慢性阻塞性肺疾病气流受限对吸入激素肺沉积的影响

Influence of Airflow Limitation upon Lung Deposition of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease

目的观察吸入激素在慢性阻塞性肺疾病(COPD)患者肺的沉积,探讨气流受限对吸入激素在肺内分布的影响。方法用放射性核素99m锝标记激素(布地奈德),采用压缩雾化泵雾化的方法吸入标记同位素的激素,肺内沉积采用核医学肺通气显像评估,药物在肺外周/中央的分布(P/C%)用感兴趣区(ROI)的方法计算。结果入选的COPD患者43例,其中41例完成了全部试验,年龄48~79岁(平均68岁),平均第1秒用力呼气容积占预计值百分比(FEV1%pred)为44.9%,P/C%为(47.96±6.08)%。P/C%≥50%患者的FEV1%pred和第1秒用力呼气容积/用力肺活量(FEV1/FVC)分别为(51.85±18.20)%和(59.95±11.87)%,明显高于P/C%<50%患者[FEV1%pred和FEV1/FVC分别为(40.52±12.99)%和(51.73±9.28)%,P<0.05]。相关分析结果显示:P/C%与FEV1%pred和FEV1/FVC均有显著正相关(r=0.391,P=0.024;r=0.517,P=0.002)。结论 COPD患者气流受限减少吸入激素在肺内外周气道的分布。

Objective To investigate the influence of airflow limitation upon lung deposition of inhaled corticosteroids in patients with chronic obstructive pulmonary disease(COPD).Methods The radionuclide 99mTc was used to lable budesonide which was inhaled through compressor nebulizer.Lung deposition was evaluated by nuclear medicine pulmonary ventilation scintigraphy.Peripheral to central ratio of lung deposition(P/C%) was calculated by region of interest (ROI) method.Results Forty-three patients with stable COPD were enrolled in the study,of whom 41 patients completed the trial.The median age was 68 years(range,48 to 79 years) and the median FEV1 was 44.9% predicted.The P/C% was(47.96±6.08)%.The patients with P/C% more than 50% had a higher FEV1%pred and FEV1/FVC than those with P/C% less than 50% [FEV1%pred:(51.85±18.20)% vs.(40.52±12.99)%.FEV1/FVC:(59.95±11.87)% vs.(51.73±9.28)%].There was a positive correlation between P/C% and FEV1%pred(r=0.391,P=0.024) and FEV1/FVC ratio(r=0.517,P=0.002).Conclusion Lung peripheral airway deposition of inhaled corticosteroids was limited by airflow obstruction.