Kerget Buğra, Gülbahar Burcu Nur, Çınar İsmail, Alper Fatih, Sağlam Leyla
Department of Pulmonary Diseases, Ataturk University School of Medicine, Yakutiye, Erzurum, Turkey.
Department of Radiology, Ataturk University School of Medicine, Yakutiye, Erzurum, Turkey.
Sarcoidosis Vasc Diffuse Lung Dis. 2024 Dec 10;41(4):e2024054. doi: 10.36141/svdld.v41i4.15614.
Post-covid pulmonary fibrosis (PCPF) is an essential cause of hypoxic respiratory failure, especially in patients with severe COVID-19 infection. In our study, we aimed to compare the effectiveness of methylprednisolone and methotrexate treatments in patients diagnosed with PCPF and in whom progression was observed despite nintedanib treatment. Methods: Forty-eight patients diagnosed with PCPF between April 2022 and February 2023 were followed up in our study. Progressive pulmonary fibrosis was observed in 18 of these patients despite nintedanib treatment. Nintedanib + methylprednisolone treatment was started in Group 1 patients, and nintedanib + methotrexate treatment was started in Group 2 patients, and after three months, a respiratory function test (PFT), 6-minute walk test (6MWT), saturation, pulse, and side effect levels were compared.
In comparing the groups at the end of the 3rd month, the change in PFT parameters was higher in Group 2 patients than in Group 1 patients. However, there was no statistically significant difference. However, the increase in fingertip saturation, 6MWT levels, and decrease in pulse levels were statistically significantly different in Group 2 patients compared to Group 1 patients (p=0.001 for all). It was observed that complaints of muscle and joint pain, weight gain, and atrophy in peripheral extremities in Group 1 patients were statistically significantly higher than in Group 2 patients (p=0.001, 0.002, 0.001, respectively).
Methotrexate can be used as an alternative to methylprednisolone in PCPF due to its low side effect profile and its effectiveness in PFT, 6MWT, and saturation levels.
新冠后肺纤维化（PCPF）是低氧性呼吸衰竭的重要原因，尤其是在重症新冠病毒感染患者中。在我们的研究中，我们旨在比较甲基强的松龙和甲氨蝶呤治疗对诊断为PCPF且尽管接受了尼达尼布治疗仍观察到病情进展的患者的疗效。
2022年4月至2023年2月期间诊断为PCPF的48例患者在我们的研究中接受随访。尽管接受了尼达尼布治疗，但其中18例患者仍观察到进行性肺纤维化。第1组患者开始接受尼达尼布+甲基强的松龙治疗，第2组患者开始接受尼达尼布+甲氨蝶呤治疗，三个月后，比较呼吸功能测试（PFT）、6分钟步行试验（6MWT）、血氧饱和度、脉搏和副作用水平。
在第3个月末比较两组时，第2组患者的PFT参数变化高于第1组患者。然而，差异无统计学意义。然而，与第1组患者相比，第2组患者的指尖血氧饱和度升高、6MWT水平升高和脉搏水平降低在统计学上有显著差异（均p = 0.001）。观察到第1组患者的肌肉和关节疼痛、体重增加及外周肢体萎缩的主诉在统计学上显著高于第2组患者（分别为p = 0.001、0.002、0.001）。
由于甲氨蝶呤副作用小，且在PFT、6MWT和血氧饱和度水平方面有效，因此可作为PCPF患者甲基强的松龙的替代药物。
