糖皮质醇激素改善慢性阻塞性肺疾病急性加重期患者肺功能的影响因素的分析

Impact factor analysis for improvement in lung function of patients with AECOPD treated with systemic corticosteroids

目的 对影响糖皮质醇激素改善COPD急性加重期（AECOPD）患者肺功能的可能因素进行分析,鉴定出影响FEV1改善的相关因素.方法 实验分两组,实验组AECOPD患者接受甲基泼尼松1mg· kg-1·d-1静脉滴注及其他常规治疗,对照组接受除激素以外的其他常规治疗,连续治疗1周.治疗前后对所有AECOPD患者进行诱导痰炎性细胞、炎性介质（IL-6和IL-8）、呼出气一氧化氮（FeNO）检测和肺功能的检测.利用单因素和多因素线性回归筛选FEV1改善值的影响因素.结果 AECOPD患者经激素治疗后FEV1改善值为（0.32±0.21） L[FEV1％pred改善率为（19.3±10.6）％],而对照组FEV1改善值为（0.13±0.09） L[FEV1％pred改善率为（6.8±5.1）％],两者差异有统计学意义.我们对影响激素改善FEV1值的可能因素,包括气道炎症指标（诱导痰中性粒细胞、嗜酸粒细胞、IL-6、IL-8和治疗前FeNO水平）、年龄、基础肺功能等进行分析,结果显示嗜酸粒细胞百分比、治疗前FeNO、IL-8与FEV1改善值呈正相关,相关系数分别为0.816、0.62和0.54,进一步分析提示诱导痰的嗜酸粒细胞百分比、治疗前FeNO是影响FEV1改善值的主要因素,诱导痰嗜酸粒细胞百分比比治疗前FeNO对FEV1改善值的影响意义更大.结论 嗜酸粒细胞百分比、基础FeNO可作为激素改善COPD患者FEV1的预测因素.

Objective To investigated impact factor on improvement in lung function of patients with AECOPD treated with systemic corticosteroids.Methods AECOPD patients in study group were administered 40 mg/d Methyllprednisolone by intravenous injection besides other routine therapy for 1 week,AECOPD patients in control group only accepted other routine therapy.Sputum induction,lung function test,inflammatory mediators and FeNO measurement were performed in all AECOPD patients before and post treatment.Impact factors on improvement in lung function of patients with AECOPD treated with systemic corticosteroids were screened by simple linear regression or multiple regression.Results Improvement in lung function of patients with AECOPD treated with systemic were （0.32± 0.21） L,and improvement of lung function in control group were （0.13±0.09） L.This improvement was highly significant.We investigate all impact factors （including neutrophils%,eosinophils% in induced sputum,IL-6,IL-8,baseline FeNO,age and lung functions） on improvement in lung function of patients with AECOPD.The improvement in FEV1 was correlated with the percentage of eosinophils （r =0.816,P 〈0.05）,baseline FeNO （r =0.62,P 〈0.05） and IL-8 （r =0.62,P 〈0.05）,respectively.The future investigate show percentage of eosinophils in induced sputum and baseline FeNO are the major factors on improvement in lung function of patients with AECOPD and eosinophils% in induced sputum is the most important factor.Conclusions Our study show percentage of eosinophils in induced sputum and baseline FeNO are the major factors on improvement in lung function of patients with AECOPD treated with systemic corticosteroids.