCO%pred)of patients in the observation group showed a gradually increasing trend,while those in the control group showed a slight decreasing trend,and there were statistical differences between the two groups at the same time point(P<0.05).There were significant differences in chest HRCT scores at different time points.Since 1 month after admission,the chest HRCT scores of the two groups gradually decreased,and there were statistical differences in pairwise comparison(P<0.05).The chest HRCT scores of the observation group were significantly higher than those of the control group after 1 month,3 months and 6 months(P<0.05).Conclusions Pirfenidone can inhibit profibrotic factors in the blood,improve oxygenation and lung function in patients with post-COVID-19 pulmonary fibrosis,and has an anti-fibrotic effect on these patients.