目的 观察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(COPD)的疗效.方法 选择2010年1月至2013年1月广东省梅州市人民医院收治的稳定期中重度COPD患者112例,完全随机分为噻托溴铵组(38例)、茶碱组(38例)和噻托溴铵联合小剂量茶碱组(联合组,36例).噻托溴铵组单独吸入噻托溴铵18 μg/d,茶碱组单独服用茶碱缓释片100 mg,1次/12 h,联合组同时使用噻托溴铵及茶碱缓释片.疗程为6个月.治疗前后分别检测3组患者肺功能、运动耐量(6 min步行距离)、生活质量(StGeorge呼吸问卷评分)和治疗期间COPD急性发作(AECOPD)情况.结果 治疗后6个月噻托溴铵组及联合组第1秒用力呼气容积(FEV1)、FEV1占用力肺活量百分比(FEV1/FVC％)、FEV1占预计值百分比(FEV1/预计值％)、运动耐量及生活质量均较治疗前明显改善[噻托溴铵组:(1.2±0.4)L比(1.1±0.3)L、(55±10)％比(49±8)％、(53±9)％比(49±8)％、(289 ±27)m比(238±23)m、(41±5)分比(50 ±4)分;联合组:(1.2±0.4)L比(1.1 ±0.3)L、(56±8)％比(49±9)％、(53±10)％比(47±9)％、(294 ±28)m比(237 ±26)m、(41±5)分比(50±3)分],差异均有统计学意义(均P＜0.05);茶碱组各项指数与治疗前比较差异无统计学意义(P＞0.05);治疗后6个月噻托溴铵组、联合组FEV1、FEV1/FVC％和FEV1/预计值％、运动耐量及生活质量均明显优于茶碱组[(1.2±0.4)、(1.2±0.4)L比(1.1 ±0.4)L,(55±10)％、(56±8)％比(52±10)％,(53±9)％、(53±10)％比(50±11)％,(289 ±27)、(294 ±28)m比(240 ±29)m,(41±5)、(41 ±5)分比(47±4)分],差异均有统计学意义(均P＜0.05);噻托溴铵组与联合组FEV1、FEV1/FVC％和FEV1/预计值％、运动耐量及生活质量比较差异无统计学意义(P＞0.05),但随访6个月联合组AECOPD发作次数较噻托溴铵组减少(3人次比5人次),差异有统计学意义(P＜0.05).结论 噻托溴铵联合小剂量茶碱不但能改善稳定期中重度COPD患者肺功能、提高其运动耐量、改善其生活质量,而且较单独使用噻托溴铵或小剂量茶碱能明显减少AECOPD次数.%Objective To observe the effect of tiotropium combined with low-dose theophylline on stable chronic obstructive pulmonary disease (COPD).Methods Totally 112 patients with moderate to severe stable COPD from January 2010 to January 2013 were enrolled and randomly divided into tiotropium group (38 cases) inhaling tiotropium (18 μg,once/d),theophylline group (38 cases) taking low dose theophylline (100 mg,1 times/12 h),and combined group (36 cases) taking tiotropium combined with low dose theophylline.The pulmonary function,exercise tolerance (6 min walking distance),life quality (St george respiratory questionnaire) and frequency of AECOPD during therapy were assessed before and 6 months after treatment.Results Six months after treatment,the forced expiratory volume in one second (FEV1),ratio of FEV1 and forced vital capacity in percentage (FEV1/FVC％) and FEV1/predicted％,exercise tolerance,life quality were all improved in tiotropium group [(1.2 ±0.4) L vs (1.1 ±0.3) L,(55 ±10)％ vs (49 ±8)％,(53 ±9)％ vs (49 ±8)％,(289 ± 27) mvs (238±23) m,(41±5) scorevs (50±4) score] and combined group [(1.2±0.4) Lvs (1.1 ± 0.3) L,(56±8)％ vs (49±9)％,(53±10)％ vs (47±9)％,(294±28) mvs (237±26) m,(41 ±5) scores vs (50 ± 3) scores] (P ＜ 0.05),but there was no significant difference in theophylline group (P ＞ 0.05).The FEV1,FEV1/FVC％ and FEV1/predicted％,exercise tolerance and life quality were improved in tiotropium group and combined group compared with those in theophylline group [(1.1 ± 0.4) L,(52 ± 10) ％,(50 ± 11) ％,(240 ± 29) m,(47 ± 4) scores] after treatment (P ＜ 0.05),but there was no differencebetween tiotropium group and combined group (P ＞ 0.05).The frequency of AECOPD was reduced significantly in combined group compared with that in tiotropium group (3 people/half year vs 5 people/half year,P ＜ 0.05).Conclusion Tiotropium combined with low dose theophylline can not only improve lung function,exercise tolerance and life quality,but also can significantly reduce the frequency of acute exacerbation in patients with moderate to severe stable COPD.
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