Effect Of Pirfenidone Combined With Acetylcysteine On Idiopathic Pulmonary Fibrosis

Objective:At present,the efficacy of pirfenidone monotherapyin the treatment of IPF is still unsatisfactory,and the combination of pirfenidone and acetylcysteine is still controversial in the exploration of the combined treatment of various drug.Some scholars believe that the combination of pirfenidone and acetylcysteine is more effective than pirfenidone alone,then some scholars think that the combination therapyof pirfenidone and acetylcysteine can not delay the deterioration of pulmonary function,and may even aggravate it.In this study,pirfenidone combined with acetylcysteine was used to treat idiopathic pulmonaryfibrosis and its effects on pulmonary function and exercise tolerance in patients with IPF were evaluated objectively.Methods:Thirty patients with idiopathic pulmonary fibrosis diagnosed by the PneumologyDepartment of Eastern Hospital of the second Hospital of Hebei Medical University were randomly divided into two groups: the observation group(n = 15)and the control group(n = 15).The observation group was treated with pirfenidone capsule combined with acetylcysteine effervescent tablet,while the control group was treated with pirfenidone capsule alone.All the patients increased the dosage of pirfenidone gradually according to the principle of increasing dose.Be careful to avoid light and prevent influenza during the medication.The follow-up time was 6 months.The change of the indexes in the two groups such as FEV1%pred,FVC%pred,DLCO SB%pred,6 minutes walk test distance and PaO2,CAT score after exercise were observed and compared before and after treatment.And the incidence of adverse reactions in the two groups such as gastrointestinal symptoms,skin lesion and liver dysfunction were recorded at the same time.Results:After 6 months of treatment,there was no statistical difference of the FEV1%pred and FVC%pred in the observation group compare with thosebefore treatment.(P>0.05),and they were all lowerin the control group after treatment,the difference was statistically significant.(P<0.05),the decrease of two indexes in the observation group was less than that of the control group,the difference was statistically significant(P<0.05)..DLCO SB%pred,6minutes walk test distance,PaO2 after exercise were lower than before treatment,CAT score was higher than before,the differences were statistically significant(P<0.05).The rise of CAT score in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in DLCO SB%pred,6minutes walk test distance and the decent degree of Pa O2 after exercise.In adverse reactions,there was no significant difference between the two groups in digestive tract symptoms,skin lesion and elevated liver enzymes(P>0.05).Conclusion:Compared with pirfenidone alone,the combination of pirfenidone and acetylcysteine could delay the deterioration of forced vital capacity and quality of life in patients with IPF due to disease progression,but the two schemes were equivalent on diffusion function,arterial oxygen pressure after exercise,exercise tolerance and so on.In adverse reactions,the incidence of gastrointestinal symptoms,abnormal liver function and skin lesion were approximately equal.So it is recommended that pirfenidone combined with acetylcysteine be used in the treatment of IPF.