麻杏石甘汤联合甲泼尼龙治疗免疫性肺炎的临床分析

doi:10.3877/cma.j.issn.1674-6902.2022.06.008

目的

检查点抑制剂肺炎(checkpoint inhibitor pneumonitis, CIP)在亚洲人群中多发且致死率高，为寻找高效治疗方案，本文采用麻杏石甘汤联合甲泼尼龙对PD-1抑制剂所致的癌症患者免疫性肺炎(immune pneumonia)的影响。

方法

将35例免疫性肺炎的癌症患者随机分为两组，对照组18例采用甲泼尼龙治疗，观察组17例给予麻杏石甘汤联合甲泼尼龙治疗。连续治疗6周后，比较两组患者的CIP评分、血清炎症因子水平、临床-影像-生理(CRP)评分、Karnofsky评分的变化。

结果

治疗后，对照组CIP评分为(1.78±0.61)，观察组(1.44±0.24)，两组CIP评分下降，观察组较对照组评分下降有显著性差异(P<0.05)；两组CRP评分显著下降(P<0.05)；两组TNF-α、IL-1β水平较治疗前下降，观察组低于对照组(P<0.05)，两组治疗后Karnofsky评分升高，观察组高于对照组(P<0.05)。

结论

麻杏石甘汤联合甲泼尼龙治疗癌症患者免疫性肺炎的疗效优于单用甲泼尼龙，有助于调节免疫抑制状态，增强免疫功能，改善生活质量。

关键词: 麻杏石甘汤, 甲泼尼龙, 免疫性肺炎

Objective

Checkpoint inhibitor pneumonitis (CIP)is more prevalent in Asian populationswith extremely high lethal rate. In order to search for highly effective therapeutic alternatives, we observed the effect of Ma Xing Shi Gan decoction (MXD) combined with methylprednisolone on immune-related pneumonitis caused by PD-1 inhibitors in cancer patients.

Methods

Thirty-five cancer patients with immune-related pneumonitis were divided into two groups. Control group: methylprednisolone 18 cases, experimental group: Ma Xing Shi Gan decoction (MXD) combined with methylprednisolone 17 cases. Comparison was made on the difference of CIP score, serum inflammatory cytokines, CRP score and Karnofsky score after 6 consecutive weeks of treatment.

Results

After treatments, control group CIP is (1.78±0.61), experimental groupis (1.44±0.24). CIP scores decreased in both groups, and the experimentalgroup decreased significantly compared with the control group. CRP were significantly decreased in both groups(P<0.05)in both groups, while Karnofsky scorewas significantly increased (P<0.05)in both groups after treatments.

Conclusion

Combination therapy of Ma Xing Shi Gan decoction (MXD) plus methylprednisolone was more effective at treating immune-related pneumonitis than methylprednisolone monotherapy in cancer patients, which contributes to regulate immunosuppression state, enhance immune function and improve quality of life.

Key words: Ma Xing Shi Gan decoction, Methylprednisolone, Immune pneumonia

表1 治疗前后血清炎症因子比较

组　别	例数	TNF-α (pg/ml)		IL-1β (pg/ml)
组　别	例数	治疗前	治疗后	治疗前	治疗后
观察组	17	19.38±0.25	9.56±0.33^ab	16.38±0.25	6.56±0.33^ab
对照组	18	20.65±0.36	12.35±0.42^a	15.65±0.36	9.35±0.42^a

表1 治疗前后血清炎症因子比较

组　别	例数	TNF-α (pg/ml)		IL-1β (pg/ml)
组　别	例数	治疗前	治疗后	治疗前	治疗后
观察组	17	19.38±0.25	9.56±0.33^ab	16.38±0.25	6.56±0.33^ab
对照组	18	20.65±0.36	12.35±0.42^a	15.65±0.36	9.35±0.42^a

表2 治疗前后CRP评分比较

组　别	例数	临床评分(C)		影像评分(R)		生理评分(P)
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	17	28.55±2.25	16.53±1.15^a	14.39±1.58	8.12±0.95^ab	19.28±3.53	10.11±2.46^ab
对照组	18	27.98±1.31	17.66±3.22^a	13.54±2.11	9.66±0.68^a	21.75±3.12	14.71±4.30^a

表2 治疗前后CRP评分比较

组　别	例数	临床评分(C)		影像评分(R)		生理评分(P)
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	17	28.55±2.25	16.53±1.15^a	14.39±1.58	8.12±0.95^ab	19.28±3.53	10.11±2.46^ab
对照组	18	27.98±1.31	17.66±3.22^a	13.54±2.11	9.66±0.68^a	21.75±3.12	14.71±4.30^a

表3 治疗前后Karnofsky评分比较

组　别	例数	Karnofsky评分(治疗前)	Karnofsky评分(治疗后)
观察组	17	52.17±5.18	77.49±5.76^ab
对照组	18	53.26±6.57	69.18±7.15^a

表3 治疗前后Karnofsky评分比较

组　别	例数	Karnofsky评分(治疗前)	Karnofsky评分(治疗后)
观察组	17	52.17±5.18	77.49±5.76^ab
对照组	18	53.26±6.57	69.18±7.15^a

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Clinical observation of Maxingshigan decoction combined with methylprednisolone on PD-1 inhibitor-induced immune pneumonia

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Clinical observation of Maxingshigan decoction combined with methylprednisolone on PD-1 inhibitor-induced immune pneumonia