噻托溴铵与沙美特罗替卡松联合吸入治疗稳定期慢性阻塞性肺疾病的疗效观察
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摘要
目的:探讨噻托溴铵与沙美特罗替卡松联合吸入治疗稳定期慢性阻塞性肺疾病的临床疗效。方法:选取2017年1月至2018年9月解放军陆军第七十一集团军医院收治的稳定期慢性阻塞性肺疾病患者86例,采用分层随机抽样法分为观察组和对照组,每组43例。对照组患者给予噻托溴铵治疗,观察组患者给予噻托溴铵联合沙美特罗替卡松治疗。持续治疗90 d后,比较两组患者的血清免疫指标水平、肺功能指标[动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)及1 s用力呼气容积占用力肺活量百分比(FEV_1/FVC)]水平、6 min步行距离(6MWT)及临床疗效的差异。结果:治疗后,观察组患者CD3~+、CD4~+、CD8~+及CD4~+/CD8~+水平明显优于治疗前和对照组治疗后,差异均有统计学意义(P<0.05)。治疗后,两组患者的PaO_2、FEV_1/FVC及6MWT水平较治疗前明显提高,PaCO_2水平明显降低;且观察组患者PaO_2、PaCO_2、FEV_1/FVC及6MWT水平明显优于对照组,差异均有统计学意义(P<0.05)。观察组患者的总有效率为90.7%(39/43),明显高于对照组的79.1%(34/43),差异有统计学意义(P<0.05)。结论:噻托溴铵与沙美特罗替卡松联合吸入疗法治疗稳定期慢性阻塞性肺疾病的疗效显著,能提高机体免疫水平,且对改善患者肺功能及缓解临床症状具有积极意义。
OBJECTIVE: To probe into the efficacy of tiotropium bromide combined with seretide for inhalation in treatment of chronic obstructive pulmonary disease(COPD) in stable phase. METHODS: 86 patients with COPD in stable phase admitted into the 71 st Army Hospital of PLA from Jan. 2017 to Sept. 2018 were selected and divided into observation group and control group via stratified random sampling, with 43 cases in each group. The control group was treated with tiotropium bromide, while the observation group was given tiotropium bromide combined with seretide. After 90-day treatment, differences in serum immune indices, pulmonary function indices [arterial partial pressure of oxygen(PaO_2), partial pressure of carbon dioxide(PaCO_2) and the proportion of 1 s forced expiratory volume accounted for forced vital capacity(FEV_1/FVC)], 6 min walking test(6 MWT) and clinical efficacy between two groups were compared. RESULTS: After treatment, the CD3~+, CD4~+, CD8~+ and CD4~+/CD8~+ levels of observation group were significantly better than those of before treatment and the control group, with statistically significant differences(P<0.05). After treatment, the PaO_2, FEV_1/FVC and 6 MWT levels of both groups had been significantly improved, with significantly lower PaCO_2 level; the PaO_2, PaCO_2, FEV_1/FVC and 6 MWT levels of observation group were significantly better than those of the control group, with statistically significant differences(P<0.05). The total effective rate of observation group was 90.7%(39/43), which was significantly higher than that of the control group(79.1%, 34/43), with statistically significant difference(P<0.05). CONCLUSIONS: The efficacy of tiotropium bromide combined with seretide for inhalation in treatment of COPD in stable phase is remarkable, which can increase immune level, with positive significance for improving pulmonary function and relieving clinical symptoms.
OBJECTIVE: To probe into the efficacy of tiotropium bromide combined with seretide for inhalation in treatment of chronic obstructive pulmonary disease(COPD) in stable phase. METHODS: 86 patients with COPD in stable phase admitted into the 71 st Army Hospital of PLA from Jan. 2017 to Sept. 2018 were selected and divided into observation group and control group via stratified random sampling, with 43 cases in each group. The control group was treated with tiotropium bromide, while the observation group was given tiotropium bromide combined with seretide. After 90-day treatment, differences in serum immune indices, pulmonary function indices [arterial partial pressure of oxygen(PaO_2), partial pressure of carbon dioxide(PaCO_2) and the proportion of 1 s forced expiratory volume accounted for forced vital capacity(FEV_1/FVC)], 6 min walking test(6 MWT) and clinical efficacy between two groups were compared. RESULTS: After treatment, the CD3~+, CD4~+, CD8~+ and CD4~+/CD8~+ levels of observation group were significantly better than those of before treatment and the control group, with statistically significant differences(P<0.05). After treatment, the PaO_2, FEV_1/FVC and 6 MWT levels of both groups had been significantly improved, with significantly lower PaCO_2 level; the PaO_2, PaCO_2, FEV_1/FVC and 6 MWT levels of observation group were significantly better than those of the control group, with statistically significant differences(P<0.05). The total effective rate of observation group was 90.7%(39/43), which was significantly higher than that of the control group(79.1%, 34/43), with statistically significant difference(P<0.05). CONCLUSIONS: The efficacy of tiotropium bromide combined with seretide for inhalation in treatment of COPD in stable phase is remarkable, which can increase immune level, with positive significance for improving pulmonary function and relieving clinical symptoms.
引文
[1] 郭海全,周向东.舒利迭/信必可联合噻托溴铵治疗中重度COPD稳定期临床疗效观察[J].现代医药卫生,2016,32(4):509-511.
[2] 刘会娟.噻托溴铵联合沙美特罗/丙酸氟替卡松吸入治疗稳定期重度COPD患者的临床疗效[J].中国医学创新,2016,13(19):52-56.
[3] 肖颖,郑江南,邹兆华,等.慢性阻塞性肺疾病稳定期康复治疗的研究进展[J].转化医学电子杂志,2018,5(5):48-51.
[4] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2007年修订版)[S].中华结核和呼吸杂志,2007,30(1):8-17.
[5] 张学钦.噻托溴铵联合舒利迭对稳定期中重度COPD临床效果研究[J].北方药学,2017,14(8):117,116.
[6] 颜文森,李斌,王燕,等.噻托溴铵联合舒利迭对老年中重度COPD患者的疗效及生存质量研究[J].中国生化药物杂志,2017,37(5):277-279.
[7] 孟志刚,余瑞芳,姚彬.持续肺康复训练对保持COPD患者肺康复治疗后运动能力和生活质量的影响[J].中国呼吸与危重监护杂志,2017,23(18):154-155.
[8] 许建强,代阅,冯娟,等.家庭长期无创通气联合噻托溴铵、舒利迭治疗重度COPD稳定期患者的效果分析[J].中国当代医药,2016,23(23):31-35.
[9] 顾垚丽.糖皮质激素用于COPD治疗中的效果观察[J].医药前沿,2016,6(28):184-185.
[10] 陈博,蒋永亮,胡瑞成,等.调节性T细胞在COPD的免疫机制研究进展[J].国际呼吸杂志,2017,37(9):711-716.
[11] 李志芳,张倩,吴世满.慢性阻塞性肺疾病患者外周血Th17、CD4+Treg细胞的检测及意义[J].国际呼吸杂志,2014,34(1):31-35.
[12] 陈建鸿,詹开宇,张冬梅,等.老年COPD疾病进展与机体调节性T细胞的关系分析[J].现代生物医学进展,2016,16(28):5543-5545.
[13] 周蓉,噻托溴铵对稳定期慢性阻塞性肺疾病患者血清细胞因子水平及肺功能的影响[J].临床肺科杂志,2016,21(8):1413-1416.
[14] Aaron SD,Vandemheen KL,Fergusson D,et al.Tiotropium in combination with placebo,salmeterol,or fluticasone-salmeterol for treatment of chronic obstructive pulmonary disease:a randomized trial[J].Ann Intern Med,2007,146(8):545-555.
[15] 李兴刚.噻托溴铵联合舒利迭治疗稳定期中重度慢性阻塞性肺疾病患者疗效观察[J].基层医学论坛,2016,20(24):3325-3327.
[2] 刘会娟.噻托溴铵联合沙美特罗/丙酸氟替卡松吸入治疗稳定期重度COPD患者的临床疗效[J].中国医学创新,2016,13(19):52-56.
[3] 肖颖,郑江南,邹兆华,等.慢性阻塞性肺疾病稳定期康复治疗的研究进展[J].转化医学电子杂志,2018,5(5):48-51.
[4] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2007年修订版)[S].中华结核和呼吸杂志,2007,30(1):8-17.
[5] 张学钦.噻托溴铵联合舒利迭对稳定期中重度COPD临床效果研究[J].北方药学,2017,14(8):117,116.
[6] 颜文森,李斌,王燕,等.噻托溴铵联合舒利迭对老年中重度COPD患者的疗效及生存质量研究[J].中国生化药物杂志,2017,37(5):277-279.
[7] 孟志刚,余瑞芳,姚彬.持续肺康复训练对保持COPD患者肺康复治疗后运动能力和生活质量的影响[J].中国呼吸与危重监护杂志,2017,23(18):154-155.
[8] 许建强,代阅,冯娟,等.家庭长期无创通气联合噻托溴铵、舒利迭治疗重度COPD稳定期患者的效果分析[J].中国当代医药,2016,23(23):31-35.
[9] 顾垚丽.糖皮质激素用于COPD治疗中的效果观察[J].医药前沿,2016,6(28):184-185.
[10] 陈博,蒋永亮,胡瑞成,等.调节性T细胞在COPD的免疫机制研究进展[J].国际呼吸杂志,2017,37(9):711-716.
[11] 李志芳,张倩,吴世满.慢性阻塞性肺疾病患者外周血Th17、CD4+Treg细胞的检测及意义[J].国际呼吸杂志,2014,34(1):31-35.
[12] 陈建鸿,詹开宇,张冬梅,等.老年COPD疾病进展与机体调节性T细胞的关系分析[J].现代生物医学进展,2016,16(28):5543-5545.
[13] 周蓉,噻托溴铵对稳定期慢性阻塞性肺疾病患者血清细胞因子水平及肺功能的影响[J].临床肺科杂志,2016,21(8):1413-1416.
[14] Aaron SD,Vandemheen KL,Fergusson D,et al.Tiotropium in combination with placebo,salmeterol,or fluticasone-salmeterol for treatment of chronic obstructive pulmonary disease:a randomized trial[J].Ann Intern Med,2007,146(8):545-555.
[15] 李兴刚.噻托溴铵联合舒利迭治疗稳定期中重度慢性阻塞性肺疾病患者疗效观察[J].基层医学论坛,2016,20(24):3325-3327.