| Objective:The herbicide paraquat poisoning is a common poisoning in China.Acute lung injury occurs in the early stage,and pulmonary fibrosis occurs in the middle and late stage,which is called "paraquat lung".The mortality rate of the herbicide paraquat poisoning is very high,up to 60-70%.In recent years,the number of paraquat poisoning patients to the hospital has been on the rise.Pirfenidone(PFD)is a new oral small molecule compound,chemical name 5-methyl-1-phenyl-2-[1H]-pyridone,is a new drug with broad spectrum anti-inflammatory,anti-fibrosis and antioxidant effects,which has a very good effect on the treatment of idiopathic pulmonary fibrosis.In vitro and animal studies,PFD inhibits fibroblast proliferation and collagen deposition by inhibiting pro-fibrotic and pro-inflammatory cytokines,including transforming growth factor(TGF-?)and tumor necrosis factor(TNF-?).Clinical trials have shown that PFD has broad spectrum anti-fibrosis effects on lung,heart,liver and kidney.PFD can reduce the decline of pulmonary function in patients with idiopathic pulmonary fibrosis and delay the progress of the disease to some extent.The purpose of this study was to evaluate the clinical efficacy of pirfinidone in the treatment of pulmonary fibrosis caused by herbicide intoxication,to actively seek an effective treatment method for lung injury caused by herbicide paraquat,to provide a new idea for the precise medical research of herbicide paraquat intoxication,and to provide the basis of translational medicine for the treatament of clinical lung injury.Methods:From January 2018 to November 2019,214 patients who met the inclusion criteria for pulmonary fibrosis caused by paraquat poisoning were collected.According to the different concentrations of paraquat in urine and blood,they were divided into the medium-high concentration H group(78 people)and the low-concentration L group(136 people).Then,the patients in the H and L groups were randomly divided into the experimental group and the control group.Intervention:in the experimental group,PFD was monotherapy with a treatment cycle of 180 days.Single drug plan:PFD is taken orally,starting dose of 200 mg,three times a day,take it orally 1 to 2 hours after a meal,according to the principle of dose escalation gradually increasing dosage,the fourth day increased to 400 mg,three times a day,in 1 day before taking the medicine and 30 days,90 days and 180 days after taking the medicine to arrange review,review content includes routine blood,liver and kidney function,pulmonary ventilation function,pulmonary diffusion function,chest Computer Tomography imaging examination and routine physical examination.Statistical methods were used to analyze the statistical differences in the change values of the main indicators of lung function in each group and between groups,and the efficacy of PFD was analyzed by comparing the changes of lung function and chest CT before and after treatment.Results:(1)After medication,the levels of VC,FEVr,FVC,PEF and DLCO in the H group were3.53±0.71L?3.11±0.68L?3.51±0.73L?8.57±1.61L/S?17.03±4.30ml/min/mmHg,respectively,which were significantly higher than those in the control group(2.62±0.98L?2.28±0.59L?2.58±0.62L?6.85±1.31L/S?11.63±2.05ml/min/mmHg).The differences were statistically significant(p<0.05);The levels of VC,FEV1,FVC,PEF and DLCO in the experimental group of group L were 4.83(4.01-5.39)L?4.21±0.91L?4.71±0.87L?9.41(7.75-10.29)L/S?20.41(16.81-25.77)ml/min/mmHg,respectively.All of them were significantly higher than 3.84(3.47-4.63)L?3.65±0.87L?3.92±0.91L?7.84(6.52-8.71)L/S?15.39(13.00-18.42)ml/min/mmHg,in the later period of the control group(p<0.05).(2)the levels of VC,FEV1,FVC,PEF and DLCO in the H group were 3.53±0.71L?3.11±0.68L?3.51±0.73L?8.57±1.61L/S?17.03±4.30ml/min/mmHg,respectively,significantly higher than the levels of 1.96±0.45L?1.57±0.45L?1.89±0.45L?6.14±1.10L/S?11.83±3.21ml/min/mmHg.The differences were statistically significant(p<0.05).The levels of VC,FEV1,FVC,PEF and DLCO in the experimental group of group L were 4.83(4.01-5.39)L?4.21±0.91L?4.71±0.87L?9.41(7.75-10.29)L/S?20.41(16.81-25.77)ml/min/mmHg,respectively.All of them were significantly higher than 3.13(2.64-3.64)L?2.53(2.15-3.14)L?3.08±0.71L?(6.90±1.59)L/S?15.27(12.36-19.73)ml/min/mmHg,before medication,with statistically significant differences(p<0.05).(3)the difference values of VC,FEV1,FVC,PEF and DLCO in the experimental group and the control group before and after improvement were compared.The difference values of the experimental group were 1.53(1.09-1.99)L?1.55(1.10-1.81)L?1.64(1.09-2.01)L?2.42±0.96L/S?4.29(3.32-6.06)ml/min/mmH.The differences in the control group were 0.52(0.37-0.82)L?0.51(1.10-1.81)L?0.47(0.34-0.88)L?0.75(0.49-1.37)L/S?0.47(0.08-1.06)ml/min/mmHg.The improvement in the experimental group was better than that in the control group,with statistically significant differences(p<0.05).The differences of VC,FEV1,FVC,PEF and DLCO before and after improvement in the experimental group and the control group were compared.The differences in the experimental group were 1.71(0.89-2.14)L?1.86(1.07-2.22)L?1.87(0.84-2.19)L?2.28± 1.36L/S?5.32(4.18-6.21)ml/min/mmHg.The difference values of the control group were 0.55(0.34-0.77)L?1.07(0.77-1.23)L?0.54(0.36-0.76)L?0.75(0.49-1.37)L/S?1.69(1.10-2.26)ml/min/mmHg.The improvement of the experimental group was better than that of the control group,with statistically significant differences(p<0.05).Conclusions:(1)PFD can significantly improve the lung function of patients with pulmonary fibrosis caused by paraquat poisoning,reduce the area and degree of double-lung fibrosis,and improve the quality of life of patients;(2)The adverse reactions caused by PFD are under control. |
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