不同剂量糖皮质激素对慢性阻塞性肺疾病患者急性加重期炎性介质的影响及临床意义

Effect and its clinical significance of different dose of glucocorticoids on inflammation mediators in patients with acute exacerbation of chronic obstructive pulmonary diseases

目的探讨不同剂量糖皮质激素对慢性阻塞性肺疾病急性加重期（AECOPD）患者炎性因子水平的影响和临床疗效。方法选取2007年3月至2011年3月我院呼吸科AECOPD（肺功能Ⅱ级和Ⅲ级）的患者45例，将患者随机分成3组：甲泼尼龙40mg组：甲泼尼龙40mg静脉注射1次／d；甲泼尼龙80mg组：甲泼尼龙40mg静脉注射2次／d；空白对照组：不使用任何糖皮质激素。观察3组患者治疗前及治疗后第7天呼吸困难评分、动脉血气分析、临床症状评分和血清白介素（IL）-6、IL-8、肿瘤坏死因子（TNF）-α和D反应蛋白（CRP）的变化，并记录相关的药物不良反应。结果治疗后第7天3组患者中甲泼尼龙40mg组和甲泼尼龙80mg组的临床症状评分、Borg评分、动脉血二氧化碳分压（PaCO2）、动脉血氧分压（PaO2）改善均优于空白对照组（F=3.67、7．16、42．88、49．83，均P〈0．05），而甲泼尼龙80mg组优于甲泼尼龙40mg组（均P〈0．05）；治疗后甲泼尼龙40mg组和甲泼尼龙80mg组血清IL-8、TNF-α、IL-6、CRP水平较空白对照组明显下降（F=12．65、16．17、30．99、20．04，均P〈0．05），而甲泼尼龙80mg组较甲泼尼龙40mg组下降更明显（均P〈0．05）。在治疗过程中，3组患者均未出现严重的药物不良反应。结论短期、适量糖皮质激素对AECOPD患者的治疗是有效、安全的；每日80mg甲泼尼龙静脉注射能更明显改善AECOPD患者症状，更好地降低炎性因子水平。

Objective To explore the effect and its clinical significance of different dose of glucocorticoids on inflammation mediators in patients with acute exacerbation of chronic obstructive pulmonary diseases. Methods 45 patients admitted to our hospitals from March 2007 to March 2011 were randomly divided into 3 groups： methylprednisolone 40 mg group （methylprednisolone 40rag, iv, qd）, methylprednisolone 80 mg group （methylprednisolone 80mg, iv, bid）, and control group （without any glucocorticoids）. The changes of dyspnea scores, arterial blood gas analysis, clinical symptom scores and serum IL-6, IL-8 and tumor necrosis factor （TNF） levels were detected in patients of each group before and at the 7th day after treatment. The related adverse drug reactions were recorded. Results The improvements in clinical symptom scores, Borg scores, PaCO2, PaO2 after treatment were higher in methylprednisolone 40 mg group and methylprednisolone 80 mg group than in control group （F= 3. 6747. 162 and 42.88, respeetively, P〈0.01 or 0. 001）, and the above improvements was better in methylprednisolone 80 mg group than in methylprednisolone 40 mg group （all P〈0.05）. The decreases in levels of serum IL-8, TNF-α, IL-6, C-RP after the treatment were more significant in methylprednisolone 40 mg group and methylprednisolone 80 mg group than in control group （F=12.65, 16.17, 30.99, respectively, all P〈0. 001）, and the decrements were moresignificant in methylprednisolone 80 mg group than in methylprednisolone 40 mg group（all P〈0.05）. NO serious adverse drug reactions happened during the course of treatment in the three groups. Conclusions Short-term and moderate dose of glucocorticoid treatment is effective and safe in treating the patients with acute exacerbation of chronic obstructive pulmonary diseases. Methylprednisolone 80 mg injection daily can more obviously improve AECOPD symptoms, and reduce the levels of inflammatory factors better.