中西藥並用治療進行性系統性硬皮病合併肺間質病變——病例報告

Progressive Systemic Sclerosis with Interstitial Lung Disease: A Case Report of Chinese-Western Combined Therapy

一名42歲女性患者於82年3月因咳喘就診於彰化基督教醫院，理學檢查顯示皮膚硬化，色素沈著，雷諾氏現象及四肢末梢皮膚壞死。吸氣時有肺底囉音，胸腔X光檢查顯示兩側肺基底部間質性病變，核醫檢查胃排空時間明顯延長，皮膚病理切片顯示膠原纖維增生。患者於82年3月至4月陸續接受methyl-prednisolone脈衝治療及Endoxan脈衝治療，Prostaglandin-E2點滴注射及口服D-penicillamine、prednisolone，皮膚硬化指數從40分進步為32分，肺功能略有改善，但肢端皮膚壞死未見進步。患者于82年9月起持續合併服用中藥，以溫陽活血化瘀法為主，治療8個月，咳喘腹脹等臨床症狀改善，周邊皮膚壞死病灶癒合，皮膚硬化指數從32分變為24分。肺功能方面：FVC及DLCO改善，TLC逐漸下降，但仍在正常範圍。結締組織疾病併發間質性肺病變患者的肺功能如不治療，一般而言是持續惡化，中醫活血化瘀法可能可以減緩或改善此等病變。

A 42-year-old woman with dyspnea on exertion, Raynaud's phenomenon and multiple skin ulcers on the extremities was first examined at Changhua Christian Hospital in March 1971. The chest roentgenograph showed bilateral basilar lung infiltration. Gastric emptying time was markedly prolonged. Skin biopsy revealed collagen proliferation. She was treated with methyl-prednisolone pulse therapy, endoxan pulse therapy, prostaglandin-E2 intravenous drip, oral D-penicillamine and prednisolonc. The response was fair. She was placed on a treatment program with a minimal dose of oral D-penicillamine and predisolone combined with traditional Chinese medicine to supplement yang, to quicken the blood, and to transform stasis. The course was 8 months and she responded well with improvement of her pulmonary function test (FVC and DLCO) and other clinical manifestations. We conclude that the combined therapy may have been beneficial to her interstitial lung disease.