CAJ | 학술논문

目的探讨糖皮质激素治疗特发性非特异性间质性肺炎(INSIP)的疗效及预后.方法选择经临床、影像学和病理学(CRP)诊断的INSIP患者29例,根据有无纤维化分为INSIP-1组(富细胞型,9例)和INSIP-2组(混合型和纤维化型,20例),经CRP诊断的30例普通型间质性肺炎(UIP)患者作为对照组(UIP组),回顾性分析3组患者糖皮质激素治疗的疗效及随访结果,用Kaplan-Meier法估计生存曲线.结果 INSIP-1组的发病中位年龄(48.0岁)低于INSIP-2组(56.0岁)和UIP组(58.5岁),INSIP-1组的病程[(60±28)个月]长于INSIP-2组[(48±33)个月]和UIP组[(44±23)个月],但差异无统计学意义(F=1.22,P＞0.05);INSIP-1组糖皮质激素有效例数(9/9)明显高于INSIP-2组(11/20)和UIP组(2/30),差异均有统计学意义(均P＜0.05);INSIP-1组随访时间[(56±27)个月]明显长于INSIP-2组[(23±18)个月]和UIP组[(25±17)个月],显效例数(6/9)明显高于INSIP-2组(9/20)和UIP组(0/30),差异均有统计学意义(F=9.224,均P＜0.05),死亡例数(0/9)明显低于INSIP-2组(4/20)和UIP组(16/30),差异有统计学意义(均P＜0.05).结论 INSIP纤维化程度与糖皮质激素疗效和预后密切相关,糖皮质激素治疗富细胞型INSIP有较好的反应和预后,纤维化型INSIP的预后较差,明确诊断和分型具有重要的临床意义.
목적 탐토당피질격소치료특발성비특이성간질성폐염(INSIP)적료효급예후.방법 선택경림상、영상학화병이학(CRP)진단적INSIP환자29례,근거유무섬유화분위INSIP-1조(부세포형,9례)화INSIP-2조(혼합형화섬유화형,20례),경CRP진단적30례보통형간질성폐염(UIP)환자작위대조조(UIP조),회고성분석3조환자당피질격소치료적료효급수방결과,용Kaplan-Meier법고계생존곡선.결과 INSIP-1조적발병중위년령(48.0세)저우INSIP-2조(56.0세)화UIP조(58.5세),INSIP-1조적병정[(60±28)개월]장우INSIP-2조[(48±33)개월]화UIP조[(44±23)개월],단차이무통계학의의(F=1.22,P＞0.05);INSIP-1조당피질격소유효례수(9/9)명현고우INSIP-2조(11/20)화UIP조(2/30),차이균유통계학의의(균P＜0.05);INSIP-1조수방시간[(56±27)개월]명현장우INSIP-2조[(23±18)개월]화UIP조[(25±17)개월],현효례수(6/9)명현고우INSIP-2조(9/20)화UIP조(0/30),차이균유통계학의의(F=9.224,균P＜0.05),사망례수(0/9)명현저우INSIP-2조(4/20)화UIP조(16/30),차이유통계학의의(균P＜0.05).결론 INSIP섬유화정도여당피질격소료효화예후밀절상관,당피질격소치료부세포형INSIP유교호적반응화예후,섬유화형INSIP적예후교차,명학진단화분형구유중요적림상의의.
Objective To investigate the efficacy of glucocorticoid therapy in idiopathic nonspecific interstitial pneumonia ( INSIP). Methods Twenty-nine cases of INSIP confirmed by clinical- radiological- pathological (CRP) diagnosis were collected and classified into 2 groups according to the degree of fibrosis; INSIP-1 (including 9 cases of cellular type) and INSIP-2 (20 cases of mixed and fibrotic type). Thirty cases of usual interstitial pneumonia (UIP) confirmed by CRP diagnosis served as the control. Clinical and pathological features, therapeutic effects of glucocorticoids and the follow-up results were retrospectively analyzed and the survival curves were evaluated by Kaplan-Meier method. Results The mean age at onset of INSIP-1 group [ (48 ±5) years] was significantly younger than INSIP-2 group [ (52 ±11) years] and the UIP group [ (57 ± 14) years]. The course of disease in INSIP-1 group [ (60 ±28) months] was longer than that in INSIP-2 group [(48 ±33) months] and that in the UIP group [(44 ±23) months], but the differences were not statistically significant (F = 1. 22, all P > 0. 05 ). The efficacy rate of glucocorticoid treatment in INSIP-1 group (9/9) was higher than that in INSIP-2 group (11/20) and that in the UIP group (2/30), the differences being statistically significant (all P < 0.05). The follow-up period for INSIP-1 group [ (56 ±27) months] was significantly longer than for INSIP-2 group [ (23 ±18) months] and for the UIP group [ (25 ± 17) months] , and the rate of significant improvement (6/9) was higher than that of the INSIP-2 group (9/20) and the UIP group (0/30) , the differences being statistically significant (F = 9. 224, all P <0. 05). The mortality of INSIP-1 group (0/9) was lower than that in INSIP-2 group (4/20) and the UIP group (16/30), the difference being statistically significant (exact propability value 0. 000 - 0. 005, P < 0. 05). Conclusions The degree of fibrosis of INSIP is closely correlated with the effect of glucocorticoid therapy and progonosis. The cellular type has a favorable reaction to glucocorticoid therapy and a better prognosis as compared to the fibrotic type.