Abstract:

Objective　To observe the efficacy and safety of bronchoalveolar lavage (BAL) combined with glucocorticoids in the treatment of patients with acute exacerbation of idiopathic pulmonary fibrosis (IPF). Methods　One hundred and twenty-three patients with acute exacerbation of IPF who received treatment at Zhumadian Central Hospital from January 2021 to October 2022 were selected for the randomized controlled trial. The patients were divided a control group (61 cases) and an observation group (62 cases) by lottery. There were 40 males and 21 females in the control group; they were (60.45±5.25) years old. There were 42 males and 20 females in the observation group; they were (61.25±5.36) years old. The control group took glucocorticoids, and the observation group BAL and glucocorticoids. The improvement and prognosis of pulmonary fibrosis were compared between the two groups before and after the treatment. t and χ² tests were applied. Results　Before the treatment, there were no statistical differences in the pulmonary fibrosis score (Ashcroft) and pulmonary fibrosis indicators between the two groups (all P>0.05). Three, seven, and fourteen days after the treatment, the Ashcroft scores in the observation group were lower than those in the control group [(4.45±1.22) vs. (5.33±1.25), (3.05±0.27) vs. (4.24±1.33), and (2.28±0.47) vs. (3.31±0.46); all P<0.05]. After the treatment, the levels of heme oxygenase-1 (HO-1), intercellular adhesion molecule-1 (ICAM-1), and hyaluronic acid (HA) in the observation group were lower than those in the control group [(45.25±10.37) ng/L vs. (51.72±10.36) ng/L, (64.48±10.45) ng/L vs. (70.44±10.28) ng/L, and (9.25±2.36) μg/L vs. (12.75±3.44) μg/L; all P<0.05]. The incidence of adverse events in the observation group was lower than that in the control group [9.68% (6/62) vs. 21.31% (13/61); P<0.05]. The incidence of treatment related complications in the observation group was slightly higher than that in the control group [8.06% (5/62) vs. 6.56% (4/61); P>0.05]. Conclusion　BAL combined with glucocorticoids in the treatment of patients with acute exacerbation of IPF is of great significance in improving their conditions and prognosis, does not significantly increase the risk of complications, and has high safety.

Key words:

Idiopathic pulmonary fibrosis, Bronchoalveolar lavage, Glucocorticoids, Prognosis

摘要：

目的　观察支气管肺泡灌洗（BAL）结合糖皮质激素治疗急性加重期特发性肺纤维化（IPF）患者的效果及安全性。方法　选择2021年1月至2022年10月驻马店市中心医院收治的123例急性加重期IPF患者进行随机对照试验。采用抽签法将患者分为对照组（61例）和观察组（62例）。对照组男40例，女21例，年龄（60.45±5.25）岁；观察组男42例，女20例，年龄（61.25±5.36）岁。对照组糖皮质激素治疗，观察组BAL结合糖皮质激素治疗。比较两组患者治疗前后肺纤维化改善情况及预后情况。采用t检验和χ²检验。结果　治疗前，两组肺纤维化评分（Ashcroft）、肺纤维化指标差异均无统计学意义（均P>0.05）。治疗3、7、14 d后，观察组Ashcroft评分均低于对照组［（4.45±1.22）分比（5.33±1.25）分、（3.05±0.27）分比（4.24±1.33）分、（2.28±0.47）分比（3.31±0.46）分，均P<0.05］。治疗后，观察组血红素氧合酶-1（HO-1）、细胞间黏附分子-1（ICAM-1）、透明质酸（HA）水平均低于对照组［（45.25±10.37）ng/L比（51.72±10.36）ng/L、（64.48±10.45）ng/L比（70.44±10.28）ng/L、（9.25±2.36）μg/L比（12.75±3.44）μg/L，均P<0.05］。观察组不良事件发生率低于对照组［9.68%（6/62）比21.31%（13/61），P<0.05］。观察组治疗相关并发症发生率略高于对照组［8.06%（5/62）比6.56%（4/61），P>0.05］。结论　采用BAL配合糖皮质激素治疗急性加重期IPF对改善患者肺纤维化病情及预后有重要意义，且未明显增加并发症发生风险，安全性高。

关键词:

特发性肺纤维化, 支气管肺泡灌洗, 糖皮质激素, 预后