噻托溴胺联合阿奇霉素治疗慢性阻塞性肺疾病

Clinical Significance of Tiotropium with Azithromycin in the Treatment of Chronic Obstructive Pulmonary Disease

目的:观察噻托溴胺联合阿奇霉素治疗慢性阻塞性肺疾病(COPD)的临床疗效和肺功能变化。方法:选择COPD急性加重期住院患者50例(第1组),COPD稳定期患者42例(第2组),对照组为同期参加呼吸疾病体检的老年人65例。分离外周血单核细胞(PBMC),用直接免疫荧光(DIF)法检测PBMC中的肺炎衣原体(Cpn)特异性抗原(Ag),同时用间接微量免疫荧光(MIF)法检测Cpn抗体(IgA,IgG和IgM)。胶体金法快速定量测定C-反应蛋白(CRP)。结果:第1组Cpn的感染率为66%(33/50),第2组为66.7%(28/42),对照组为21.5%(14/65)。Cpn-Ag和Cpn-IgM抗体的检出率第1组显著高于对照组(P<0.001),Cpn-IgA和IgG抗体的检出率第1组和第2组均显著高于对照组(P<0.01)。治疗后第1组和第2组患者的临床症状均有显著改善:Borg记分下降和FEV1/FVC(%)显著增加(P<0.01);Cpn-IgM阳性率显著下降(P<0.001);第1组和第2组CRP水平下降均有显著差异(P<0.01)。结论:COPD患者有较高的Cpn感染率,噻托溴胺联合阿奇霉素治疗COPD彼此有正协同效应。

Objective：To observe the efficacy and changes in lung function of tiotropium with azithromycin in the treatment of chronic obstructive pulmonary disease（COPD）.Methods：The first group consisted of 50 patients who were hospitalized due to acute exacerbation of COPD.The second group consisted of 42 patients with stable COPD.The control group was 65 participants in a community survey of respiratory diseases in the elderly.The human peripheral blood mononuclear cells（PBMC） were separated.The Chlamydia pneumoniae-antigen（Cpn-Ag） was detected by direct immunofluorescence（DIF） method.We measured antibodies against C.pneumoniae using microimmunofluorescence technique（MIF） and rapid quantitation of C-reactive protein（CRP） was measured by DIGFA method.Results：The infection rates of Cpn were 66.0%（33/50） in group one,66.7%（28/42） in group two and 21.5%（14/65） in control,respectively.The prevalences of Cpn-A and Cpn-IgM representing acute infection were significantly higher in group one than in control l（P0.001）,the prevalences of Cpn-IgA and Cpn-IgG representing chronic infection were significantly higher in group one and group two than in control（P0.01）.After treatment,the patient＇s clinical symptoms of COPD groups were improved markely.Borg scores were significant less and FEV1/FVC（%） was increased significantly（P0.01）.In group one and group two only the positive rate of Cpn-IgM was decreased significantly（P0.001）.Falling rate of CRP levels in COPD groups were significant：（P0.01）.Conclusions：The patients with COPD have higher Cpn infection rates,tiotropium plus azithromycin for curing COPD have positive synergistic effects with each other.