大剂量布地奈德联合异丙托溴铵雾化对AECOPD患者气道重塑及黏液分泌的影响  

Effects of nebulization with high-dose budesonide combined with ipratropium bromide on airway remodeling and mucus secretion in patients with AECOPD

作　　者：蔡高翔 强丽霞[2] Cai Gaoxiang;Qiang Lixia(Department of Respiratory Medicine,Wenling Hospital of Traditional Chinese Medicine,Wenling 317500,Zhejiang Province,China;Department of Respiratory Medicine,The Fourth Affiliated Hospital of Harbin Medical University,Harbin 150001,Heilongjiang Province,China)

机构地区：[1]温岭市中医院呼吸科,温岭317500 [2]哈尔滨医科大学附属第四医院呼吸内科,哈尔滨150001

出　　处：《中国基层医药》2022年第7期989-993,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：黑龙江省自然科学基金项目(YQ2019H011)。

摘　　要：目的观察大剂量布地奈德(BUD)联合异丙托溴铵(IB)雾化对慢性阻塞性肺疾病急性加重期(AECOPD)患者气道重塑及黏液分泌的影响。方法选取温岭市中医院2020年1月至2021年6月收治的AECOPD患者90例为观察对象,根据门诊单的单双号分为常规剂量组(单号)和大剂量组(双号),每组45例。在常规治疗基础上,常规剂量组IB雾化吸入,0.5 mg/次,持续20 min,3次/d;加用BUD混悬液,雾化吸入,2 mg/次,持续20 min,2次/d,吸后漱口。大剂量组予大剂量BUD联合IB雾化治疗:BUD混悬液雾化吸入,4 mg/次,持续20 min,2次/d;IB雾化吸入用法及用量同对照组,吸后漱口。均治疗7 d,比较两组临床疗效;于治疗前、治疗7 d,比较两组患者气道重塑水平[血清基质金属蛋白酶9(MMP-9)、白细胞介素8(IL-8)]、气道黏液分泌情况[痰液黏蛋白5ac(MUC5ac)、中性粒细胞弹性蛋白酶(NE)];比较两组不良反应发生率。结果大剂量组治疗总有效率[95.56%(43/45)]高于常规剂量组[82.22%(37/45)](χ^(2)=4.05,P<0.05);治疗7 d后大剂量组MMP-9[(416.96±30.96)μg/L]、IL-8[(6.33±1.03)μg/L]均低于常规剂量组[(452.25±32.16)μg/L、(7.85±1.24)μg/L](t=5.30、6.32,均P<0.001);治疗7 d后大剂量组MUC5ac[(1.33±0.21)μg/L]、NE[(4.06±1.03)μg/L]均低于常规剂量组[(1.58±0.23)μg/L、(5.11±1.14)μg/L](t=5.38、4.58,均P<0.001);大剂量组不良反应发生率[8.89%(4/45)]与常规剂量组[4.44%(2/45)]对比,差异无统计学意义(χ^(2)=0.71,P>0.05)。结论大剂量BUD联合IB雾化治疗AECOPD患者,可改善患者气道重塑,减轻气道黏液高分泌状态,疗效确切。该研究成果具备显著创新性和科学性。Objective To investigate the effects of nebulization with high-dose budesonide(BUD)combined with ipratropium bromide(IB)on airway remodeling and mucus secretion in patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD).Methods Ninety patients with AECOPD who received treatment in Wenling Hospital of Traditional Chinese Medicine between January 2020 and June 2021 were included in this study.They were assigned to the conventional-dose group(n=45,odd number)and high-dose group(n=45,even number)according to the number of admission.In the conventional-dose group,nebulization with IB(0.5 mg administered within 20 minutes,three times daily)and BUD(2 mg administered within 20 minutes,twice daily)was performed.In the high-dose group,nebulization with IB(0.5 mg administered within 20 minutes,three times daily)and BUD(4 mg administered within 20 minutes,twice daily)was performed.After nebulization,a mouthwash was required in each group.After 7 days of treatment,clinical efficacy was compared between the two groups.Before and 7 days after treatment,airway remodeling level(matrix metalloproteinase-9 and interleukin-8),airway mucus secretion(mucin-5ac and neutrophil elastase)and the incidence of adverse reactions were compared between the two groups.Results Total response rate in the high-dose group was significantly higher than that in the conventional-dose group[95.56%(43/45)vs.82.22%(37/45),χ^(2)=4.05,P<0.05].After 7 days of treatment,serum matrix metalloproteinase-9 and interleukin-8 levels in the high-dose group were(416.96±30.96)μg/L and(6.33±1.03)μg/L,respectively,which were significantly lower than those in the conventional-dose group[(452.25±32.16)μg/L,(7.85±1.24)μg/L,t=5.30,6.32,both P<0.001)].After 7 days of treatment,serum mucin-5ac and neutrophil elastase levels in the high-dose group were(1.33±0.21)μg/L and(4.06±1.03)μg/L,respectively,which were significantly lower than those in the conventional-dose group[(1.58±0.23)μg/L,(5.11±1.14)μg/L,t=5.38,4.58,both P<0.001].There

关 键 词：肺疾病 慢性阻塞性 布地奈德 支气管扩张药 投药 吸入 气道重塑 白细胞介素8 基质金属蛋白酶9 黏蛋白 治疗效果 

分 类 号：R563.9[医药卫生—呼吸系统]