噻托溴铵粉吸入剂联合盐酸氨溴索对轻/中度稳定期慢性阻塞性肺疾病患者血清细胞因子水平及气道重塑的影响分析  

Analysis of the therapeutic effect of the combination of tiotropium bromide power for inhalation and Ambroxol in patients with mild-to-moderate stable chronic obstructive pulmonary disease

作　　者：朱科[1] 陈先华[1] 

机构地区：[1]第三军医大学西南医院预防保健科,重庆400038

出　　处：《中国医学前沿杂志（电子版）》2017年第5期131-135,共5页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的分析噻托溴铵粉吸入剂联合盐酸氨溴索对轻/中度稳定期慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者血清细胞因子水平及气道重塑的影响。方法选取2014年1月至2016年6月于本院就诊的110例轻/中度稳定期COPD患者为研究对象。按照随机数表法将患者分为观察组和对照组,每组各50例。对照组患者接受吸氧、止咳、平喘等常规治疗,观察组患者在对照组治疗基础上加用噻托溴铵粉吸入剂联合盐酸氨溴索。比较两组患者治疗前和治疗后6个月肺功能变化、COPD评估测试(the COPD assessment test,CAT)评分、气道炎性指标、气道重塑指标及观察期内因急性发作而住院的患者例数。结果治疗后两组患者第一秒用力呼气量(forced expiratory volume in one second,FEV_1)、FEV_1占预计值百分比(FEV_1%预计值)、FEV_1/用力肺活量(forced vital capacity,FVC)、呼气流量峰值(peak expiratory flow,PEF)、PEF占预计值百分比(PEF%预计值)、25%肺活量最大呼气流量(maximal expiratory flow in 25%vital capacity,MEF_(25%))、25%~75%肺活量最大呼气流量(MEF_(25%)~_(75%))、75%肺活量最大呼气流量(MEF_(75%))均显著高于治疗前(P<0.05)。与对照组相比,观察组患者FEV_1、FEV_1%预计值、FEV_1/FVC、PEF、PEF%预计值、MEF_(25%)、MEF_(25%~75%)改善更显著(P<0.05),MEF75%有所提高,但两组间比较均无显著差异(P>0.05)。治疗后两组患者CAT评分较治疗前均显著降低(P<0.05),观察组患者治疗后CAT评分显著低于对照组(P<0.05)。观察期内,观察组5例和对照组13例患者因急性加重而住院治疗,两组比较差异具有显著性(χ~2=4.420,P=0.036)。治疗后两组患者白介素(interleukin,IL)-6和IL-18水平较治疗前均显著降低(P<0.05),克拉拉细胞蛋白(Clara cell protein,CC16)水平较治疗前显著升高(P<0.05);观察组患者治疗后IL-6和IL-18水平显著低于对照组(P<0.05),CC16水平显著高于对照组(P<0.05)。治疗后�Objective To explore the therapeutic effect of the combination of Tiotropium bromide power for inhalation and Ambroxol in patients with mild-to-moderate stable chronic obstructive pulmonary disease （COPD）. Method 110 patients with mild-to-moderate stable COPD from January 2014 to June 2016 in our hospital were selected as the subjects, all patients were randomly divided into observation group and control group by the random number table method. Control group patients were accepted regular treatment included oxygen therapy, cough and asthma relieving medicine. Observation group patients were treated with tiotropium bromide and ambroxol on the bosis of observation group. Before treatment and 6 months after treatment, the pulmonary function, the severity of symptoms estimated by the COPD assessment test （CAT）, airway inflammatory index and airway remodeling index and hospitalization frequency during the follow-up period were compared between the two groups. Result After treatment, the forced expiratory volume in one second （FEV1）, FEV1% predicted value, FEV1/forced vital capacity （FVC）, peak expiratory flow （PEF）, PEF% predicted value, maximal expiratory flow in 25% vital capacity （MEF25%）, MEF25% - 75%, MEF75% in the two groups were significantly higher than before treatment （P 〈 0.05）. Compared with control group, the FEV1, FEV1% predicted value, FEV1/FVC, PEF, PEF% predicted value, MEF25%, MEF25% ~ 75% of observation group were significantly higher than that of control group （P 〈 0.05）, MEF75% improved, but there was no significant difference between the two groups （P 〉 0.05）. After treatment, the CAT scores of the two groups were significantly lower than those before treatment （P 〈 0.05）. The score of CAT in observation group was significantly lower than control group （P〈0.05）. The frequency of acute exacerbation of observation group （5 cases） requiring hospitalization was significantly lower than that of control group （13 cases） during the whole foll

关 键 词：慢性阻塞性肺疾病 噻托溴铵粉吸入剂 盐酸氨溴索 气道重塑 

分 类 号：R563.9[医药卫生—呼吸系统]