噻托溴铵吸入剂治疗稳定期D组慢性阻塞性肺疾病的疗效评价

Therapeutic Effects of Tiotropium in Treatment of Stable COPD Patients of Group D

目的探讨噻托溴铵吸入剂对稳定期D组慢性阻塞性肺疾病(COPD)患者临床症状及肺功能的改善作用。方法 62例稳定期D组COPD患者随机分为治疗组32例,给予噻托溴铵吸入剂(18μg,吸入,1次/d)联合沙美特罗/丙酸氟替卡松吸入剂(50μg/500μg,吸入,2次/d)治疗;对照组30例,给予沙美特罗/丙酸氟替卡松(50μg/500μg,吸入,2次/d)治疗。观察患者治疗前、治疗后8、24、48周运动耐量、呼吸困难评分的变化及治疗前、治疗后1、8、24、48周后肺功能变化。结果治疗8周、24周、48周后两组6 min步行距离(6MWD)值均较治疗前明显增加,呼吸困难评分(MRC)均较治疗前显著下降(P<0.05),而治疗组中各项指标改善显著优于对照组(P<0.05)。治疗1周、8周后两组FVC、FEV1和FEV1%pred值均较治疗前明显增加(P<0.05),治疗组指标改善显著优于对照组(P<0.05)。24周、48周治疗组上述指标仍显著高于治疗前(P<0.05),而对照组与治疗前比较无显著差异,治疗组与对照组比较有显著性差异。结论噻托溴铵与沙美特罗/氟替卡松联合吸入治疗稳定期D组COPD患者,优于沙美特罗/丙酸氟替卡松单药吸入治疗。

Objective To investigate the therapeutic effects of tiotropium in the treatment of stable COPD（chronic obstructive pulmonary disease） patients of group D.Methods Sixty-two subjects with stable COPD in group D classified by combined COPD assessment in GOLD 2011,were randomly divided into a treatment group（n=32） and a control group（n=30）.The treatment group was treated with tiotropium（18 μg,inhalation,once daily） plus salmeterol/fluticasone（50/500 μg,inhalation,twice a day） and the control group was treated only with salmeterol/fluticasone（50/500 μg,inhalation,twice a day）.The exercise tolerance,dyspnea score and lung function were measured before and 1,8,24,and 48 weeks after the treatment respectively.Results 8,24,48 weeks after the treatment respectively,there were improvements of 6 minute walk test and the dyspnea score of medical research council scale（MRC） in both groups than before treatment,and which was better in the treatment group.Compared with baseline and the control group,significantly greater improvements in the FVC,FEV1 and FEV1%pred were seen in the treatment group at all time points.In the control group,FVC,FEV1 and FEV1%pred 1 and 8 weeks after treatment were higher than those before treatment,but there was no significant difference after treatment of 24 and 48 weeks.Conclusion Combination treatment with tiotropium and salmeterol/fluticasone inhalation results in greater therapeutic benefits than salmeterol/fluticasone inhalation alone in stable COPD patients of group D.