肺康复疗法对老年COPD稳定期患者血清炎症因子的影响

摘要

目的 探讨肺康复疗法对老年慢性阻塞性肺疾病(COPD)稳定期患者的血清炎症因子的影响.方法 选择凉山州第一人民医院于2012年11月至2015年10月收治的166例老年COPD稳定期患者为对象,以随机数表法分为观察组(n=83)与对照组(n=83),对照组患者给予常规治疗,观察组在对照组基础上加用肺康复锻炼,12周后比较两组患者肺功能(FEV1、FEV1/FVC)、运动耐力(6MWT)、呼吸困难(CAT)以及血清炎症因子(CRP、IL-6、TNF-α)变化.结果 治疗后观察组FEV1占预计值百分比及FEV1/FVC分别为(67.2±9.3)％、(66.3±6.8)％,均显著高于治疗前的(61.1±8.7)％与(62.2±6.6)％,差异有显著统计学意义(P<0.01),对照组治疗前后,差异无统计学意义(P>0.05),且治疗后观察组均显著高于对照组,差异有显著统计学意义(P<0.01);观察组治疗后CAT评分为(8.3±2.3)分,显著低于治疗前的(10.4±2.1)分,6MWT为(386.5±39.4)米,显著优于治疗前的(301.2±38.8)米,对照组治疗后CAT评分为(12.5±2.4),显著高于治疗前的(10.6±2.2),6MWT为(322.4±39.2)米,显著优于治疗前的(301.5±38.7)米,差异均有显著统计学意义(P<0.01),治疗后观察组CAT显著低于对照组,6MWT显著高于对照组,差异均有显著统计学意义(P<0.01);观察组治疗后CRP、IL-6、TNF-α分别为(3.21±1.68)mg/L、(9.04±1.34)pg/mL、(6.54±0.95)pg/mL,均显著低于治疗前的(3.82±1.71)mg/L、(9.83±1.32)pg/mL、(7.47±0.98)pg/mL,差异均有显著统计学意义(P<0.01),对照组CRP、IL-6治疗前后,差异无统计学意义(P>0.05),TNF-α显著降低,差异有显著统计学意义(P<0.01),治疗后观察组上述三项指标均显著低于对照组,差异均有显著统计学意义(P<0.01).结论 肺康复在老年COPD稳定期患者的治疗中可有效减轻患者临床症状体征,改善肺功能,提高运动耐力,提高生活质量,减轻炎症反应.%Objective To discuss the influence of pulmonary rehabilitation on serum inflammatory factors in el-derly patients with COPD in stable phase. Methods A total of 166 elderly patients with COPD in stable phase, who ad-mitted to the First People's Hospital of Liangshan were divided into the observation group (n=83) and the control group (n=83) according to random number table. The control group was treated with conventional therapy, while the observation group was given pulmonary rehabilitation exercise based on the control group. After 12 weeks, lung function (FEV1, FEV1/FVC), exercise tolerance (6MWT), dyspnea (CAT), serum inflammatory factors (CRP, IL-6, TNF-α) were contrast-ed between the two groups. Results Forced expiratory volume in one second (FEV1) percentage of estimated value and FEV1/FVC (forced vital capacity) were respectively (67.2±9.3)％and (66.3±6.8)％in the observation group after the treat-ment, which were significantly higher than (61.1±8.7)％and (62.2±6.6)％before treatment (P<0.01), but there was no sig-nificant difference before and after the treatment in the control group (P>0.05);after the treatment, FEV1 percentage of es-timated value and FEV1/FVC in the observation group were significantly higher than those in the control group (P<0.01). Chronic obstructive pulmonary disease assessment test (CAT) after the treatment in the observation group was (8.3±2.3), which was significantly lower than (10.4±2.1) before treatment;6-minute-walk test (6MWT) was (386.5±39.4) m, which was significantly better than (301.2 ± 38.8) m before treatment. CAT after the treatment in the control group was (12.5 ± 2.4), which was significantly higher than (10.6±2.2) before treatment;6MWT was (322.4±39.2) m, which was significant-ly better than (301.5 ± 38.7) m before treatment (P<0.01). After the treatment, CAT in the observation group was signifi-cantly lower than that in the control group, while 6MWT in the observation group was significantly higher than that in the control group (P<0.01). C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) were re-spectively (3.21 ± 1.68) mg/L, (9.04 ± 1.34) pg/mL, and (6.54 ± 0.95) pg/mL in the observation group after the treatment, which were significantly lower than (3.82±1.71) mg/L, (9.83±1.32) pg/mL, and (7.47±0.98) pg/mL before treatment (P<0.01);there was no significant changes between before and after the treatment in the control group in CRP and IL-6 (P>0.05), while TNF-αsignificantly reduced (P<0.01). After the treatment, CRP, TNF-α, and IL-6 in the observation group were significantly lower than those in the control group (P<0.05). Conclusion Pulmonary rehabilitation can effectively alleviate the clinical symptoms in elderly patients with stable COPD, improve the quality of life, lung function and endur-ance of the patients, and reduce the inflammation and the level of inflammatory factors, which is worthy of promotion.