噻托溴铵辅助下双水平气道正压通气对慢性阻塞性肺疾病患者血清MMP-9、TNF-α的影响  

Effects of tiotropium bromide assisted bilevel positive airway pressure ventilation on the levels of serum MMP-9 and TNF-α in patients with chronic obstructive pulmonary disease

作　　者：李文军[1] 唐齐兵 常红 高峰[1] 王开绿[1] 

机构地区：[1]四川省绵阳市第三人民医院呼吸内科,621000

出　　处：《中华肺部疾病杂志（电子版）》2017年第6期718-722,共5页Chinese Journal of Lung Diseases(Electronic Edition)

基　　金：四川省科技厅软科学研究基金资助(2016ZR07841)

摘　　要：目的探讨噻托溴铵辅助下双水平气道正压通气对慢性阻塞性肺疾病(COPD)患者血清基质金属蛋白酶-9(MMP-9)、肿瘤坏死因子-α(TNF-α)的影响。方法选取2014年9月至2016年9月在我院进行治疗的74例COPD患者作为研究对象,按照简单随机法分为三组,分别行单用噻托溴铵25例、单用双水平气道正压通气23例及二者联合26例进行治疗。比较三组患者治疗前后血清中MMP-9、TNF-α含量,肺功能水平、治疗效果,及不良反应发生情况。结果三组患者治疗后的血清中MMP-9、TNF-α含量与治疗前相比均有下降(P<0.05),联合治疗组患者血清中MMP-9、TNF-α含量明显低于噻托溴铵组或BiPAP组(P<0.05);三组患者治疗后肺功能评价指标FEV1、FVC、FEV1/FVC、PEF较治疗前均有提高(P<0.05),联合治疗组患者治疗后FEV_1、FVC、FEV_1/FVC、PEF明显高于噻托溴铵组或Bi PAP组(P<0.05);噻托溴铵治疗COPD的有效率为77.50%,Bi PAP治疗COPD的有效率为75.00%,联合治疗COPD的有效率为88.75%,联合治疗的效果明显优于Bi PAP组(P<0.05);但联合治疗组有效率与噻托溴铵组比较差异无统计学意义(P>0.05)。比较三组治疗后1年的复发及不良反应发生情况,联合治疗的COPD复发率明显低于噻托溴铵或Bi PAP治疗(P<0.05),三种治疗方式在治疗后1年内不良反应发生率比较无统计学意义(P>0.05)。结论噻托溴铵辅助下双水平气道正压通气对COPD患者的治疗效果显著,可有效改善患者肺功能,并可降低血清中MMP-9、TNF-α含量,同时治疗后COPD患者复发率较低。Objective To explore the effect of tiotropium bromide assisted bilevel positive airway pressure ventilation on the levels of serum matrix metalloproteinase-9( MMP-9) and tumor necrosis factor-α( TNF-α) in patients with chronic obstructive pulmonary disease( COPD). Methods From September 2013 to September 2015,74 cases of chronic obstructive pulmonary disease patients was stuided in our hospital.According to randomly divided into three groups,respectively with tiotropium bromide 25 cases,single bilevel positive airway pressure ventilation 23 cases and combination therapy 26 cases. The levels of MMP-9 and TNF-α in serum of three groups before and after treatment were compared,and the level of pulmonary function,treatment effect and adverse reaction were observed. Results The serum of TNF-α,MMP-9 contentafter treatmentwere lower than before treatment( P < 0. 05),combined treatment group in serum of patients with MMP-9 and TNF-α was significantly lower than that in the tiotropium bromide group or Bi PAP group( P <0.05); three groups of patients after treatment,lung function index of FEV1,FVC,FEV1/FVC,PEF compared with before treatment were improved( P<0.05),combined treatment group after treatment in patientswith FEV1,FVC,FEV1/FVC and PEF were higher than those in the tiotropium bromide group or BiP AP group( P<0.05); tiotropium bromide in the treatment of COPD with 77.50% efficiency,BiP AP COPD treatment efficiency was 75%,the efficiency of combined treatment of COPD 88. 75%,the effect of the combined treatment was better than that of BiP AP group( P< 0. 05); but the effective rate of combination therapy group was not statistically significant compared with that of tiotropium group( P > 0. 05). the incidence of 1 years recurrence and adverse reactions of three groups were compared after treatment,combined treatment of the recurrence rate of COPD was significantly lower than that of tiotropium bromide or BiP AP treatment( P<0.05)there was no significant difference in the incidence of adverse reactions between th

关 键 词：肺疾病 慢性阻塞性 噻托溴铵 双水平气道正压通气 基质金属蛋白酶-9 肿瘤坏死因子-α 

分 类 号：R563[医药卫生—呼吸系统]