目的 观察盐酸氨溴索联合吡非尼酮治疗肺间质纤维化的临床疗效。方法 选择2020年9月—2024年1月在天津市泰达医院治疗的特发性肺间质纤维化患者80例，按照随机数字表法分为对照组和治疗组，每组各40例。对照组患者口服吡非尼酮片，200 mg/次，3次/d，两周内每次增加0.2 g，增加至每次0.6 g，此后维持在每次0.6 g。治疗组在对照组基础上口服盐酸氨溴索片，30 mg/次，3次/d。两组患者治疗3个月。观察两组患者临床疗效，比较治疗前后两组患者肿瘤坏死因子-α（TNF-α）、骨桥蛋白、白细胞介素-13（IL-13）、趋化因子配体14（CXCL14）、脂质过氧化物（LPO）、谷胱甘肽过氧化物酶（GSH-Px）、过氧化氢酶（CAT）、血管细胞黏附分子-1（VCAM-1）、胰岛素生长因子I（IGF-I）、层黏连蛋白（LN）、肺总量（TLC）、动脉血氧饱和度（SaO₂）、最大呼气中段流量（MMF）和肺一氧化碳弥散量（DLCO）水平，及特发性肺纤维化患者生活质量量表（ATAQ-IPF）和圣乔治呼吸问卷（SGRQ）评分。结果 治疗后，治疗组总有效率为97.50%，明显高于对照组总有效率（80.00%），两组比较差异具有统计学意义（P＜0.05）。治疗后，两组TNF-α、骨桥蛋白、IL-13、CXCL14、LPO、VCAM-1、IGF-Ⅰ、LN水平较治疗前降低，而GSH-Px、CAT、TLC、SaO₂、MMF、DLCO水平较治疗前明显升高（P＜0.05），且治疗组这些指标水平较对照组明显好转（P＜0.05）。治疗后，两组患者SGRQ评分较治疗前增加，而ATAQ-IPF评分较治疗前降低（P＜0.05），且治疗组SGRQ和ATAQ-IPF评分较对照组明显好转（P＜0.05）。结论 盐酸氨溴索联合吡非尼酮治疗肺间质纤维化，可减少氧化应激及炎症损伤，减少肺纤维化，改善呼吸状态，提升肺功能、临床疗效及生活质量。

Objective To observe the clinical effect of ambroxol hydrochloride combined with pirfenidone in treatment of pulmonary interstitial fibrosis. Methods Patients (80 cases) with pulmonary interstitial fibrosis in Tianjin Teda Hospital from September 2020 to January 2024 were divided into control and treatment group by random number table method, and each group had 40 cases. Patients in the control group were po administered with Pirfenidone Tablets, 200 mg/time, three times daily, increase by 0.2 g each time within 2 weeks until 0.6 g/time. Patients in the treatment group were po administered with Ambroxol Hydrochloride Talets on the basis of the control group, 30 mg/time, three times daily. Patients in two groups were treated for 3 months. After treatment, the clinical evaluations were evaluated, the levels of TNF-α, osteopontin, IL-13, CXCL14, LPO, GSH-Px, CAT, VCAM-1, IGF-Ⅰ, LN, TLC, SaO₂, MMF and DLCO, and the scores of ATAQ-IPF and SGRQ in two groups before and after treatment were compared. Results After treatment, the total effective rate in the treatment group was 97.50%, which was significantly higher than that in the control group (80.00%), and the difference between the two groups was statistically significant (P < 0.05). After treatment, the levels of TNF-α, osteopontin, IL-13, CXCL14, LPO, VCAM-1, IGF-I, and LN in two groups were significantly decreased compared with before treatment, while the levels of GSH-Px, CAT, TLC, SaO₂, MMF, and DLCO were significantly increased compared with before treatment (P < 0.05), and the levels of these indicators in the treatment group were significantly improved compared with the control group (P < 0.05). After treatment, the SGRQ scores of patients in two groups were increased compared with before treatment, while the ATAQ-IPF scores were decreased (P < 0.05). The SGRQ and ATAQ-IPF scores in the treatment group were significantly improved compared with the control group (P < 0.05). Conclusion Ambroxol hydrochloride combined with pirfenidone in treatment of pulmonary interstitial fibrosis can reduce oxidative stress and inflammatory damage, reduce pulmonary fibrosis, improve respiratory status, and enhance lung function, clinical efficacy and quality of life.

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