低分子肝素联合乙酰半胱氨酸治疗特发性间质性肺炎的疗效分析

doi:10.3969/j.issn.1006-6233.2020.06.036

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摘要目的:探讨低分子肝素联合乙酰半胱氨酸(AC)治疗特发性间质性肺炎(IIP)的疗效分析。方法:选取2016年1月至2019年2月我院收治的62例IIP患者,随机数字表法分为两组进行前瞻性研究,各31例。对照组给予综合治疗,观察组在此基础上加用低分子肝素联合AC,比较两组总有效率、肺功能指标[最大自主通气量(MVV)、肺总量(TLC)、用力肺活量(FVC)、单位肺泡容积的一氧化碳弥散量占预计值百分比(DLco/VA% pred)]、血气指标[动脉血氧分压(PaO₂)、动脉血二氧化碳分压(PaCO₂)]、血清转化生长因子-β1(TGF-β1)、涎液化糖链蛋白6(KL-6)、过氧化物酶体增殖物激活受体γ(PPARγ)水平、不良反应,并采用Pearson分析治疗前血清TGF-β1、KL-6、PPARγ与治疗前临床-影像-生理(CRP)的相关性。结果:观察组治疗后CRP评分降低幅度大于对照组,总有效率(83.87%)高于对照组(61.29%,P<0.05);观察组治疗后MVV、TLC、FVC、DLco/VA% pred升高幅度高于对照组(P<0.05);观察组治疗后PaO₂高于对照组,PaCO₂低于对照组(P<0.05);观察组治疗后血清TGF-β1、KL-6降低幅度大于对照组,PPARγ升高幅度高于对照组(P<0.05);治疗前血清TGF-β1、KL-6与治疗前CRP评分呈正相关,治疗前血清PPARγ与治疗前CRP评分呈负相关(P<0.05)。结论:低分子肝素联合AC治疗IIP,可抑制肺纤维化进程,改善患者临床症状体征、血气指标,提高肺功能,疗效显著,其机制可能与上调PPARγ、下调TGF-β1与KL-6有关。

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	蔡燕
	宋林峰
	王璐

关键词 ：特发性间质性肺炎, 低分子肝素, 乙酰半胱氨酸, 肺功能, KL-6, PPARγ

Abstract：Objective:To investigate the efficacy of low molecular heparin combined with acetylcysteine (AC) in the treatment of idiopathic interstitial pneumonia (IIP). Methods: A total of 62 patients with IIP treated in the First Hospital of Dandong City from January 2016 to February 2019 were selected and were divided into two groups for prospective study, 31 cases each, with the random number table method. The control group was given comprehensive treatment, and the observation group was added with low-molecular-weight heparin combined with AC. On the basis of this, the total effective rate, pulmonary function indicators [maximum voluntary ventilation (MVV), total lung capacity (TLC), and forced vital capacity (FVC) of the two groups were compared. ], carbon monoxide dispersion per unit of alveolar volume as a percentage of predicted value (DLco / VA% pred)], blood gas indicators [arterial blood oxygen partial pressure (PaO₂), arterial blood carbon dioxide partial pressure (PaCO2)], serum transforming growth factor-β1 (TGF-β1), sialylated glycin 6 (KL-6), peroxisome proliferator-activated receptor gamma (PPARγ) levels, adverse reactions,are compared. And Pearson analysis was performed to analyze the correlation between serum TGF-β1, KL-6, PPARγ before treatment and pre-treatment clinical-imaging-physiological (CRP). Results: The CRP score of the observation group after treatment was lower than that of the control group, and the total effective rate (83.87%) was higher than that of the control group (61.29%, P <0.05). The MVV, TLC, FVC, and DLco / VA% pred of the observation group were higher than the control group after treatment (P <0.05); PaO₂ was higher in the observation group after treatment, PaCO₂ was lower than the control group (P <0.05); serum TGF-β1, KL-6 were lower in the observation group after treatment, and PPARγ was higher than the control group. (P <0.05); serum TGF-β1 and KL-6 before treatment were positively correlated with CRP score before treatment, and serum PPARγ before treatment was negatively correlated with CRP score before treatment (P <0.05). Conclusion:Low-molecular-weight heparin combined with AC in the treatment of IIP can significantly effectively inhibit the progression of pulmonary fibrosis, improve clinical symptoms and blood gas indicators, and improve pulmonary function. The mechanism may be related to up-regulation of PPARγ and down-regulation of TGF-β1 and KL-6

Key words： Low-molecular-weight heparin Acetylcysteine Idiopathic interstitial pneumonia Lung function KL-6 PPARγ

基金资助:辽宁省卫生厅科研项目,(编号:B2018-L138)

引用本文:

蔡燕, 宋林峰, 王璐. 低分子肝素联合乙酰半胱氨酸治疗特发性间质性肺炎的疗效分析[J]. 河北医学, 2020, 26(6): 1039-1044.
CAI Yan, SONG Linfeng, WANG Lu. Analysis of the Efficacy of Low Molecular Weight Heparin Combined with Acetylcysteine in the Treatment of Idiopathic Interstitial Pneumonia. HeBei Med, 2020, 26(6): 1039-1044.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2020.06.036 或 http://www.hbyxzzs.cn/CN/Y2020/V26/I6/1039

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