吸入糖皮质激素辅助常规抗炎治疗稳定期COPD的价值分析
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摘要
目的:分析吸入糖皮质激素辅助常规抗炎治疗对稳定期慢性阻塞性肺疾病(COPD)患者肺功能和生活质量(CAT)评分等方面的影响。方法:将笔者所在医院2015年6月-2017年8月收治的83例稳定期COPD患者,按随机数字表法分为A组42例和B组41例。A组行常规抗炎治疗,B组给予常规抗炎治疗+吸入糖皮质激素,对两组患者治疗前后最大呼气流量(PEF)、第1 s用力呼气容积(FEV1)和第1 s用力呼气容积/用力肺活量(FEV1/FVC)等肺功能指标,可溶性细胞间黏附分子(sICAM-1)及内皮素-1(ET-1)等内皮功能指标,呼出气一氧化氮(NO)水平和CAT评分进行比较分析。结果:治疗前,两组患者肺功能指标比较,差异无统计学意义(P>0.05);治疗后,两组患者PEF、FEV1和FEV1/FVC等肺功能指标均优于治疗前,且B组上述指标水平均优于A组,差异均有统计学意义(P<0.05)。治疗前,两组患者sICAM-1及ET-1等内皮功能指标比较,差异无统计学意义(P>0.05);治疗后,B组sICAM-1及ET-1水平均低于治疗前,且低于A组治疗后,差异均有统计学意义(P<0.05),而A组治疗前后两指标比较,差异无统计学意义(P>0.05)。治疗前,两组患者呼出气NO水平及CAT评分比较,差异均无统计学意义(P>0.05);治疗后,B组呼出气NO水平及CAT评分均低于治疗前,且低于A组治疗后,差异均有统计学意义(P<0.05),而A组治疗前后两指标比较,差异无统计学意义(P>0.05)。结论:吸入糖皮质激素辅助常规抗炎治疗能够显著改善稳定期COPD患者的肺功能,提升患者内皮功能和生活质量,减少呼出气NO量,临床应用价值较高。
Objective:To analyze the effects of inhaled corticosteroid-assisted conventional anti-inflammatory therapy on pulmonary function and quality of life(CAT) scores in patients with stable chronic obstructive pulmonary disease(COPD).Method:A total of 83 stable COPD patients admitted by our hospital from June 2015 to August 2017 were divided into 42 patients in group A and 41 patients in group B according to the random number table.Routine antiinflammatory treatment was used in group A,B group was given routine anti-inflammatory treatment combined inhaled corticosteroids,the two groups before and after treatment in patients with maximum expiratory flow(PEF),forced expiratory volume in one second(FEV1) and forced expiratory volume in one second/forced vital capacity(FEV1/FVC) of lung function index,and endothelial function indexes such as soluble cell adhesion molecules(sICAM-1) and endothelin-1(ET-1),breath of nitric oxide(NO) level and the CAT scores were comparative analyzed.Result:There was no significant difference in pulmonary function indexes between the two groups before treatment(P>0.05).After treatment,the pulmonary function indexes including PEF,FEV1 and FEV1/FVC of the two groups were better than those before treatment and the group B were better(P<0.05).Before treatment,there was no significant difference in endothelial function indexes such as sICAM-1 and ET-1 between the two groups(P>0.05).After treatment,the level of sICAM-1 and ET-1 in group B was lower than that before,and lower than after treatment in group A(P<0.05),while there was no significant difference in two indexes before and after treatment in group A(P>0.05).NO and CAT scores of the two groups before treatment showed no significant difference(P>0.05),NO and CAT scores of the group B after treatment were lower than those before and after treatment(P<0.05),and there were no significant differences of 2 indexes before and after treatment in group A(P>0.05).Conclusion:Inhaled corticosteroidassisted conventional anti-inflammatory therapy can significantly improve lung function in stable COPD patients,improve endothelial function and quality of life,reduce exhaled NO,and have high clinical application value.
Objective:To analyze the effects of inhaled corticosteroid-assisted conventional anti-inflammatory therapy on pulmonary function and quality of life(CAT) scores in patients with stable chronic obstructive pulmonary disease(COPD).Method:A total of 83 stable COPD patients admitted by our hospital from June 2015 to August 2017 were divided into 42 patients in group A and 41 patients in group B according to the random number table.Routine antiinflammatory treatment was used in group A,B group was given routine anti-inflammatory treatment combined inhaled corticosteroids,the two groups before and after treatment in patients with maximum expiratory flow(PEF),forced expiratory volume in one second(FEV1) and forced expiratory volume in one second/forced vital capacity(FEV1/FVC) of lung function index,and endothelial function indexes such as soluble cell adhesion molecules(sICAM-1) and endothelin-1(ET-1),breath of nitric oxide(NO) level and the CAT scores were comparative analyzed.Result:There was no significant difference in pulmonary function indexes between the two groups before treatment(P>0.05).After treatment,the pulmonary function indexes including PEF,FEV1 and FEV1/FVC of the two groups were better than those before treatment and the group B were better(P<0.05).Before treatment,there was no significant difference in endothelial function indexes such as sICAM-1 and ET-1 between the two groups(P>0.05).After treatment,the level of sICAM-1 and ET-1 in group B was lower than that before,and lower than after treatment in group A(P<0.05),while there was no significant difference in two indexes before and after treatment in group A(P>0.05).NO and CAT scores of the two groups before treatment showed no significant difference(P>0.05),NO and CAT scores of the group B after treatment were lower than those before and after treatment(P<0.05),and there were no significant differences of 2 indexes before and after treatment in group A(P>0.05).Conclusion:Inhaled corticosteroidassisted conventional anti-inflammatory therapy can significantly improve lung function in stable COPD patients,improve endothelial function and quality of life,reduce exhaled NO,and have high clinical application value.
引文
[1]张瑞,陈亚飞,王志新,等.丙酸氟替卡松对稳定期COPD患者肺功能、炎症因子和内皮功能的影响[J].药物评价研究,2017,40(7):967-970.
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[8]高清华.支气管扩张剂联合吸入性糖皮质激素和长效β受体激动剂治疗慢性阻塞性肺病的疗效研究[J].黑龙江医学,2017,41(4):327-328.
[9]赵洪达,陈建波,许群,等.吸入糖皮质激素治疗稳定期COPD的疗效及对患者内皮功能及生活质量的影响[J].河北医学,2016,22(2):209-212.
[10]刘超,杨金凤,尚刚.吸入糖皮质激素联合化痰降气活血方对ACOS疗效及FeNO和ET-1水平的影响[J].贵州医科大学学报,2018,43(2):240-243.
[11]李成博,刘璐,海鑫.糖皮质激素联合复方异丙托溴胺治疗慢性阻塞性肺疾病急性加重期的效果及对血清炎性因子水平的影响[J].四川医学,2018,39(3):316-319.
[12]刘增超,张贵萍,赵慧娟,等.糖皮质激素联合胰岛素泵对慢性阻塞性肺疾病急性期合并糖尿病患者临床疗效及炎性指标和肺功能的影响[J].微循环学杂志,2018,28(2):23-28.
[13]郑锋.吸入糖皮质激素和支气管扩张剂对COPD患者肺功能的影响及副作用对比[J].泰山医学院学报,2018,39(7):782-784.
[14]杨旭艳.布地奈德福莫特罗吸入剂治疗慢性阻塞性肺病患者的临床效果[J].医疗装备,2017,30(7):4-6.
[2]张琼.布地奈德福莫特罗粉吸入剂在稳定期慢性阻塞性肺疾病的临床观察[J].中国药物与临床,2016,16(5):935-937.
[3]林贻照,王芳,张荣照.β2受体激动剂联合糖皮质激素雾化吸入对COPD患者血浆IL-6、IL-8的影响[J].医学理论与实践,2018,31(1):52-53.
[4]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中华结核和呼吸杂志,2013,36(4):255.
[5]纪淑清.联合吸入糖皮质激素和支气管舒张剂在COPD治疗中的应用[J].世界最新医学信息文摘,2017,17(64):137-140.
[6]郦巧莲,陈培锋,王文红.呼出气一氧化氮检测在行吸入性糖皮质激素治疗慢性阻塞性肺病中的意义[J].北方药学,2017,20(4):422-423.
[7]吴蕾,许凡凡,关英慧,等.吸入性糖皮质激素对稳定期COPD获益及风险的meta分析[J].中国实验诊断学,2017,21(4):655-658.
[8]高清华.支气管扩张剂联合吸入性糖皮质激素和长效β受体激动剂治疗慢性阻塞性肺病的疗效研究[J].黑龙江医学,2017,41(4):327-328.
[9]赵洪达,陈建波,许群,等.吸入糖皮质激素治疗稳定期COPD的疗效及对患者内皮功能及生活质量的影响[J].河北医学,2016,22(2):209-212.
[10]刘超,杨金凤,尚刚.吸入糖皮质激素联合化痰降气活血方对ACOS疗效及FeNO和ET-1水平的影响[J].贵州医科大学学报,2018,43(2):240-243.
[11]李成博,刘璐,海鑫.糖皮质激素联合复方异丙托溴胺治疗慢性阻塞性肺疾病急性加重期的效果及对血清炎性因子水平的影响[J].四川医学,2018,39(3):316-319.
[12]刘增超,张贵萍,赵慧娟,等.糖皮质激素联合胰岛素泵对慢性阻塞性肺疾病急性期合并糖尿病患者临床疗效及炎性指标和肺功能的影响[J].微循环学杂志,2018,28(2):23-28.
[13]郑锋.吸入糖皮质激素和支气管扩张剂对COPD患者肺功能的影响及副作用对比[J].泰山医学院学报,2018,39(7):782-784.
[14]杨旭艳.布地奈德福莫特罗吸入剂治疗慢性阻塞性肺病患者的临床效果[J].医疗装备,2017,30(7):4-6.