Page 103 - 《中国药房》2021年12期

激素联合环磷酰胺治疗结缔组织病相关性间质性肺疾病的疗效

及其影响因素分析 Δ

＊
苏 菁 ，杨雅婷，贾聚娟，项保利，钱海红，支学军，李 琛，赵建清（河北北方学院附属第一医院呼吸与危重症
医学科，河北 张家口 075000）

+
中图分类号 R593.2；R563.1 3；R969.4 文献标志码 A 文章编号 1001-0408（2021）12-1501-05
DOI 10.6039/j.issn.1001-0408.2021.12.16

摘 要 目的：探讨激素联合环磷酰胺治疗结缔组织病相关性间质性肺疾病（CTD-ILD）的疗效，并分析其影响因素。方法：将
2018年1月－2019年1月于我院确诊CTD-ILD的患者100例根据随机数字表法分为观察组和对照组各50例。对照组患者给予复
方环磷酰胺片治疗，每次50 mg，每天3～4次；观察组患者在对照组基础上加用醋酸泼尼松片，每次10 mg，每天3～4次；两组患者
的疗程均为6个月。比较两组患者的临床疗效、不良反应发生情况和治疗前后的肺功能，外周血白细胞介素6（IL-6）、C反应蛋白
（CRP）、降钙素原（PCT）水平以及生活质量[圣乔治呼吸问卷（SGRQ）评分]。根据疗效结果，将所有患者分为治疗有效组和治疗无
效组，采用单因素及多因素Logistic回归分析法分析影响CTD-ILD临床疗效的相关因素。结果：治疗后，观察组患者的总有效率、
用力肺活量、第1 秒用力呼气容积和一氧化碳弥散量均显著高于对照组，SGRQ评分和外周血IL-6、CRP、PCT水平均显著低于对
照组（P＜0.05）。两组患者的不良反应总发生率比较，差异无统计学意义（P＞0.05）。单因素分析结果显示，治疗有效组患者的性
别、年龄、既往病史和CTD类型与治疗无效组比较，差异均无统计学意义（P＞0.05）；但两组患者在不同外周血IL-6、CRP和PCT
水平中的分布比较，差异均有统计学意义（P＜0.05）。多因素Logistic回归分析结果显示，IL-6是影响该联合用药方案疗效的独立
危险因素[比值比为4.537，95％置信区间为（3.668，10.352），P＝0.002]。结论：激素联合环磷酰胺可以显著提高CTD-ILD患者的
疗效，改善其肺功能和生活质量，降低其炎性因子表达水平；IL-6水平是影响该方案疗效的独立危险因素，在治疗过程中应密切关
注该指标水平变化。
关键词 结缔组织病相关性间质性肺疾病；激素；环磷酰胺；临床疗效；白细胞介素6；影响因素

Efficacy of Hormone Combined with Cyclophosphamide in the Treatment of Connective Tissue
Disease-associated Interstitial Lung Disease and Analysis of Its Influential Factors
SU Jing，YANG Yating，JIA Jujuan，XIANG Baoli，QIAN Haihong，ZHI Xuejun，LI Chen，ZHAO Jianqing（Dept.
of Respiratory and Critical Care Medicine，the First Affiliated Hospital of Hebei North University，Hebei
Zhangjiakou 075000，China）

ABSTRACT OBJECTIVE：To investigate the efficacy of hormone combined with cyclophosphamide in the treatment of
connective tissue disease-associated interstitial lung disease （CTD-ILD） and to analyze its influential factors. METHODS：100
patients diagnosed as CTD-ILD in our hospital from Jan. 2018 to Jan. 2019 were randomly divided into observation group and
control group，with 50 cases in each group. Control group was treated with Compound cyclophosphamide tablets，50 mg each
time，3-4 times each day. Observation group was additionally treated with Prednisone acetate tablets，10 mg each time，3-4 times
each day，on the basis of control group. Treatment courses of 2 groups lasted for 6 months. The clinical efficacy，the occurrence of
ADR，lung function before and after treatment，the levels of peripheral IL-6，CRP and PCT and quality of life（SGRQ score）were
compared between 2 groups. According to the therapeutic efficacy，all patients were divided into effective group and ineffective
group. The related factors influencing the clinical efficacy of CTD-ILD were analyzed by univariate and multivariate Logistic
regression analysis. RESULTS： After treatment， total response rate， FVC， FEV1 and DLCO of observation group were
significantly higher than those of control group，while SGRQ score，levels of IL-6，CRP and PCT in peripheral blood were
significantly lower than control group（P＜0.05）. There was no significant difference in the total incidence of ADR between 2
groups（P＞0.05）. Univariate analysis showed that there were no significant differences in gender，age，past medical history and
CTD type between effective group and ineffective group（P＞0.05）. However，there were statistical significancant differences in the
distribution of different levels of IL-6，CRP and PCT in peripheral blood between 2 groups （P＜0.05）. Multivariate Logistic
regression analysis showed that IL-6 was an independent risk factor for therapeutic efficacy of combined therapy [OR（95％CI）＝
4.537（3.668，10.352），P＝0.002]. CONCLUSIONS：Hormone combined with cyclophosphamide can significantly improve the
therapeutic efficacy of CTD-ILD patients，improve their lung
Δ 基金项目：河北省医学科学研究重点课题计划（No.20160366）；
function and quality of life，and reduce the expression level of
张家口市科技计划自筹经费项目（No.1921051D）
＊主治医师，硕士。研究方向：内科学。电话：0313-8046906。 inflammatory factors. The level of IL-6 is an independent risk
E-mail：hb_sujing@163.com factor affecting the efficacy of the treatment，and its changes

中国药房 2021年第32卷第12期 China Pharmacy 2021 Vol. 32 No. 12 ·1501 ·