噻托溴胺粉雾剂对稳定期慢性阻塞性肺疾病患者深吸气量的改善作用

Influence and significance of tiotropium on inspiratory capacity in patients with stable chronic obstructive pulmonary disease.

目的观察噻托溴胺对稳定期慢性阻塞性肺疾病(COPD)患者深吸气量的影响,探讨深吸气量(IC)对评价支气管扩张剂疗效评估的价值。方法将2003年8月至2005年3月南京医科大学附属南京第一医院呼吸内科收治的60例稳定期COPD患者,随机分成观察组(A组)噻托溴胺粉雾剂吸入;对照组(B组)安慰剂吸入。于研究第1天、第43天(约6周)、第85天(约12周)检测1秒钟用力呼气量(FEV1)、FEV1占预计值的百分比[FEV1(%)]、用力呼气量(FVC)、FEV1/FVC、IC等指标。结果观察组FEV1在第6周与对照组比较显著升高(t=2.018,P=0.048),12周差异无显著性(t=1.723,P=0.090);FEV1(%)在第6周、12周与对照组比较差异无显著性(t分别为1.761、1.387,P分别为0.083、0.171);FVC在第6周、12周与对照组比较,均有显著升高(t分别为2.762、2.255,P分别为0.008、0.029);FEV1/FVC在第6周、12周与对照组比较,差异无显著性(t分别为0.370、0.668,P分别为0.713、0.507);IC在第6周、12周较对照组显著增高(t分别为3.204、3.109,P分别为0.002、0.003)。结论噻托溴胺可使稳定期COPD患者IC增大。对于判断COPD气流受限的指标FEV1/FVC、FEV1(%),用于判断支气管扩张剂的疗效方面则不够敏感。IC是评价支气管扩张剂疗效的可靠指标。

Objective To observe the influence of tiotropium on inspiratory capacity（IC） in patients with stable COPD and investigate the value of IC in evaluating therapeutic effect of bronehodilators. Methods A 12-week, randomized, double-blind, placebo-controlled study was conducted in 60 patients with stable COPD, patients in A group by haling tiotropium and those in B group by inhaling placebo. At each of the visits days 1,43 （about 6 weeks）and 85 （about 12 weeks ） ,forced expiratory volume in one second （ FEVI ） , percentage of FEVI and predict value[ FEVI （%） ] , forced expiratory volume（FEV） , FEVI/FVC and .IC were measured. Results Compared with B group, FEVI in A group increased significantly in week 6 （ t = 2. 018, P = 0. 048 ） , but there was no statistical significance between them in week 12 （ P 〉 0. 05）. FEV4 （%）increased in week 6 and 12, but there was also no statistical significance between two groups （P 〉 0. 05 ）. FVC increased significantly in week 6 and 12 （ t = 2. 762, P = 0. 008 ; t = 2. 255, P = 0. 029, respectively）. There was no statistical significance in FEVI/FVC between two groups. IC increased significantly in week 6 and 12 （t = 3. 204, P = 0. 002 ;t = 3. 109.P = 0. 003, respectively）. Conclusion Inhaling tiotropium increases IC in patients with stable COPD. As lung function targets judging limit extent of airflow in patients with COPD, FEVI/FVC and FEVI （%）are not sensitive in evaluating therapeutic effect of bronchodilators. IC is more reliable than other targets in evaluating therapeutic effect of bronchodilators.