吸入噻托溴铵对COPD患者肺功能和运动耐量的影响

Effects of tiotropium on pulmonary function and exercise tolerance in patients with chronic obstructive pulmonary disease

目的评价噻托溴铵对稳定期中、重度慢性阻塞性肺部疾病(COPD)患者肺功能和运动耐量的影响。方法60例COPD患者随机分成吸入噻托溴铵干粉剂组(n=30)和异丙托溴铵定量气雾剂治疗组(n=30),在给药前及给药后第21天和第42天分别测定Borg评分、肺功能及6 min步行距离(6MWD)。结果呼吸困难指数在第42天时噻托溴铵组下降了(1.65±0.22)Borg单位,异丙托溴铵组下降了(0.70±0.13)Borg单位,两组比较差异有统计学意义(P=0.011),而在21 d时两组比较差异无统计学意义(P=0.261)。肺功能检查提示只有深吸气量在第42天时噻托溴铵组与异丙托溴铵组比较差异有统计学意义[(0.29±0.04)Lvs(0.12±0.04)L](P=0.002),而FEV1和FVC在第21天和第42天时两组比较均无统计学意义(P>0.05)。6MWD运动试验显示,噻托溴铵组在用药后第21天和第42天的谷值反应为(34.33±6.08)m和(54.5±7.90)m,两者差异有统计学意义(P<0.05)。结论COPD患者每天1次吸入噻托溴铵(18μg)较异丙托溴铵气雾剂治疗能更好地减少肺过度充气、减轻呼吸困难症状,并提高运动耐量。

Objective To evaluate the effects of a single dose of tiotropium on the pulmonary function and exercise tolerance of patients with stable moderate-to-severe chronic obstructive pulmonary disease（COPD）. Methods Adjusted mean dyspnea intensity on day 42 was significantly decreased [ tiotropium vs ipratropium, （ 1.65 ± 0.22 ） Borg units vs （0.70±0.13） Borg units,P =0.011 ], while there was no significant difference between the two groups on day 21 （P = 0. 261 ）. It was revealed by pulmonary function test that significant differences were only found in inspiratory capacity（IC） on day 42 between the two groups[tiotropium vs ipratropium, （0.29±0.04） L vs （0.12±0.04）L, P=0.002], while there was no significant difference between the two groups in forced expiratory volume in 1 second （ FEV1 ） and forced vital capacity（FVC） on day 21 or day 42 （ P 〉 0.05 for both）. The 6MWD test indicated that on day 21 and day 42 after use of tiotropium, the trough responses were （34.33 ± 6.08） m and （ 54.5± 7.90） m, respectively, and there were significant differences between them（P 〈 0.05）. Results Adjusted mean dyspnea intensity on day 42 was significantly decreased [ （ 1.65 ± 0.22 ） Borg units （tiotropium） vs （0.70 ±0.13 ） Borg units （ ipratropium ） ] （ P = 0.011 ）, and the changes were not significant on day 21 （P = 0. 261 ）. Pulmonary function test, Tiotropium group versus ipratropium suggested that only inspiratory capacity （ IC ） had significant improvement on day 42 [ （0.29± 0.04 ） L vs （ O. 12 ± 0.04 ） L ] （ P = 0. 002 ）, and forced expiratory volume in 1 second（ FEVI ） ,forced vital capacity（FVC） were not significant whether on 21 day or 42 day （ all P 〉 0.05 ）. The 6-min walk distance （6MWD） after the use of tiotropium on day 42 was significantly longer compared to ipratropium[ （54.5 ±7.90） mvs （34.83 ±5.37）m] （P =0.044） ,and not significant on day 21 （P 〉0.05）. Conclusion The present study confirms that tiotropium 18 ug once daily compare with ipratropium can reduce lung hyperinflation, ease exertional dyspnea and improve symptom-limited exercise tolerance in COPD patients.