茶碱缓释片联合沙美特罗替卡松粉吸入剂对慢性阻塞性肺疾病患者的疗效及对其生活质量的影响
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摘要
目的探讨茶碱缓释片联合沙美特罗替卡松粉吸入剂对慢性阻塞性肺疾病(COPD)患者的疗效及对患者生活质量的影响。方法选取2016年7月至2017年5月在新疆维吾尔自治区喀什地区第一人民医院接受治疗的COPD患者74例,根据随机数表法将患者分为观察组和对照组,各37例。对照组患者给予沙美特罗替卡松粉吸入剂进行治疗,观察组在对照组基础上联用茶碱缓释片进行治疗,2组均连续治疗3个月。比较2组患者治疗前后的6 min步行距离、COPD自我评估测试评分、圣乔治呼吸问卷评分、第1秒用力呼气容积与用力肺活量比值、第1秒用力呼气容积占预计值百分比、深吸气量,比较2组患者不良反应发生情况。结果治疗后观察组的6 min步行距离、第1秒用力呼气容积与用力肺活量比值、第1秒用力呼气容积占预计值百分比、深吸气量均明显长于/高于对照组[(326±14)m比(306±17)m、(61±9)%比(56±10)%、(49±9)%比(44±9)%、(2.1±0.4)L比(1.8±0.4)L],COPD自我评估测试评分、圣乔治呼吸问卷各项评分(疾病症状评分、日常活动能力评分、疾病影响评分、总分)均明显低于对照组[(20.6±1.1)分比(23.5±1.2)分、(41±12)分比(47±12)分、(45±10)分比(53±10)分、(38±10)分比(43±10)分、(41±10)分比(47±11)分](均P<0.05)。观察组与对照组总不良反应发生率比较,差异无统计学意义(P>0.05)。结论茶碱缓释片联合沙美特罗替卡松粉吸入剂对COPD有较好的治疗效果,能显著改善患者的生活质量和肺功能,与单用沙美特罗替卡松粉吸入剂治疗相比联合用药优势明显。
Objective To explore the effect of theophylline sustained-release tablets combined with salmeterol xinafoate and fluticasone propionate inhalation on chronic obstructive pulmonary disease( COPD) and quality of life. Methods Totally 74 patients with COPD from July 2016 to May 2017 in the First People's Hospital of Kashi were randomly divided into observation group and control group, with 37 cases in each group. The control group was treated with salmeterol xinafoate and fluticasone propionate inhalation; the observation group was treated with theophylline sustained-release tablets combined with salmeterol xinafoate and fluticasone propionate inhalation;both groups were treated for 3 months. Six minutes walk distance(6 MWD), scores of the COPD Assessment Test(CAT) and the St George's Respiratory Questionnaire(SGRQ), forced expiratory volume in 1 second to forced vital capacity ratio( FEV,/FVC), percentage of FEV_1 in the predicted value(FEV_1%), inspiratory capacit(IC)and adverse reactions were analyzed. Results After treatment, 6 MWD, FEV_1/FVC, FEV_1% and IC in observation group were significantly longer/higher than those in control group[(326 ± 14)m vs(306 ± 17)m,(61±9)% vs(56 ±10)%,(49 ±9)% vs(44±9)%,(2. 1±0. 4)L vs(1.8±0.4)L]; CAT score and SGRQ score(disease symptom score, activity of daily living score, disease impact score and total score) in observation group were significantly lower than those in control group[(20. 6 ± 1. 1) vs(23. 5 ± 1.2),(41 ± 12) vs(47 ± 12),(45 ± 10) vs(53 ± 10),(38 ± 10) vs(43 ± 10),(41 ± 10) vs(47 ± 11) ](P <0. 05). Incidence of adverse reactions showed no significant difference between groups(P >0. 05). Conclusion Theophylline sustainedrelease tablets combined with salmeterol xinafoate and fluticasone propionate inhalation has a good therapeutic effect on COPD; it can effectively improve lung function and quality of life.
Objective To explore the effect of theophylline sustained-release tablets combined with salmeterol xinafoate and fluticasone propionate inhalation on chronic obstructive pulmonary disease( COPD) and quality of life. Methods Totally 74 patients with COPD from July 2016 to May 2017 in the First People's Hospital of Kashi were randomly divided into observation group and control group, with 37 cases in each group. The control group was treated with salmeterol xinafoate and fluticasone propionate inhalation; the observation group was treated with theophylline sustained-release tablets combined with salmeterol xinafoate and fluticasone propionate inhalation;both groups were treated for 3 months. Six minutes walk distance(6 MWD), scores of the COPD Assessment Test(CAT) and the St George's Respiratory Questionnaire(SGRQ), forced expiratory volume in 1 second to forced vital capacity ratio( FEV,/FVC), percentage of FEV_1 in the predicted value(FEV_1%), inspiratory capacit(IC)and adverse reactions were analyzed. Results After treatment, 6 MWD, FEV_1/FVC, FEV_1% and IC in observation group were significantly longer/higher than those in control group[(326 ± 14)m vs(306 ± 17)m,(61±9)% vs(56 ±10)%,(49 ±9)% vs(44±9)%,(2. 1±0. 4)L vs(1.8±0.4)L]; CAT score and SGRQ score(disease symptom score, activity of daily living score, disease impact score and total score) in observation group were significantly lower than those in control group[(20. 6 ± 1. 1) vs(23. 5 ± 1.2),(41 ± 12) vs(47 ± 12),(45 ± 10) vs(53 ± 10),(38 ± 10) vs(43 ± 10),(41 ± 10) vs(47 ± 11) ](P <0. 05). Incidence of adverse reactions showed no significant difference between groups(P >0. 05). Conclusion Theophylline sustainedrelease tablets combined with salmeterol xinafoate and fluticasone propionate inhalation has a good therapeutic effect on COPD; it can effectively improve lung function and quality of life.
引文
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[5]包鹤龄,方利文,王临虹.1990-2014年中国40岁及以上人群慢性阻塞性肺疾病患病率Meta分析[J].中华流行病学杂志,2016,37(1):119-124.DOI:10.3760/cma.j.issn.0254-6450.2016.01.026.Bao HL,Fang LW,Wang LH.Prevalence of chronic obstructive pulmonary disease among community population aged-40 in China:a Meta-analysis on studies published between 1990 and 2014[J].Chinese Journal of Epidemiology,2016,37(1):119-124.DOI:10.3760/cma.j.issn.0254-6450.2016.01.026.
[6]张小娥,张彩莲.慢性阻塞性肺疾病流行病学及疾病经济负担研究进展[J].中国慢性病预防与控制,2017,25(6):472-476.DOI:10.16386/j.cjpccd.issn.1004-6194.2017.06.021.Zhang XE,Zhang CL.Progress in the epidemiology of chronic obstructive pulmonary disease and the economic burden of disease[J].Chinese Journal of Prevention and Control of Chronic Diseases,2017,25(6):472-476.DOI:10.16386/j.cjpccd.issn.1004-6194.2017.06.021.
[7]Vogelmeier C,Paggiaro PL,Dorca J,et al.Efficacy and safety of aclidinium/formoterol versus salmeterol/fluticasone:a phase 3COPD study[J].Eur Respir J,2016,48(4):1030-1039.DOI:10.1183/13993003.00216-2016.
[8]Liang JB,Liu LJ,Fang QH.Clinical characteristics of patients with chronic obstructive pulmonary disease overlapped with bronchial asthma[J].Ann Allergy Asthma Immunol,2017,118(5):564-569.DOI:10.1016/j.anai.2017.02.019.
[9]郭俊华,黄四云,李建国.噻托溴铵联合小剂量茶碱治疗稳定期中重度慢性阻塞性肺疾病的效果观察[J].中国医药,2015,10(8):1126-1130.DOI:10.3760/cma.j.issn.1673-4777.2015.08.011.Guo JH,Huang SY,Li JG.Effect of tiotropium combined with low dose theophylline on stable chronic obstructive pulmonary disease[J].China Medicine,2015,10(8):1126-1130.DOI:10.3760/cma.j.issn.1673-4777.2015.08.011.
[10]黄志文,聂汉祥.茶碱缓释片联合沙美特罗氟替卡松对慢性阻塞性肺疾病急性加重和小气道功能的影响[J].现代中西医结合杂志,2014,23(32):3590-3592.DOI:10,3969/j.issn.1008-8849.2014.32.022.Huang ZW,Nie HX.Effect of theophylline sustained-release tablets combined with salmeterol and fluticasone on acute exacerbation of chronic obstructive pulmonary disease and small airway function[J].Modern Journal of Integrated Traditional Chinese and Western Medicine,2014,23(32):3590-3592.DOI:10.3969/j.issn.1008-8849.2014.32.022.
[11]王建云,王玉梅.茶碱缓释片治疗成人支气管哮喘的有效性及安全性[J].医学综述,2016,22(18):3707-3712.DOI:10.3969/j.issn.1006-2084.2016.18.046.Wang JY,Wang YM.Efficacy and safety of theophylline sustained-release tablets treatment of adult bronchial asthma[J].Medical Recapitulate,2016,22(18):3707-3712.DOI:10.3969/i.issn.1006-2084.2016.18.046.
[2]Cosío BG,Shafiek H,Iglesias A,et al.Oral low-dose theophylline on top of inhaled fluticasone-salmeterol does not reduce exacerbations in patients with severe COPD:a pilot clinical trial[J].Chest,2016,150(1):123-130.DOI:10.1016/j.chest.2016.04.011.
[3]李改平,刘宇,徐燕杰,等.沙美特罗替卡松粉吸人剂联合无创正压通气治疗老年慢性阻塞性肺疾病合并呼吸衰竭的临床效果[J].中国医药,2017,12(8):1153-1156.DOI:10.3760/cma.j.issn.1673-4777.2017.08.009.Li GP,Liu Y,Xu YJ,et al.Clinical effect of salmeterol xinafoat and fluticasone propionate powder for inhalation combined with non-invasive positive pressure ventilation on chronic obstructive pulmonary disease complicated with respiratory failure in elderly patients[J].China Medicine,2017,12(8):1153-1156.DOI:10.3760/cma.j.issn.1673-4777.2017.08.009.
[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):255-264.DOI:10.3760/cma.j.issn.1001-0939.2013.04.007.Chronic Obstructive Pulmonary Disease Committee,Respiratory Society,Chinese Medical Association.Guidelines for the diagnosis and treatment of chronic obstructive pulmonary disease(revised edition in 2013)[J].Chinese Journal of Tuberculosis and Respiratory Diseases,2013,36(4):255-264.DOI:10.3760/cma.j.issn.1001-0939.2013.04.007.
[5]包鹤龄,方利文,王临虹.1990-2014年中国40岁及以上人群慢性阻塞性肺疾病患病率Meta分析[J].中华流行病学杂志,2016,37(1):119-124.DOI:10.3760/cma.j.issn.0254-6450.2016.01.026.Bao HL,Fang LW,Wang LH.Prevalence of chronic obstructive pulmonary disease among community population aged-40 in China:a Meta-analysis on studies published between 1990 and 2014[J].Chinese Journal of Epidemiology,2016,37(1):119-124.DOI:10.3760/cma.j.issn.0254-6450.2016.01.026.
[6]张小娥,张彩莲.慢性阻塞性肺疾病流行病学及疾病经济负担研究进展[J].中国慢性病预防与控制,2017,25(6):472-476.DOI:10.16386/j.cjpccd.issn.1004-6194.2017.06.021.Zhang XE,Zhang CL.Progress in the epidemiology of chronic obstructive pulmonary disease and the economic burden of disease[J].Chinese Journal of Prevention and Control of Chronic Diseases,2017,25(6):472-476.DOI:10.16386/j.cjpccd.issn.1004-6194.2017.06.021.
[7]Vogelmeier C,Paggiaro PL,Dorca J,et al.Efficacy and safety of aclidinium/formoterol versus salmeterol/fluticasone:a phase 3COPD study[J].Eur Respir J,2016,48(4):1030-1039.DOI:10.1183/13993003.00216-2016.
[8]Liang JB,Liu LJ,Fang QH.Clinical characteristics of patients with chronic obstructive pulmonary disease overlapped with bronchial asthma[J].Ann Allergy Asthma Immunol,2017,118(5):564-569.DOI:10.1016/j.anai.2017.02.019.
[9]郭俊华,黄四云,李建国.噻托溴铵联合小剂量茶碱治疗稳定期中重度慢性阻塞性肺疾病的效果观察[J].中国医药,2015,10(8):1126-1130.DOI:10.3760/cma.j.issn.1673-4777.2015.08.011.Guo JH,Huang SY,Li JG.Effect of tiotropium combined with low dose theophylline on stable chronic obstructive pulmonary disease[J].China Medicine,2015,10(8):1126-1130.DOI:10.3760/cma.j.issn.1673-4777.2015.08.011.
[10]黄志文,聂汉祥.茶碱缓释片联合沙美特罗氟替卡松对慢性阻塞性肺疾病急性加重和小气道功能的影响[J].现代中西医结合杂志,2014,23(32):3590-3592.DOI:10,3969/j.issn.1008-8849.2014.32.022.Huang ZW,Nie HX.Effect of theophylline sustained-release tablets combined with salmeterol and fluticasone on acute exacerbation of chronic obstructive pulmonary disease and small airway function[J].Modern Journal of Integrated Traditional Chinese and Western Medicine,2014,23(32):3590-3592.DOI:10.3969/j.issn.1008-8849.2014.32.022.
[11]王建云,王玉梅.茶碱缓释片治疗成人支气管哮喘的有效性及安全性[J].医学综述,2016,22(18):3707-3712.DOI:10.3969/j.issn.1006-2084.2016.18.046.Wang JY,Wang YM.Efficacy and safety of theophylline sustained-release tablets treatment of adult bronchial asthma[J].Medical Recapitulate,2016,22(18):3707-3712.DOI:10.3969/i.issn.1006-2084.2016.18.046.