来氟米特联合小剂量环磷酰胺治疗结缔组织病合并肺间质病变患者的临床观察

发布时间：2018-06-20 23:26

本文选题：结缔组织病 + 肺间质病变　；参考：《山西医科大学》2015年硕士论文

【摘要】：目的:1、观察来氟米特(LEF)联合小剂量环磷酰胺(CTX)对结缔组织病合并肺间质病变(CTD-ILD)的疗效;2、比较LEF联合小剂量CTX组及单用LEF组不同方案对CTD-ILD的疗效。方法:选取我科确诊的CTD-ILD患者32例,随机分为2组:单用药组(LEF)和联合用药组(LEF+小剂量CTX组)。收集临床资料:记录患者治疗前及治疗6个月后的临床表现(呼吸道症状、VelcroUp音)、ESR、血清表面活性蛋白(SP-A、SP-D)、肺功能(用力肺活量FVC和一氧化碳弥散DLCO)、肺高分辨率CT(HRCT)及不良反应,整理资料,统计分析。血清表面活性蛋白SP-A和SP-D的检测:清晨空腹采血,采集18例健康对照人群、32例CTD-ILD患者治疗前和治疗6个月后的外周静脉血2.0-3.0m L,离心后吸取上层血清,-80℃冰箱保存,避免血清反复冻融,标本收集齐后采用ELISA法集中测试。结果:1、临床表现:32例患者治疗前后以及不同用药组呼吸道症状及VelcroUp音的变化无差异,差异无统计学意义(P0.05);2、ESR:32例患者治疗后ESR较治疗前明显下降(P0.001),但不同用药组之间ESR水平无差异(P0.05);3、SP-A和SP-D:治疗后较治疗前SP-A水平明显下降(P0.05),且联合组较单用药组SP-A水平下降更显著(P0.001);治疗后与治疗前SP-D水平无差异(P0.05),但联合用药组SP-D水平较单用药组明显降低(P0.05);4、肺功能:联合用药组FVC水平较单用药组有明显改善(P0.05),DLCO改善无显著差异(P0.05);5、联合用药组肺HRCT较治疗前有明显改善;6、治疗6个月,在不良事件的发生方面联合用药组与单用药组相比无明显增多。结论:1、LEF联合小剂量CTX治疗CTD-ILD,能改善其ESR、SP-A及FVC;2、联合用药组能有效降低CTD-ILD特异的血清学标志物SP-A和SP-D;3、联合治疗组较单用药组疗效显著,且不良事件发生较单用药组并无增多。
[Abstract]:Objective: 1, to observe the effect of leflunomide (LEF) combined with small dose cyclophosphamide (CTX) on connective tissue disease with interstitial lung disease (CTD-ILD). 2, compare the effect of LEF combined with small dose CTX group and single LEF group on CTD-ILD. Methods: 32 patients with CTD-ILD were selected and divided into 2 groups randomly: single drug group (LEF) and combined use of drugs. Group (LEF+ small dose CTX group). The clinical data were collected: the clinical manifestations (respiratory symptoms, VelcroUp sounds), ESR, serum surface active protein (SP-A, SP-D), pulmonary function (vital capacity FVC and carbon monoxide dispersion DLCO), pulmonary high resolution CT (HRCT) and adverse reactions, the data, statistical analysis of the serum, and the statistical analysis. The detection of surface active protein SP-A and SP-D: 18 cases of healthy controls were collected in the morning on empty stomach. 32 cases of CTD-ILD patients were treated with 2.0-3.0m L before and after 6 months of treatment. After centrifugation, the upper serum was absorbed and the refrigerator was stored at -80 C to avoid repeated freeze-thaw. The specimens were collected and collected by ELISA method. Results: 1, clinical manifestations: There was no difference in respiratory symptoms and VelcroUp sounds in 32 patients before and after treatment, and there was no significant difference (P0.05). 2, ESR in ESR:32 patients decreased significantly after treatment (P0.001), but there was no difference between ESR levels (P0.05) between different medication groups (P0.05); SP-A and SP-D: were significantly lower than those before treatment (P0.05) (P0.05). And the SP-A level of the combined group was significantly lower than that in the single drug group (P0.001), and there was no difference in the level of SP-D before treatment (P0.05), but the SP-D level of the combined drug group was significantly lower than that in the single drug group (P0.05); 4, the lung function: the FVC level of the combined drug group was significantly improved (P0.05) and the DLCO improvement was not significant (P0.05); 5, the combination group was not significantly different (P0.05). The lung HRCT was significantly better than before the treatment; 6, for 6 months, the combination group had no significant increase in the incidence of adverse events. Conclusion: 1, LEF combined with small dose CTX for CTD-ILD, can improve its ESR, SP-A and FVC; 2, the combination group can effectively reduce CTD-ILD specific serological markers SP-A and SP-D; 3, combined treatment group. Compared with the single medication group, the curative effect was significant, and the incidence of adverse events was not increased compared with the single medication group.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R593.2

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