糖皮质激素雾化吸入和全身应用治疗AECOPD疗效及对患者CCL19、ICAM-1水平影响  

Effects of glucocorticoid atomization inhalation and systemic application on the levels of CCL19 and ICAM-1 in patients with AECOPD

作　　者：李欢 吉训恋[1] Li Huan;Ji Xunlian(Department of Pharmacy,Haikou People’s Hospital,Haikou 570208,China)

机构地区：[1]海口市人民医院药学部,570208

出　　处：《中华保健医学杂志》2022年第4期270-273,共4页Chinese Journal of Health Care and Medicine

基　　金：海南省卫生健康行业科研项目(19A200163)。

摘　　要：目的观察不同程度的慢性阻塞性肺疾病(COPD)患者急性加重时糖皮质激素不同给药方式的疗效及对患者血清趋化因子-19(CCL19)、细胞间粘附分子1(ICAM-1)水平影响。方法选取2019年1月~2021年6月海口市人民医院治疗的COPD患者145例,根据《慢性阻塞性肺疾病诊治指南》综合评估分组方法分为B组和C组。按照随机数字法将B组和C组患者再分为3个亚组,在基础治疗基础上,分别采用糖皮质激素全身给药、雾化吸入、全身给药联合雾化吸入。分别于治疗前、治疗5 d后比较各组患者肺功能、动脉血气、CCL19、ICAM-1水平,记录患者不良反应。结果治疗前,B组和C组不同给药方式的第1秒用力呼气容积(FEV1)、第1秒用力呼气容积占预计值百分比(FEV1/%pred)、PaO_(2)、动脉血二氧化碳分压(PaCO_(2))、CCL19、ICAM-1差异无统计学意义(P>0.05)。治疗后,各组FEV1和FEV1/%pred、PaO_(2)均升高,PaCO_(2)、CCL19、ICAM-1降低,B组除联合给药的ICAM-1水平均低于全身给药和雾化吸入组外,不同给药方式其余指标差异无统计学意义。C组全身给药和联合给药的FEV1和FEV1/%pred高于雾化吸入,ICAM-1水平低于雾化吸入组,差异均有统计学意义(P<0.05)。B组和C组雾化吸入不良反应发生率分别为12.5%和8.69%,均低于全身给药和联合给药方式的不良反应发生率,差异有统计学意义(P<0.05)。结论对于COPD综合分组为B组的患者急性加重期时可选择雾化吸入糖皮质激素,效果与全身用药接近。C组患者首选全身使用糖皮质激素可迅速改善肺功能、降低ICAM-1水平,在用药过程中应严密监测患者不良反应,及时调整用药方案。Objective To observe the effects of different administration methods of glucocorticoids on the levels of serum chemokine CCL19 and intercellular adhesion molecule-1(ICAM-1)in patients with acute exacerbation of chronic obstructive pulmonary disease(COPD).Method According to the guidelines for the diagnosis and treatment of chronic obstructive pulmonary disease,the patients in group B and group C were divided into three subgroups according to the random number method.On the basis of basic treatment,glucocorticoid systemic administration,atomization inhalation and systemic administration combined with atomization inhalation were used respectively.The pulmonary function,arterial blood gas analysis,CCL19 and ICAM-1 were compared before and 5 days after treatment,adverse reactions were recorded.Results Before treatment,there was no significant difference in FEV1,FEV1/%PRED,PaO_(2),PaCO_(2),CCL19 and ICAM-1 between group B and group C(P>0.05).After treatment,FEV1,FEV1/%PRED and PaO_(2)increased in each group,while PaCO_(2),CCL19 and ICAM-1 decreased.Except that the ICAM-1 level of combined administration in group B was lower than that of systemic administration and atomization inhalation group,there was no significant difference in other indexes in different administration methods.FEV1 and FEV1/%PRED of systemic administration and combined administration in group C were higher than those of atomization inhalation,and the level of ICAM-1 was lower than that of atomization inhalation group,the difference was statistically significant(P<0.05).The adverse reaction rates of atomization inhalation in group B and group C were 12.5%and 8.69%respectively,which were lower than those of systemic administration and combined administration,the difference was statistically significant(P<0.05).Conclusion For patients with COPD who are divided into group B,aerosol inhalation of glucocorticoid can be selected during acute exacerbation,and the effect is close to that of systemic medication.Patients in group C preferred systemic use of g

关 键 词：慢阻肺 糖皮质激素 雾化吸入 趋化因子 细胞间粘附分子1 

分 类 号：R563[医药卫生—呼吸系统]