噻托溴铵联合沙美特罗/福莫特罗对老年稳定期COPD患者肺功能的影响

Effects of Salmeterol or Formoterol Combined with Tiotropium on Lung Function of the Elderly with Stable COPD

目的:观察噻托溴铵联合沙美特罗/福莫特罗对老年稳定期慢性阻塞性肺疾病(COPD)患者肺功能的影响。方法:将64例老年稳定期COPD患者按随机数字表法均分为沙美特罗组和福莫特罗组。沙美特罗组患者给予噻托溴铵粉吸入剂,1粒/次(每次应用药粉吸入器吸入1粒),1次/d;沙美特罗-丙酸氟替卡松干粉吸入剂,1吸/次,2次/d。福莫特罗组患者给予噻托溴铵粉吸入剂,用法、用量同沙美特罗组;布地奈德福莫特罗粉吸入剂,1吸/次,2次/d。两组患者疗程均为12周。观察所有患者生活质量、呼吸困难程度和COPD评估测试(CAT),第一秒用力呼气容积(FEV1)、占预计值百分比(FEV1%)、占用力肺活量比值(FEV1/FVC),动脉血氧气分压[pbt(O2)]、动脉血二氧化碳分压[pbt(CO2)],白介素(IL-)6、IL-8、IL-10、肿瘤坏死因子(TNF-)α的变化及不良反应发生情况。结果:治疗后两组患者生活质量三个维度评分、呼吸困难分级和CAT评分、pbt(CO2)、IL-6、IL-8、IL-10、TNF-α水平均显著低于同组治疗前,FEV1、FEV1%、FEV1/FVC、pbt(O2)均显著高于同组治疗前,差异均有统计学意义(P<0.05),各指标组间比较差异无统计学意义(P>0.05)。沙美特罗组不良反应发生率(3.13%)显著低于福莫特罗组(12.5%),两组比较差异有统计学意义(P<0.05)。结论:噻托溴铵联合沙美特罗/福莫特罗均可显著降低患者血浆炎症细胞因子水平,改善患者呼吸功能,提高患者生存质量,但噻托溴铵联合沙美特罗组的安全性更好。

OBJECTIVE： To observe the effects of salmeterol or formoterol combined with tiotropium on lung function of the elderly with stable COPD. METHODS： 64 elderly patients with COPD were randomly divided into salmeterol group and formoterol group. Salmeterol group was given Tiotropium powder inhalation 1 pill per time （using powder inhaler）, 1 time/d＋Salmeterol/fluticasone propionate dry powder inhalation one dose per time, 2 times/d; formoterol group was given Tiotropium powder inhalation 1 pill per time, 1 time/d ＋ Budesonide formoterol powder inhalation one dose per time, 2 times/d. Treatment course of 2 groups lasted for 12 weeks. The quality of life, dyspnea and COPD evaluation （CAT） test, FEV1, pbt（O2）, pbt（CO2）, IL-6, IL-8, IL-10 and TNF-a were evaluated as well as the occurrence of ADR. RESULTS： After treatment, three dimensions score, dyspnea grading, CAT score, the levels of pbt（CO2）, IL-6, IL-8, IL-10 and TNF-a were significantly lower than before; FEV1, FEV1%, FEV1/ FVC, pbt（O2） were significantly higher than before, and there were statistical significance （P〈0.05）. There was no statistical significance among these groups. The incidence of ADR in salmeterol group （3.13%） was significantly lower than that of formoterol group （12.5%）; there was statistical significance （P〈0.05）. CONCLUSIONS： Salmeterol or formoterol combined with tiotropium significantly reduce inflammatory cytokine in plasma of patients, improve lung function and the quality of life, but tiotropium combined with salmeterol is better in security.