沙美特罗／氟替卡松改善慢性阻塞性肺疾病患者肺功能的预测因素的初探

Impact factor analysis for improvement in lung function of patients with COPD treated with Salmeterol/ fluticasone

目的探讨影响吸入糖皮质醇激素（ICS）＋长效β受体激动剂（LABA）（沙美特罗/氟替卡松）改善COPD患者肺功能的预测指标。方法实验分两组，实验组COPD患者166例，对照组COPD患者73例，实验组所有COPD患者吸入50／500μg沙美特罗／氟替卡松（1吸，2次／d），对照组吸入安慰剂，两组均治疗6个月。所有患者在治疗前后均进行诱导痰嗜酸粒细胞、IL-8、呼出气一氧化氮检测（FeNO）和肺功能的检测。应用单因素和非条件Logistic多因素回归分析方法，分析影响FEV1改善的可能因素。结果实验组患者吸入50／500μg沙美特罗替卡松（1吸，2次／d）治疗后FEV1改善值为（86±11）ml，而对照组FEV1改善值为（19±16）ml（t=6．205，P〈0．05）。我们对影响ICS＋LABA改善FEV1值的可能因素，包括诱导痰中嗜酸粒细胞、炎性介质IL-8水平、反应气道炎症水平的FENO，基础肺功能FEV1等因素进行分析，结果显示诱导痰中炎性介质IL-8水平、FENO基础水平和基础肺功能与FEV1改善无相关；而嗜酸粒细胞〉2．5％（χ^2=3．181，P〉0．05）及治疗后FeNO下降〉10bbp（χ^2=17．237，P〉0．05）与FEV1改善相关。进一步多因素Logisitc分析显示诱导痰嗜酸粒细胞〉2．5％和治疗后FeNO降低〉10ppb是影响ICS＋LABA改善FEV1的重要因素。结论诱导痰嗜酸粒细胞、治疗后FENO下降的水平可成为ICS＋LABA改善COPD患者FEV1的预测因素。

Objective To investigated impact factor on improvement in lung function of patients with C（）Pl） treated with ICS＋LABA. Methods COPD patients in study group were administered 50/500 lag Salmeterol/fluticasone （1puff bid） for 6 months. Eosinophil in sputum induction, inflammatory mediators （11.-8）,lung function test and FeNO measurement were performed in all COPD patients before and post treatment. Impact factors on improvement in lung function of patients with COPD treated with 50/500 μg Salmeterol/fluticasone were analyzed by using single factor and non-conditional logistic regression analysis method. Results Improvement in lung function of patients with COPD treated .with 50/500 μg Salmeterol/flutieasone were （86±11） ml, and improvement of lung function in control group were （19±16） ml （P 〈0.05）. We investigate all impact factors （including eosinophils in induced sputum,IL-8,FeNO and lung functions） on improvement in lung function of patients with COPD. The improvement m FEVj was not correlated with IL-8 in induced sputum, baseline FeNO and baseline FEV1 , respectively. While eosinophils in induced sputum and decrease in FeNO after treatment 〈 10 bbp were closely related with the change in FEV1. The future logistic regression analysis showed percentage of vosinophils in induced sputum and decrease in FeNO after treatment 〉 10 ppb are the major factors on improvement in lung function of patients with COPD. Conclusions Our study show percentage ofeosinophils, in induced sputum and decrease in FENO after treatment 〉 10 ppb maybe important predictors of improvement in lung function of patients with COPD treated with ICS＋LABA.