减量应用吸入型糖皮质激素对稳定期COPD急性加重风险影响的单中心前瞻性随机对照试验  

A single-centre prospective randomised controlled trial of the effect of reduced doses of inhaled glucocorticoids on the risk of acute exacerbation of stable COPD

作　　者：刘书香 安勇鹏 杨秀芝 Liu Shuxiang;An Yongpeng;Yang Xiuzhi(Department of Respiratory and Critical Care Medicine,Kaifeng Central Hospital,Kaifeng 475000,China)

机构地区：[1]开封市中心医院呼吸与危重症医学科,河南开封475000

出　　处：《中国急救医学》2023年第7期545-550,共6页Chinese Journal of Critical Care Medicine

基　　金：开封市科技发展计划项目(1803055)。

摘　　要：目的探讨吸入型糖皮质激素减量应用对稳定期慢性阻塞性肺疾病(COPD)急性加重风险影响。方法选取2019年1月至2021年11月开封市中心医院145例稳定期COPD患者,根据吸入型糖皮质激素剂量分为高剂量组(50μg/500μg沙美特罗替卡松,n=73)和低剂量组(50μg/250μg沙美特罗替卡松,n=72);另设空白对照组(n=72),不给予糖皮质激素。比较三组疗效、急性加重次数、不良反应及治疗前后外周血单个核细胞硫氧还蛋白结合蛋白/Nod样受体蛋白3(TXNIP/NLRP3)炎性小体通路、肺功能指标[第1秒用力肺活量占预计值的百分比(FEV1%)、第1秒用力呼气量(FEV1)、第1秒用力呼气量占所有呼气量的比例(FEV1/FVC)]、多因素分级系统(BODE)指数、COPD评估测试量表(COPD assessment test,CAT)评分。结果低剂量组、高剂量组治疗总有效率(87.50%、89.04%)、COPD急性加重次数(次,0.90±0.35 vs.0.78±0.49)比较差异无统计学意义(P>0.05);治疗前后三组TXNIP/NLRP3炎性小体通路(外周血单个核细胞TXNIP、NLRP3表达及差值)、肺功能指标(FEV1/FVC、FEV1、FEV1%水平及差值)、BODE指数、CAT评分及差值比较差异无统计学意义(P>0.05);治疗后低剂量组、高剂量组外周血单个核细胞TXNIP[低剂量组:(0.96±0.26 vs.1.21±0.33)、高剂量组:(1.01±0.24 vs.1.30±0.28)]、NLRP3表达[低剂量组:(1.20±0.28 vs.1.52±0.44)、高剂量组:(1.15±0.33 vs.1.48±0.47)]、BODE指数[分,低剂量组:(2.91±0.34 vs.4.26±0.42)、高剂量组:(2.84±0.40 vs.4.14±0.55)]、CAT评分[分,低剂量组:(18.21±1.46 vs.23.61±2.73)、高剂量组:(17.75±1.74 vs.23.19±2.78)]均低于治疗前(P<0.05)。低剂量组不良反应发生率(8.33%)低于高剂量组(20.55%,P<0.05)。结论吸入型糖皮质激素低剂量、高剂量应用于稳定期COPD均可有效缓解炎症反应,改善肺功能及临床症状,预防稳定期COPD急性加重,且低剂量应用不良反应较少,更具安全性。Objective To investigate the effect of glucocorticoid tapering on the risk of acute exacerbation of stable chronic obstructive pulmonary disease(COPD).Methods One hundred and forty-five patients with stable COPD in Kaifeng Central Hospital from January 2019 to November 2021 were selected and divided into high-dose group(50μg/500μg salmeterol/fluticasone,n=73)and low-dose group(50μg/250μg salmeterol/fluticasone,n=72)according to glucocorticoid dose,and another blank control group(n=72)was established without glucocorticoid administration.The efficacy,the number of acute exacerbation of COPD,adverse effects,and inflammatory corpuscular pathways of peripheral blood mononuclear cell thioredoxin binding protein/Nod-like receptor protein 3(TXNIP/NLRP3)before and after treatment,and pulmonary function indexes[the percentage of 1st second expiratory volume to expected value(FEV1%),1st second expiratory volume(FEV1),the ratio of 1st second expiratory volume to all expiratory volumes(FEV1/FVC)],body mass index,obstruction,dyspnea,exercise(BODE)index,and COPD assessment test(CAT)score were compared among three groups.Results There were no statistically significant differences in the total effective rate(87.50%,89.04%)and the number of acute exacerbations of COPD(times,0.90±0.35 vs.0.78±0.49)between the low-dose group and the high-dose group(P>0.05);There were no statistically significant differences in TXNIP/NLRP3 inflammatory corpuscular pathway(expression and difference of TXNIP and NLRP3 in peripheral blood mononuclear cell),lung function indicators(FEV1/FVC,FEV1,FEV1%level and difference),BODE index,CAT score and difference among the three groups before and after treatment(P>0.05).After treatment,the expression of TXNIP[low dose group:(0.96±0.26 vs.1.21±0.33),high dose group:(1.01±0.24 vs.1.30±0.28)],NLRP3[low dose group:(1.20±0.28 vs.1.52±0.44),high dose group:(1.15±0.33 vs.1.48±0.47)],BODE index[score,low-dose group:(2.91±0.34 vs.4.26±0.42),high-dose group:(2.84±0.40 vs.4.14±0.55)]and CAT score[score

关 键 词：吸入型糖皮质激素 硫氧还蛋白结合蛋白/Nod样受体蛋白3(TXNIP/NLRP3) 肺功能 多因素分级系统(BODE)指数 慢性阻塞性肺疾病(COPD) 

分 类 号：R563.9[医药卫生—呼吸系统]