慢性阻塞性肺疾病稳定期治疗药物的优化选择  

Optimal selection of drugs for the treatment of chronic obstructive pulmonary disease at stable stage

作　　者：张永华 谷伟[1] 毛山[1] 马吉勇[1] 叶亮[1] 赵太宏[1] ZHANG Yonghua;GU Wei;MAO Shan;MA Jiyong;YE Liang;ZHAO Taihong(Department of Respiratory,Nanjing Hospital Affiliated to Nanjing Medical University,Nanjing 210006,Jiangsu Province,China)

机构地区：[1]南京医科大学附属南京医院呼吸科,江苏南京210006

出　　处：《世界临床药物》2021年第8期675-679,共5页World Clinical Drug

基　　金：江苏省卫生健康委科研项目(ZDB2020012);江苏省自然科学基金青年基金(BK20190129);江苏省高校自然科学基金面上项目(19KJB320012)。

摘　　要：目的解析长效β2受体激动剂(long acting β2 agonists,LABA)、长效抗胆碱药物(long acting anticholinergic,LAMA)和吸入型糖皮质激素(inhaled corticosteroids,ICS)3种药物在慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)稳定期患者中的作用,优化选择方案。方法纳入南京医科大学附属南京医院呼吸科2017年7月至2019年6月的门诊COPD稳定期且COPD评估测试(COPD assessment test,CAT)评分在10分以上的患者共260例,其中,观察组纳入160例,结合患者外周血中的嗜酸性粒细胞(eosinophils,EOS)水平和CAT评分入组后予以4种治疗方案:EOS<2%、CAT评分11~20分者,予以LAMA一种支气管舒张剂吸入治疗;EOS<2%、CAT评分>20分者,予以LABA+LAMA两种支气管舒张剂联合吸入治疗;EOS≥2%、CAT评分11~20分者,予以ICS+LABA两种药物联合吸入治疗;EOS≥2%、CAT评分>20分者予以LABA+LAMA+ICS三种药物联合吸入治疗。对照组纳入100例,入组后均予以LABA+LAMA+ICS三种药物联合吸入治疗。观察组及对照组就症状缓解情况、肺功能情况、治疗效果、不良反应、急性加重情况及生活质量改善等方面予以比较分析。结果观察组与对照组在缓解临床症状、改善肺功能指标、治疗有效率、急性加重及生活质量改善方面均无明显差别(P>0.05),在不良反应发生率方面,观察组显著低于对照组(P<0.05)。结论对于病情处于稳定期的COPD患者,在权衡选择LABA、LAMA和ICS三种药物联合治疗方案时,应结合患者的多种评估结果予以个体化治疗,这不仅临床应用效果显著,且用药安全,减少临床不良反应,同时可节约患者的用药费用,因此建议优化选择方案。Objective To analyze the effects of long-actingβ2 receptor agonist(LABA),long-acting anticholinergic(LAMA)and inhaled glucocorticoids(ICS)in patients with chronic obstructive pulmonary disease(COPD)at stable stage and to optimize the selection.Methods A total of 260 patients with stable COPD and COPD assessment test(CAT)score of more than 10 points were included in the respiratory department of Nanjing Hospital Affiliated to Nanjing Medical University from July 2017 to June 2019,160 cases were included in the observation group.Four treatment options were given in combination with the patients’peripheral blood eosinophil(EOS)level and CAT score:patients with EOS<2%and CAT score 11-20 were treated with LAMA.Patients with EOS<2%and CAT score>20 were treated with LABA+LAMA.Patients with EOS≥2%and CAT score 11-20 were treated with ICS+LABA.Patients with EOS≥2%and CAT score>20 were treated with LABA+LAMA+ICS.100 cases in the control group were treated with LABA+LAMA+ICS combined inhalation therapy.The observation group and the control group were compared and analyzed on symptom relief,pulmonary function,therapeutic effect,adverse reactions,acute exacerbation and improvement of quality of life.Results There was no significant difference between the observation group and the control group in relieving clinical symptoms,improving pulmonary function indexes,effective rate,acute exacerbation and improvement of quality of life(P>0.05).The incidence of adverse reactions in the observation group was significantly lower than the control group(P<0.05).Conclusion:For patients with stable COPD,the combination of LABA,LAMA and ICS should be combined with various evaluation results,which not only clinical application effect is remarkable,and drug safety,reduce clinical adverse reactions,but also can save the cost of medication for patients.Therefore,it is recommended to optimize the choice of scheme.

关 键 词：慢性阻塞性肺疾病 支气管舒张剂 糖皮质激素 肺功能 不良反应 

分 类 号：R563.9[医药卫生—呼吸系统] R974[医药卫生—内科学]