肺康复对慢性阻塞性肺疾病稳定期患者BODE指数和血清炎症因子的影响  

Effect of pulmonary rehabilitation on BODE index and serum inflammatory factors in patients with stable chronic obstructive pulmonary disease

作　　者：尹正录[1] 孟兆祥[1] 王继兵[1] 陈波[1] 杨双月 全逸峰 Yin Zhenglu;Meng Zhaoxiang;Wang Jibing;Chen Bo;Yang Shuangyue;Quan Yifeng(Department of Rehabilitation,Jiangsu Northern People′s Hospital,Yangzhou 225002,China)

机构地区：[1]江苏省苏北人民医院康复科

出　　处：《中华临床医师杂志（电子版）》2019年第7期521-526,共6页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的观察肺康复治疗对中重度慢性阻塞性肺疾病(COPD)患者稳定期BODE指数和血清炎症因子的影响。方法2016年1月至2017年12月期间在江苏省苏北人民医院诊断为中重度COPD稳定期患者65例,随机分为肺康复组(33例)和对照组(32例),2组均给予常规药物干预,肺康复组同时进行12周的肺康复治疗。年龄、病程,BODE各项指标及BODE指数,血清超敏C-反应蛋白(hs-CRP),白介素-6(IL-6)和肿瘤坏死因子(TNF-α)水平和成人COPD生存质量评分(COPD-QOL量表)等属于计量资料,2组治疗前、治疗12周后上述相关指标比较采用配对样本t检验,组间比较采用独立样本t检验;采用χ^2检验比较性别、COPD临床严重程度分级的组间差异。结果最终有63例患者完成研究。治疗后肺康复组BODE指标中体质量指数(BMI)、改良呼吸困难指数(MMRC分级)、6 min步行距离(6MWD)均较治疗前有改善[(21.5±1.4)kg/m^2 vs(18.7±1.2)kg/m^2;(1.6±0.3)分vs(2.1±0.3)分;(270.3±37.8)m vs(158.3±42.4)m],差异均具有统计学意义(t=2.125、2.036、5.021,P=0.036、0.046、<0.001)。对照组6MWD治疗后较治疗前有改善[(188.3±40.3)m vs(160.1±39.7)m],差异具有统计学意义(t=2.659,P=0.009)。组间比较,肺康复组治疗后BMI、MMRC和6MWD均优于对照组[(21.5±1.4)kg/m^2 vs(18.6±1.3)kg/m^2;(1.6±0.3)分vs(2.1±0.4)分;(270.3±37.8)m vs(188.3±40.3)m],差异均具有统计学意义(t=2.124、2.031、4.568,P=0.038、0.016、<0.001);BODE指数比较,肺康复组改善优于对照组[(3.9±0.9)分vs(4.5±1.3)分],差异具有统计学意义(t=2.131,P=0.037)。治疗后肺康复组IL-6、TNF-α较治疗前均降低[(62.1±6.4)pg/ml vs(95.9±5.9)pg/ml;(48.5±7.3)pg/ml vs(73.3±10.1)pg/ml],差异均具有统计学意义(t=7.872、7.136,P均<0.001);COPD-QOL总分较治疗前提高[(110.5±17.8)分vs(96.2±20.4)分],差异具有统计学意义(t=7.521,P<0.001);组间比较,肺康复组治疗后IL-6、TNF-α和COPD-QOL总分优于对照组[(62.1±6.4)pg/ml vs(94.6±6Objective To observe the effect of pulmonary rehabilitation on BODE index and serum inflammatory factors in patients with moderate to severe chronic obstructive pulmonary disease(COPD).Methods From January 2016 to December 2017,65 patients with stable COPD at our hospital were randomly divided into two groups:pulmonary rehabilitation group(n=33)and control group(n=32).Age,disease duration,BODE index and its individual components,serum high-sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6),and tumor necrosis factor(TNF-α),and COPD quality of life score(Chinese version of the COPD-QOL scale)were measured.The relevant indicators were compared between before and after 12 weeks of treatment and between two groups by the paired sample t-test and independent sample t-test.Gender and clinical severity of COPD were compared using the χ^2 test between groups.Results Sixty-three patients completed the study.The body mass index(BMI),modified dyspnea index(MMRC grade),and 6-minute walk test(6 MWD)of the BODE index in the post-treatment group were improved compared with those before treatment[(21.5±1.4)kg/m^2 vs(18.7±1.2)kg/m^2;(1.6±0.3)vs(2.1±0.3);(270.3±37.8)m vs(158.3±42.4),t=2.125,2.036,and 5.021,P=0.036,0.046,and<0.001,respectively].6 MWD in the control group was statistically significantly improved after treatment[(188.3±40.3)m vs(160.1±39.7)m,t=2.659,P=0.009].The improvements of BMI,MMRC,and 6 MWD in the lung rehabilitation group were significantly better than those in the control group[(21.5±1.4)kg/m^2 vs(18.6±1.3)kg/m^2,(1.6±0.3)vs(2.1±0.4),(270.3±37.8)m vs(188.3±40.3)m,t=2.124,2.031,and 4.568,P=0.038,0.016,and<0.001,respectively].The BODE index was also significantly improved in the lung rehabilitation group than in the control group[(3.9±0.9)scores vs(4.5±1.3)scores,t=2.131,P=0.037].After treatment,IL-6 and TNF-αin the lung rehabilitation group were significantly lower than those before treatment[(62.1±6.4)pg/ml vs(95.9±5.9)pg/ml;(48.5±7.3)pg/ml vs(73.3±10.1)pg/ml,t=7.872 and 7.136,P<

关 键 词：肺康复 肺疾病 慢性阻塞性 稳定期 BODE指数 炎症趋化因子类 

分 类 号：R56[医药卫生—呼吸系统]