长效β_2-受体激动剂预混表面激素治疗慢性阻塞性肺疾病疗效观察

The therapeutic effect of mixture preparation of long-acting β_2 agonists and inhaled-corticosteroid on COPD

目的 :探讨吸入型肾上腺糖皮质激素 (表面激素 )与长效β2 -受体激动剂 (LABA)的预混制剂对慢性阻塞性肺疾病 (COPD)的治疗作用。方法 :Ⅲ期 (重度 )COPD病人 33例 ,全部病例入组前无使用过任何剂型的激素、β -受体激动剂、抗胆碱药 ,无氧疗史。随机分成两组 ,A组 1 7例 ,吸入丙酸氟替卡松 沙美特罗 (舒利迭TM5 0 2 5 0 )干粉剂 ,1吸 次 ,2次 d ;B组 1 6例 ,无吸入上述药物 ;两组病人均服用舒弗美 0 .2 q1 2h、沐舒坦 30mg tid ,必要时短期吸氧 (<2W ) ,均无使用抗胆碱药 ,观察治疗 4W、1 2W、2 4W三个时间点病人临床症状、健康状态、生活质量和肺功能。结果 :观察期各不同时间点A、B两组临床症状、急性加重发生次数及严重度、健康状态和生活质量等各项观察指标差异有显著性 ,A组明显优于B组 ,P <0 .0 5 ;且随疗程A组呈逐步改善 ,B组改善不明显。结论 :表面激素与LABA治疗COPD具有良好协同作用 ,其预混制剂使用方便 ,病人依从性高 ,近期疗效好 ,有一定的临床应用价值 。

Objective: To evaluate the therapeutic effect of inhaled corticosteroid in combination long-acting β 2 agonist (LABA) on patients with chronic obstructive pulmonary disease(COPD). Method: 33 patients with severe (Ⅲ°)COPD were divided into two groups-A group of 17 patients and B group of 16 patients. Before this study, all patients didn’t receive corticosteroid,β-receptor agonist, anticholine drugs and oxygen therapy. In this study, both groups received routine treatment(mucosolvan 30mg tid, theophylline 200mg bid, short term oxygen therapy when needs). In addition, the group A received inhaled fluticasone propinate/salmeterol (SeretideTM-50/250mcg,Accuhaler) (1 consperge, bid). At the following three time points of 4wk,12wk and 24wk, pulmonary symptom, quality of life and lung function were evaluate respectively. Result: After treatment, the observed index of two groups improved. But group Ais superior to group B (P<0.05). The lung function of group A was obviously improved(P<0.05). Conclusion: Inhaled corticosteroid and LABA had synergistic effect. The patients compliance was high and the curative effect in the near future was good. It had certain value of clinical application. It could step down the degression of lung function on COPD.