沙美特罗替卡松吸入治疗慢性阻塞性肺疾病急性加重期的临床疗效及其对血清炎性因子水平和肺功能的影响

摘要

Objective To observe the clinical effect of inhalation of salmeterol and fluticasone propionate on acute exacerbation of chronic obstructive pulmonary disease (AECOPD),to investigate the impact on serum inflammatory cytokines levels and pulmonary function.Methods A total of 173 patients with AECOPD were selected in the Third Hospital of Wuhan from March 2012 to April 2015,and they were divided into control group (n =86) and test group (n =87) according to random number table.Based on conventional treatment,patients of control group received inhalation of salbutamol,while patients of test group received inhalation of salmeterol and fluticasone propionate;both groups continuously treated for 14 days.Clinical effect,SGRQ score,index of pulmonary function (including FEV1,FEV1/FVC and FEV1％),6-minute walking distance and serum inflammatory cytokines (including hs-CRP,IL-6,IL-8 and TNF-α) levels before and after treatment were compared between the two groups,and incidence of adverse reactions was observed during the treatment.Results Clinical effect of test group was statistically significantly better than that of control group (P ＜ 0.05).No statistically significant differences of SGRQ score,FEV1,FEV1/FVC,FEV1 ％ or 6-minute walking distance was found between the two groups before treatment (P ＞ 0.05);after treatment,SGRQ score of test group was statistically significantly lower than that of control group,FEV1 of test group was statistically significantly larger than that of control group,meanwhile FEV1/FVC and FEV1％ of test group were statistically significantly higher than those of control group,while 6-minute walking distance of test group was statistically significantly longer than that of control group (P ＜ 0.05).No statistically significant differences of serum level of hs-CRP,IL-6,IL-8 or TNF-α was found between the two groups before treatment (P ＞ 0.05),while serum levels of hs-CRP,IL-6,IL-8 and TNF-α of test group were statistically significantly lower than those of control group after treatment (P ＜ 0.05).No statistically significant differences of incidence of adverse reactions was found between the two groups during the treatment (P ＞ 0.05).Conclusion Inhalation of salmeterol and fluticasone propionate has certain clinical effect in treating patients with AECOPD,can effectively reduce the serum inflammatory cytokines levels,improve the pulmonary function,exercise tolerance and quality of life,with relatively high safety.%目的 观察沙美特罗替卡松吸入治疗慢性阻塞性肺疾病急性加重期(AECOPD)的临床疗效,并探讨其对血清炎性因子水平和肺功能的影响.方法 选取2012年3月-2015年4月武汉市第三医院收治的AECOPD患者173例,采用随机数字表法分为对照组86例和试验组87例.在常规治疗基础上,对照组患者给予沙丁胺醇吸入治疗,试验组患者给予沙美特罗替卡松吸入治疗;两组患者均连续治疗14 d.比较两组患者临床疗效,治疗前后圣·乔治呼吸调查问卷(SGRQ)评分、肺功能指标[包括第1秒用力呼气容积(FEV1)、第1秒用力呼气容积与用力肺活量比值(FEV1/FVC)及第1秒用力呼气容积占预计值百分比(FEV1％)]、6分钟步行距离(6MWD)及血清炎性因子[包括超敏C反应蛋白(hs-CRP)、白介素6(IL-6)、白介素8(IL-8)、肿瘤坏死因子α(TNF-α)]水平,并观察两组患者治疗期间不良反应发生情况.结果 试验组患者临床疗效优于对照组(P＜0.05).治疗前两组患者SGRQ评分、FEV1、FEV1/FVC、FEV1％及6MWD比较,差异无统计学意义(P＞0.05);治疗后试验组患者SGRQ评分低于对照组,FEV1大于对照组,FEV1/FVC和FEV1％高于对照组,6MWD长于对照组(P＜0.05).治疗前两组患者血清hs-CRP、IL-6、IL-8及TNF-α水平比较,差异无统计学意义(P＞0.05);治疗后试验组患者血清hs-CRP、IL-6、IL-8及TNF-α水平低于对照组(P＜0.05).两组患者治疗期间不良反应发生率比较,差异无统计学意义(P＞0.05).结论 沙美特罗替卡松吸入治疗AECOPD的临床疗效确切,可有效降低血清炎性因子水平并改善患者肺功能,提高患者运动耐量及生活质量,且安全性较高.