Department of Rheumatology and Immunology, The Second Affiliated Hospital, Air Force Medical University, No. 569 Xinsi Road, Baqiao District, Xi'an, 710038, Shaanxi, China.
The College of Life Sciences, Northwest University, Xi'an, China.
Int J Rheum Dis. 2024 Oct;27(10):e15354. doi: 10.1111/1756-185X.15354.
Interstitial lung disease (ILD) resulting from connective tissue disease (CTD) greatly undermines people's health. Cyclophosphamide (CYC) is a widely used agent in treating CTD-ILD. We compared the efficacy and safety of oral and intravenous CYC in CTD-ILD treatment.
The retrospectively enrolled CTD-ILD patients were divided into the oral and intravenous CYC groups. The chest high-resolution computed tomography examination, forced vital capacity (FVC), lung carbon monoxide diffusion capacity (Dlco) determinations, and 6 min walk test (6MWT) were performed pre-treatment and at the 3rd, 6th, and 12th months posttreatment. Radiographic ILD severity was assessed using the Warrick score. Krebs Von den Lungen-6, surfactant protein A (SP-A), SP-D, and erythrocyte sedimentation rate (ESR) before and at the 12th month post-treatment were determined. CYC cumulative dose and occurrence of adverse reactions during treatment were recorded.
CYC cumulative dose in the intravenous CYC group was reduced. Compared with oral CYC treatment, intravenous CYC caused decreased Warrick score and increased FVC and 6MWT at the 6th month, and elevated DLco at the 3rd and 6th months posttreatment. SP-A, SP-D and ESR levels in both groups were reduced 12 months posttreatment, with a more evident decrease in the intravenous CYC group. Intravenous CYC had lower total adverse reaction incidence.
Compared with oral CYC, intravenous CYC decreases Warrick score and increases FVC and 6MWT at 6 months posttreatment, and reduces SP-A, SP-D, and ESR levels after 12 months of treatment, which shows low CYC cumulative dose and adverse reaction incidence in treating CTD-ILD.
结缔组织病（CTD）相关的间质性肺病（ILD）严重影响患者健康。环磷酰胺（CYC）是治疗 CTD-ILD 的常用药物。我们比较了口服和静脉注射 CYC 治疗 CTD-ILD 的疗效和安全性。
回顾性纳入 CTD-ILD 患者，分为口服和静脉 CYC 组。治疗前及治疗后第 3、6、12 个月行胸部高分辨率 CT 检查、用力肺活量（FVC）、肺一氧化碳弥散量（Dlco）、6 分钟步行试验（6MWT）检查。采用 Warrick 评分评估肺部间质性病变严重程度。检测治疗前及治疗后 12 个月 Krebs Von den Lungen-6、表面活性蛋白 A（SP-A）、表面活性蛋白 D（SP-D）、红细胞沉降率（ESR）。记录 CYC 累积剂量和治疗期间不良反应的发生情况。
静脉 CYC 组 CYC 累积剂量减少。与口服 CYC 治疗相比，静脉 CYC 治疗在第 6 个月时降低了 Warrick 评分，增加了 FVC 和 6MWT，在第 3 和 6 个月时增加了 Dlco。两组治疗后 12 个月时 SP-A、SP-D 和 ESR 水平均降低，静脉 CYC 组降低更明显。静脉 CYC 总不良反应发生率较低。
与口服 CYC 相比，静脉 CYC 治疗在第 6 个月时降低了 Warrick 评分，增加了 FVC 和 6MWT，治疗 12 个月后降低了 SP-A、SP-D 和 ESR 水平，显示了在治疗 CTD-ILD 时低 CYC 累积剂量和不良反应发生率。
