支气管扩张剂合并吸入糖皮质激素对COPD患者的疗效分析

Effects of Bronchodilator agents plus inhaled corticosteroid on patients with chronic obstructive pulmonary disease

目的支气管扩张剂合并吸入皮质激素对于COPD患者的临床疗效及抗炎效果。方法选择60例,分为对照组(30例)和治疗组(30例),均为COPD的患者,两组患者均给予吸入长效β2受体激动剂(沙美特罗5μg,每日两次),治疗组加用吸入的糖皮质激素(布地奈德,400μg/d),为时12周。在治疗前后监测肺功能和动脉血气等指标,同时采血检测血清炎性标志物并诱导痰留取标本。结果治疗组痰中炎性细胞总数,嗜酸性粒细胞和中性粒细胞数随着糖皮质激素的应用而减少,痰中IL-8和TNF-α水平也明显下降(P<0.01),呼吸功能指标明显改善,而对照组临床症状评分及呼吸功能指标有所改善(P<0.05),但诱导痰中炎性细胞总数及炎性因子均无明显变化(P<0.05)。两组患者血清炎性标志物IL-8和TNF-α都没有随着治疗而改变(P>0.05)。结论研究结果表明,对于COPD患者,在支气管扩张剂治疗基础上并用吸入的糖皮质激素可增强呼吸道局部抗炎效果而改善患者的通气功能。

Objective The aim of this study was to evaluate clinical effects and antiinflamation effects of bronchodilator agents plus inhaled corticostoroid to patients with COPD. Methods This study choiced 60 cases as subjects which was classfied into controlled group and treatment group. All of them were given β2 -adrenoceptor agonists （ LABA, salmeterol,50 μg, bid ） for 12 weeks and coupled with inhaled corticosteroid（ budesonide,400 μg/d） in treatment group for 12 weeks. Before and after treatment. All of them underwent pulmonary function tested and arterial blood gas analysis and other serum indicators. Blood serum inflamatory indicators and induced sputum were testeed too. Result Induced sputum total imflammatory cell counts and IL-8 and TNF-α in induced sputum reduced remarkly in treatment group（P 〈 0. 01 ）, Respiratoy function improved significenfly （P 〈 0. 01 ）, While in controlled group, the evaluation of clinical symptoms and indicators of respirotory function test have partily improved （P 〈 0. 05 ） , but induced sputums total inflammatory cell counts and IL-8 and TNF-α have not reduced obviously （P 〉 0. 05 ）. The serum inflammatory indicator in both groups have not changed with the treatment （P 〉 0. 05）. Conclusion The results indicated that for patients with COPD broncbodilator agents plus inhaled corticosteroid may add effects of local respirery tract antiinflammation and improve venfilafive functions.