清肺排毒汤联合甲泼尼龙治疗免疫检查点抑制剂相关性肺炎患者临床观察

Clinical observation of Qingfei Paidu Decoction combined with methylprednisolone in treating immune checkpoint inhibitor related pneumonia

关键词:  免疫检查点抑制剂相关性肺炎  免疫检查点抑制剂  清肺排毒汤  疗效评价  临床观察

Key words:  immune related pneumonia  immune checkpoint inhibitors  Qingfei Paidu Decoction  efficacy evaluation  clinical research

摘要:

[目的] 探讨清肺排毒汤联合甲泼尼龙治疗临床2~4级免疫检查点抑制剂相关性肺炎（CIP）患者的有效性及安全性。[方法] 将30例免疫检查点抑制剂所致免疫性肺炎的恶性实体瘤患者以随机数字表法随机分为两组，对照组给予甲泼尼龙治疗；联合组给予清肺排毒汤联合甲泼尼龙治疗，比较两组患者治疗前后的临床-影像-生理（CRP）评分、影像学疗效评价、卡式功能状态（KPS）评分、中医证候积分。[结果] 治疗后，两组的CRP评分均下降，联合组比对照组下降明显（P<0.05）；两组的影像学表现均改善，联合组有效率为86.7%，对照组为66.7%，但两组比较差异无统计学意义（P>0.05）；两组的KPS评分均升高，联合组比对照组升高明显（P<0.05）；两组中医证候积分均减少，联合组比对照组减少明显（P<0.05）。[结论] 清肺排毒汤联合甲泼尼龙可改善CIP患者的临床症状，提高生活质量，且疗效优于单独使用甲泼尼龙治疗。

Abstract:

[Objective] To investigate the efficacy and safety of Qingfei Paidu Decoction combined with methylprednisolone in the treatment of patients with 2~4 grade of immune checkpoint inhibitor-related pneumonia （CIP）. [Methods] Thirty malignant tumor patients with immune pneumonia caused by ICIs were randomly divided into two groups. The control group was treated with methylprednisolone，and the combined group was treated with Qingfei Paidu Decoction and methylprednisolone. The Clinical-imaging-physiological （CRP） score，imaging efficacy evaluation，Karnofsky Performance Status （KPS） score and traditional Chinese medicine （TCM） syndrome score were compared between the two groups before and after treatment. [Results] After treatment，CRP scores in both groups were decreased，and the combined group was significantly lower than the control group （P<0.05）. The imaging manifestations of both groups were improved， and the effective rate of the combined group was 86.7% better than that of the control group 66.7%，but there was no statistical significance （P>0.05）. KPS scores in both groups were increased，and the combined group was significantly higher than the control group （P<0.05）. TCM syndrome score were decreased in both groups，and the combined group was significantly lower than the control group （P<0.05）. [Conclusion] The combination of Qingfei Paidu Decoction with methylprednisolone can improve clinical symptoms and quality of life of CIP patients，and the efficacy was better than that of methylprednisolone alone.