摘要
目的观察噻托溴铵联合吸入糖皮质激素对哮喘-慢阻肺重叠综合征(asthma-COPD overlap syndrome,ACOS)患者肺功能、FeNO及免疫功能的影响。方法回顾性分析118例ACOS患者的临床资料,根据临床治疗方式分为观察组(n=59)和对照组(n=59),均给予布地奈德粉吸入剂,观察组加用噻托溴铵干粉胶囊,比较2组患者用力肺活量(forced vital capacity,FVC)、第1秒用力呼气量容积(forced expirator y volume in one second,FEV1)、第1秒用力呼气容积占用力肺活量百分比(FEV1/FVC)和FeNO,血清炎症因子IL-6和TNF-α及免疫功能指标(Th1和Th2细胞亚群)和哮喘症状评分(ACT)、慢性阻塞性肺疾病症状(CAT)评分。结果观察组治疗总有效率明显高于对照组,差异有统计学意义(P<0.05);治疗后观察组FVC、FEV1、FEV1/FVC和FeNO指标改善程度明显优于对照组(t=9.785、7.537、11.045和3.037,P<0.05);观察组血清中IL-6、TNF-α表达含量明显低于对照组(t=4.568和2.835,P<0.05)。观察组免疫指标Th1和Th2及Th1/Th2指标明及CAT和ACT评分改善程度明显优于对照组(t=14.192、2.222、12.692和8.565、7.863,P<0.05)。2组患者不良反应发生率差异无统计学意义(χ~2=0.778,P<0.05)。结论噻托溴铵联合吸入糖皮质激素能够明显改善ACOS患者临床症状,提高患者肺功能和免疫功能,其疗效要优于单独使用糖皮质激素吸入治疗,同时不增加患者不良反应。
Objective To observe the effect of tiotropium bromide combined with inhaled glucocorticoids on lung function, FeNO and immune function in patients with asthma-chronic obstructive pulmonary disease （ACOS） overlap syndrome.Methods One hundred and eighteen patients with ACOS were selected as subjects and were equally divided into the observation group and control group by the random number table method. Both groups were treated with budesonide powder inhalation, but the observation group was additionally treated with tiotropium bromide dry powder capsules. The clinical effect, pulmonary function indexes [forced vital capacity （FVC）, forced expiratory volume in one second （FEV1）, the percentage of forced expiratory volume in forced vital capacity （FEV1/FVC）, FeNO], serum inflammatory factors [interleukin （IL-6）, tumor necrosis factor alpha （TNF-α）, immune function indexes （Th1 and Th2 cell subsets） and scores of asthma symptom （ACT） and chronic obstructive pulmonary disease symptoms （CAT） before and after treatment were compared between the two groups.Results The total effective rate in the observation group was significantly higher than that in the control group （P〈0.05）. After treatment, the improvement of FVC, FEV1, FEV1/FVC and FeNO in the observation group was more significant than that in the control group （t=9.785, 7.537, 11.045 and 3.037, P〈0.05）. The expression levels of IL-6 and TNF-α in the observation group were significantly lower than those in the control group （t=4.568 and 2.835,P〈0.05）. The immune indexes （Th1, Th2, Th1/Th2） and improvement of CAT and ACT scores in the observation group were significantly better than those in control （t=14.192, 2.222, 12.692 and 8.565, 7.863, P〈0.05）. There was no significant difference in the incidence of adverse reactions between the two groups （χ^2=0.778,P〈0.05）.Conclusion Tiotropium bromide combined with inhaled glucocorticoids can significantly relieve the clinical symptoms of patients with ACOS and improve lung function and immune function in patients. This approach is more effective than inhalation of glucocorticoids alone, without increasing adverse reactions.
出处
《空军医学杂志》
2017年第2期113-117,共5页
Medical Journal of Air Force
基金
湖北省自然科学基金资助项目(2014CFB486)
关键词
噻托溴铵
糖皮质激素
哮喘-慢阻肺重叠综合征
tiotropium bromide
gucocorticoid
asthma-chronic obstructive pulmonary disease overlap syndrome
