CAJ | 학술논문

目的：观察血必净联合糖皮质激素治疗特发性肺纤维化急性加重（AE-IPF）的临床疗效。方法38例AE-IPF患者随机分为联合组和激素组，分别给予血必净联合糖皮质激素及单药糖皮质激素治疗，观察3个月，比较两组临床治疗结果、氧合指数及CT评分等方面的差异。结果38例AE-IPF患者的总体死亡率为44.74％，且联合组的死亡率和机械通气发生率明显低于激素组，差异均有统计学意义（χ2分别=5.17、4.86，P均＜0.05）。联合组二次AE发生率虽低于激素组，但差异无统计学意义（χ2=2.39，P＞0.05）。联合组第14天和第28天氧合指数均较第一天明显提高，差异均有统计学意义（t分别=3.59、2.87，P均＜0.05），但第28天较第14天无明显进一步改善，差异无统计学意义（t=1.03，P＞0.05）。激素组与联合组类似，但两组之间比较，联合组在第14天及第28天均较激素组改善明显，差异均有统计学意义（t分别=2.74、3.11，P均＜0.05）。联合组和激素组治疗1月后的CT评分均较治疗前有所降低，差异均有统计学意义（t分别=3.48、3.92，P均＜0.05），但两组治疗1月后之间差异无统计学意义（t=0.86，P＞0.05）。结论血必净联合糖皮质激素较单用糖皮质激素治疗AE-IPF能够减少再次急性加重，改善氧合，利于预后。
목적：관찰혈필정연합당피질격소치료특발성폐섬유화급성가중（AE-IPF）적림상료효。방법38례AE-IPF환자수궤분위연합조화격소조，분별급여혈필정연합당피질격소급단약당피질격소치료，관찰3개월，비교량조림상치료결과、양합지수급CT평분등방면적차이。결과38례AE-IPF환자적총체사망솔위44.74％，차연합조적사망솔화궤계통기발생솔명현저우격소조，차이균유통계학의의（χ2분별=5.17、4.86，P균＜0.05）。연합조이차AE발생솔수저우격소조，단차이무통계학의의（χ2=2.39，P＞0.05）。연합조제14천화제28천양합지수균교제일천명현제고，차이균유통계학의의（t분별=3.59、2.87，P균＜0.05），단제28천교제14천무명현진일보개선，차이무통계학의의（t=1.03，P＞0.05）。격소조여연합조유사，단량조지간비교，연합조재제14천급제28천균교격소조개선명현，차이균유통계학의의（t분별=2.74、3.11，P균＜0.05）。연합조화격소조치료1월후적CT평분균교치료전유소강저，차이균유통계학의의（t분별=3.48、3.92，P균＜0.05），단량조치료1월후지간차이무통계학의의（t=0.86，P＞0.05）。결론혈필정연합당피질격소교단용당피질격소치료AE-IPF능구감소재차급성가중，개선양합，리우예후。
Objective To evaluated the efficacy of combination therapy of xubijing and corticosteroid for acute exacer-bation of idiopathic pulmonary fibrosis (AE-IPF). Methods A total of 38 cases of AE-IPF were divided into combination group and corticosteroid group which were given corticosteroid whether combined with xuebijing or not. The partial pressure of arterial oxygen/fraction of inspired oxygen ratio and computed tomography score were also assessed. Results The overall mortality of 38 patients with AE-IPF was 44.74%. The mortality rate and incidence of mechanical ventilation of combina-tion group were significantly lower than that of corticosteroid group (χ2=5.17,4.86,P<0.05). The AE reoccurrence rate of combination group was lower than that of corticosteroid group, but the difference was no statistically significant (χ2=2.39, P>0.05). The P/F ratio of combination group on 28th day and 14th day were significantly higher than that of the 1st day (t=3.59,2.87,P<0.05), but there was no further improvement on 28th day compared with 14th day(t=1.03,P>0.05). The P/F ratio of combination group was significantly improved on 14th day and 28th day compared to corticosteroid group, the difference was statistically significant(t=2.74,3.11,P<0.05). CT scores of combination group and corticosteroid group were both reduced after treatment for 1 month, the differences were statistically significant (t=3.48,3.92,P<0.05) while the CT scores after treatment for 1 month between the two groups was not statistically different (t=0.86,P>0.05). Conclusion The combination therapy of xuebijing and corticosteroid for AE-IPF can prevent re-acute exacerbation, improve P/F ratio and contribute to a better prognosis.