噻托溴铵治疗慢性阻塞性肺疾病稳定期的临床疗效及对血清白介素18、肿瘤坏死因子α、基质金属蛋白酶9水平的影响研究

摘要

目的：观察噻托溴铵治疗慢性阻塞性肺疾病（COPD）稳定期的临床疗效，探讨其对血清白介素18（IL-18）、肿瘤坏死因子α（TNF-α）、基质金属蛋白酶9（MMP-9）水平的影响。方法选取2013年7月—2015年1月沧州和平医院收治的 COPD 稳定期患者114例，按随机数字表法分为对照组与观察组，每组57例。对照组患者予以常规治疗，观察组患者在对照组基础上加用噻托溴铵治疗；两组患者均连续治疗12周。比较两组患者临床疗效，治疗前后肺功能指标〔第1秒用力呼气容积（ FEV1）、用力肺活量（ FVC）、第1秒用力呼气容积与用力肺活量比值（FEV1/ FVC）、呼气峰流速（PEF）〕及血清 IL-18、TNF-α、MMP-9水平，不良反应发生情况。结果观察组患者临床疗效优于对照组（P <0.05）。治疗前两组患者 FEV1、FVC、FEV1/ FVC、PEF 比较，差异无统计学意义（ P >0.05）；治疗后观察组患者 FEV1、FVC、FEV1/ FVC、PEF 高于对照组（ P <0.05）。治疗前两组患者血清 IL-18、TNF-α、MMP-9水平比较，差异无统计学意义（P >0.05）；治疗后观察组患者血清 IL-18、TNF-α、MMP-9水平低于对照组（P<0.05）。两组患者不良反应发生率比较，差异无统计学意义（ P >0.05）。结论噻托溴铵治疗 COPD 稳定期患者的临床疗效确切，可有效改善患者肺功能，降低患者血清 IL-18、TNF-α、MMP-9水平，且不良反应较少。%Objective To observe the clinical effect of tiotropium bromide on chronic obstructive pulmonary disease (COPD)at stable stage,to investigate its impact on serum levels of IL-18,TNF-α and MMP-9. Methods A total of 114 patients with COPD at stable stage were selected in Heping Hospital of Cangzhou from July 2013 to January 2015,and they were divided into control group and observation group according to random number table,each of 57 cases. Patients of control group received conventional treatment,while patients of observation group received extra tiotropium bromide based on control group;both groups continuously treated for 12 weeks. Clinical effect,index of pulmonary function( including FEV1 ,FVC,FEV1 /FVC and PEF)and serum levels of IL-18,TNF-α and MMP-9 before and after treatment,and incidence of adverse reactions were compared between the two groups. Results The clinical effect of observation group was statistically significantly better than that of control group(P < 0. 05). No statistically significant differences of FEV1 ,FVC,FEV1 / FVC or PEF was found between the two groups before treatment( P > 0. 05),while FEV1 ,FVC,FEV1 / FVC and PEF of observation group were statistically significantly higher than those of control group after treatment(P < 0. 05). No statistically significant differences of serum level of IL-18,TNF-α or MMP-9 was found between the two groups before treatment( P > 0. 05),while serum levels of IL-18, TNF-α and MMP-9 of observation 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(P > 0. 05). Conclusion Tiotropium bromide has certain clinical effect in treating COPD at stable stage,can effectively improve the pulmonary function,reduce the serum levels of IL-18,TNF-α and MMP-9,and with less adverse reactions.