噻托溴铵对轻、中度稳定期COPD患者小气道肺功能的影响

Effect of tiotropium on small airway lung function in mild and moderate stable patients with chronic obstructive pulmonary disease

目的:比较异丙托溴铵气雾剂、噻托溴铵干粉剂治疗轻、中度稳定期慢性阻塞性肺疾病(COPD)患者6周、12周的小气道肺功能参数变化。方法:采用随机、单盲、平行对照试验设计,入选42例COPD稳定期患者,分为噻托溴铵干粉剂吸入组(18μg/次,每天1次),异丙托溴铵气雾剂吸入组(40μg/次,qid),总疗程12周。结果:治疗6周末,2组间肺功能无统计学差异,同基线值比较异丙托溴铵组仅最大用力呼气中期流速(FEF25-75)有增高;治疗12周末,噻托溴铵组较异丙托溴铵组FEVl、FEF25、FEF50、FEF25-75均有明显改善,同基线值比较,亦有显著性增加;并且噻托溴铵组用药12周末较6周末患者FEF25增加有显著性意义(P<0.05)。结论:噻托溴铵较异丙托溴铵更能改善轻、中度稳定期COPD患者的肺功能,包括小气道肺功能。

OBJECTIVE To compare the effect of tiotropium bromide with ipratropium bromide on small airway function in stable chronic obstructive pulmonary disease（COPD） . METHODS A randomized and single blind controlled clinical trail was conducted in 41 patients with stable COPD. 20 patients were treated by tiotropium bromide （18 μg, qd inhaled） and 21 patients were treated by ipratropium bromide（40μg,qid inhaled） for 12 weeks. RESULTS There was no significant difference in the lung function between two groups after 6 weeks＂ therapy. Compared with baseline, only in ipratropium bromide group FEF25 increased（P〈0. 05）. But at the end of 12th week, compared with baseline, tiotropium bromide improved significantly in forced expiratory volume in one second （FEV1）, and FEF25, FEF50, FEF25-75 ; FEV1, FEF25, FEF50 and FEF25-75 were also significantly higher in tiotropium bromide group than in ipratropium bromide group （P〈0. 05）. The change of FEF25 was higher at the end of 12 weeks therapy than 6 weeks in tiotropium bromide group. CONCLUSION Tiotropium bromide is more effective than ipratropium bromide on improving lung function in patients with stable COPD. The improvement also involved small airways function.