COPD稳定期患者噻托溴铵联合沙美特罗/氟替卡松治疗效果的CAT量表评估

摘要

目的:探讨噻托溴铵联合沙美特罗/氟替卡松吸入治疗的慢性阻塞性肺疾病(COPD)稳定期患者采用观察健康相关生活质量改善情况的COPD评估测试量表(CAT)评估的意义.方法:选择重度、极重度COPD稳定期患者125例,根据患者治疗方式分为噻托溴铵联合沙美特罗/氟替卡松吸入治疗组(观察组,78例)和沙美特罗/氟替卡松吸入治疗组(对照组,47例),入组时登记临床基本资料,在入组时、3个月末、6个月末分别行肺功能检查和CAT量表评分,记录6个月中患者出现急性加重的次数.结果:入组时观察组和对照组患者各项临床指标均无显著差异.在3个月末和6个月末时,两组患者CAT评分比入组时均显著降低(均P＜0.05),第1秒用力呼气容积占预计值百分比(FEV1%)较入组时均显著升高(均P＜0.05),且观察组患者CAT评分较对照组低(P＜0.05),FEV1%较对照组高(P＜0.05).患者CAT评分与FEV1%之间中度负相关(Pearson相关系数波动于-0.58～-0.79).在随访过程中,出现急性加重患者CAT评分比未出现急性加重患者高(P＜0.05).结论:与单一使用沙美特罗/氟替卡松治疗相比,噻托溴铵联合沙美特罗/氟替卡松吸入治疗可以更加显著地降低COPD稳定期患者的CAT评分,提高患者健康相关生活质量,改善肺功能,减少急性加重;CAT量表可以作为COPD稳定期患者噻托溴铵联合沙美特罗/氟替卡松吸入治疗前后健康相关生活质量评价的一个有效工具.%Objective; To investigate the improvement of health-related quality of life during stable stage of chronic obstructive pulmonary disease ( COPD) with salmeterol/fluticasone therapy using COPD assessment test (CAT). Methods; 125 subjects with moderate-to-severe COPD treated with a combination of tiotropium bromide and salmeterol/fluticasone( observed group, n = 78) , or Salmeterol/fluticasone alone(control group, n = 47) were enrolled into this clinical trial and were observed for six months. All patients were documented their information after inclusion. Health-related Quality of life was measured by CAT and lung function test was done at baseline, third month and sixth month. The events of acute exacerbation were also recorded. Results; No significant differences existed between the two groups at baseline. After 3 month and 6 month the average improvements (lower CAT scores and higher FEV1% ) were significant in both observed group and control group (P <0. 05) , and there had been a greater improvement in observed group. There were good association between CAT score and FEV1% ( - 0. 58 to - 0. 79 ) . In patients with acute exacerbation more than once during the six month were associated with higher CAT scores (P < 0. 05 ). Conclusions; In patients with stable COPD, compared with therapy with salmeterol/fluticasone alone, tiotropium bromide combined with salmeterol/fluticasone is associated with lower CAT score, higher quality of life and fewer exacerbations, under such a situation where CAT is a reliable for assessing health-related quality of life of stable COPD patient.