维生素D血浆浓度与氟替卡松对COPD患者肺功能的影响

The Level of vitamin D in Blood Plasma and Fluticasone to the Change of Pulmonary Function in Patients with COPD

目的探讨25-羟维生素D血浆浓度与吸入性糖皮质激素对COPD患者肺功能影响的关系。方法 120例重度COPD患者于初入院时进行气量测定以及清晨禁食采集血样标本,用高效液相色谱法检测25(OH)D水平;而后每日2次,每次使用500μg氟替卡松,50μg沙美特罗,疗程4周。4周后再检测第1秒用力通气量及其改变,抽取血样,检测25(OH)D水平。治疗前后测量第1秒用力呼气容积(FEV1),与25(OH)D血浆水平进行相关性分析。结果 25(OH)D血浆浓度水平平均为(23.3±9.3)ng/mL.在COPD患者中普遍维生素D缺乏,约占40%。对氟替卡松起效的患者体内25(OH)D水平偏高,在使用氟替卡松4周后,第1秒用力通气量有明显改善。结论 25(OH)D血浆水平与患者对氟替卡松的敏感性有关,并可提高第1秒用力通气量,提高1秒率,改善肺功能。

Objective To explore the relationship of the pulmonary function of patients with chronic obstructive pulmonary disease （ COPD ） with serum levels of 25 （ OH ） D and fluticasone. Methods A total of 120 exsmokers with severe COPD （mean forced expiratory volume in one second （ FEV1 ） 1.07 L, 36% of predicted ） spent 4 weeks free of any ICS, followed by 4 weeks of ICS use （ fluticasone propionate 500 μ g twice daily ）. Spirometry was performed prior to and after 4 weeks of ICS use. Blood 25 （ OH ） D levels were measured prior to ICS use and examined for relationships to changes in FEV1 following the 4 weeks of ICS use. Results The mean 25 （ OH ） D level was （ 23.3 ± 9.3 ） ng/mL. There was a high prevalence of vitamin D deficiency （ 40% ）. The high 25 （ OH ） D level can changes in FEV1 following 4 weeks of ICS. Conclusion According to that high serum levels of 25 （ OH ） D contribute to the variation in short-term FEV1 responses to fluticasone, it can increase the pulmonary function （ FEV1 was more than before treated ） in patients of COPD who was sensitivity to the fluticasone.