小剂量红霉素联合沙美特罗替卡松对COPD缓解期患者生存质量的影响

摘要

目的 观察小剂量红霉素联合沙美特罗替卡松对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)缓解期患者维持治疗中的疗效,及对患者生活质量及呼吸功能的影响.方法 选取2014年1月~2016年1月于杭州红十字会医院接受诊疗的87例COPD患者的资料.依据治疗方法的不同将患者分为观察组(沙美特罗替卡松+红霉素)46例及对照组(沙美特罗替卡松)41例.治疗6个月评估2组呼吸功能、生活质量、COPD急性发作及外周血炎症因子等指标的改变.结果 治疗后,2组圣乔治呼吸系统疾病生活质量问卷(St.George's respiratory questionnaire,SGRQ)评分及MMRC评分均显著降低,同时观察组患者显著低于对照组,差异有统计学意义(P<0.05).治疗后2组FEV1/FVC%水平均显著升高,但观察组显著高于对照组,差异有统计学意义(P<0.05).观察组治疗期间COPD急性加重的累积发生率为10.87%(5/46)显著低于对照组29.27%(12/41),差异有统计学意义(Log-rankχ2=4.833,P=0.028).治疗后,2组患者外周血白介素-1β(Interleukin-1β,IL-1β)及肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平均显著降低,且观察组患者显著低于对照组患者,差异有统计学意义(P<0.05).结论 小剂量红霉素可有效改善COPD稳定期患者的维持治疗疗效,改善生活质量及呼吸功能.%Objective To observe the clinical efficacy of low-dose erythromycin combined with salmeterol-fluticasone in the treatment of stable COPD, focus on the quality of life and respiratory function of patients.Methods 87 patients with stable COPD admitted to Hangzhou Red Cross Hospital from January 2014 to January 2016 were selected.Patients were divided into two groups by therapeutic methods, observation group ( salmeterol-fluticasone+erythromycin) 46 cases and control group (salmeterol-fluticasone) 41 cases.Six months of treatment, the quality of life of two groups of respiratory function assessment, acute COPD and peripheral inflammatory factor and other indicators of change.Results After treatment, both of the two groups got significantly decreased in SGRQ and MMRC scores, while the observation group was significantly lower than the control group, the difference was statistically significant(P<0.05).After treatment, FEV1/FVC%levels were significantly increased in both groups, but the observation group was significantly higher than the control group, the difference was statistically significant(P <0.05).The cumulative incidence of acute exacerbation of COPD was 10.87%(5/46) in the observation group, which was significantly lower than that in the control group 29.27%(12/41), the difference was statistically significant(Log-rankχ2 =4.833, P=0.028).After treatment, the levels of IL-1βand TNF-αin the peripheral blood of the patients in the observation group were significantly lower than those in the control group, the difference was statistically significant (P <0.05).Conclusion In the treatment of stable COPD, low-dose erythromycin could significantly improve the clinical efficacy, improve the quality of life and respiratory function.