吸入沙美特罗替卡松对中重度慢性阻塞性肺疾病患者运动耐力的影响

Effect of Salmeterol/Fluticasone Propionate on exercise endurance in moderate-severe COPD

目的通过对吸入沙美特罗替卡松粉(SFC)治疗中重度慢性阻塞性肺疾病(COPD)患者进行研究,探讨吸入糖皮质激素联合长效β2受体激动剂对中重度COPD静息肺功能和运动耐力的影响。方法选择稳定期的中重度COPD患者53例,随机分为治疗组与对照组。治疗组吸入SFC(每泡含沙美特罗50μg,丙酸氟替卡松250μg),每日2次,每次1喷,对照组给予一般治疗。24周后,观察患者肺功能(PFT)及心肺运动试验(CPET)各项生理参数指标的变化。结果试验开始时,治疗组与对照组的PFT参数与CPET参数相比较,无统计学差异。SFC治疗24周后,治疗组的静态肺功能指标显示,患者用力肺活量(FVC)由治疗前(2.5±0.6)L增加至(3.0±0.5)L,第一秒用力呼气量(FEV1)由治疗前(1.1±0.4)L增加至(1.3±0.2)L,深吸气量(IC)由治疗前(1.9±0.4)L增加至(2.2±0.5)L,胸廓内气量(ITGV)由治疗前(5.8±0.6)L减低至(5.1±0.7)L,残气量(RV)由治疗前(4.8±0.7)L减低至(4.0±0.8)L,肺总量(TLC)由治疗前(7.6±1.1)L减低至(7.3±1.0)L,差异均有统计学意义;CPET发现,峰值功率(Peak WR)由治疗前(86.2±13.5)watt增加至(91.2±15.1)watt,稍有改善,但无显著的统计学差异;峰值摄氧量(Peak VO2)由治疗前(1341.2±261.4)ml/min增加至(1796.0±282.5)ml/min,峰值公斤摄氧量(Peak VO2/kg)由治疗前(20.7±5.0)ml.min-1.kg-1增加至(23.5±4.4)ml.min-1.kg-1,Peak VCO2由治疗前(1671.4±254.3)ml/min增加至(1995.1±241.7)ml/min,峰值氧脉搏(Peak O2 pulse)由治疗前(7.5±2.3)ml/beat增加至(10.9±2.7)ml/beat,峰值通气量(Peak VE)由治疗前(31.2±10.2)L/min增加至(37.2±9.2)L/min,死腔/潮气量(VD/VT)由治疗前(39.4±7.0)%减低至(32.4±6.1)%,二氧化碳通气当量最低值(Lowest VE/VCO2)由治疗前32.5±3.2减低至28.8±2.9;PFT中IC改善值与CPET中Peak VO2、Peak VO2/kg、Peak VE、VD/VT、Lowest VE/VCO2等的改善值有良好的相关性,而FEV1的改善值与上述CPET的参数改善无显著相关。对照组用药前后,患者PFT及CPET各参数无明显的变化。结论中重度COPD患者的运动耐力显著减低,长期使用SFC后,其气流受限的改善程度有限,峰值运动功率仅有轻微改善,但患者的静息及运动时的肺过度充气状态明显减轻,通气/血流匹配状况明显好转,通气效率得到显著改善,从而提高运动耐受能力。

Objective To investigate the effect of Salmeterol/Fluticasone Propionate（SFC） on exercise endurance and pulmonary function in moderate-severe COPD.Methods 53 patients with moderate-severe COPD were randomly divided into two groups.Treatment group inhaled dry powder SFC（salmeterol 50 μg,fluticasone propionate 250 μg）twice daily for 24 weeks.Control group got symptomatic treatment for 24 weeks.Predose and postdose pulmonary and cycle cardiopulmonary exercise test（CPET） evaluations were compared.Results There were no difference in predose pulmonary and CPET between two groups.In treatment group,with SFC treatment for 24 weeks,FVC increased from（2.5±0.6）L to（3.0±0.5）L,FEV1 increased from（1.1±0.4）L to（1.3±0.2）L,IC increased from（1.9±0.4）L to（2.2±0.5）L,ITGV decreased from（5.8±0.6）L to（5.1±0.7）L,RV decreased from（4.8±0.7）L to（4.0±0.8）L,TLC decreased from（7.6±1.1）L to（7.3±1.0）L;Peak WR increased from（86.2±13.5）watt to（91.2±15.1）watt,Peak VO2 increased from（1341.2±261.4）ml/min to（1796.0±282.5）ml/min,Peak VO2/kg increased from（20.7±5.0）ml·min-1·kg-1 to（23.5±4.4）ml·min-1·kg-1,Peak VCO2 increased from（1671.4±254.3）ml/min to（1995.1±241.7）ml/min,Peak O2 pulse increased from（7.5±2.3）ml/beat to（10.9±2.7）ml/beat,Peak VE increased from（31.2±10.2）L/min to（37.2±9.2）L/min,VD/VT decreased from（39.4±7.0）% to（32.4±6.1）%,Lowest VE/VCO2 decreased from 32.5±3.2 to 28.8±2.9;postdose improvement in IC was significantly correlated with the increase in Peak VO2,Peak VO2/kg,Peak VE,VD/VT and Lowest VE/VCO2,but not with FEV1.Predose and postdose pulmonary and CPET were no changes in control group.Conclusions Exercise tolerance in patients with moderate-severe COPD are distinguished impaired.After long term SFC treatment,lung hyperinflation at rest and exercise are decreased,ventilatory efficiency were better,exercise endurance are increased.