噻托溴铵对慢性阻塞性肺疾病稳定期患者血清超敏C反应蛋白、肿瘤坏死因子-α水平及肺功能的影响

Influence of Tiotropium Bromide on serum high sensitive C-reactive protein and tumor necrosis factor-α levels and lung function of patients with stable chronic obstructive pulmonary disease

目的探讨噻托溴铵对慢性阻塞性肺疾病（COPD）稳定期患者血清超敏C反应蛋白（hs-CRP）和肿瘤坏死因子-α（TNF-α）水平及肺功能的影响。方法选取2012年8月～2013年9月宁波市北仑区人民医院呼吸科治疗的COPD稳定期患者70例,随机分为观察组（n=35）和对照组（n=35）。对照组患者予以茶碱缓释片口服,0.1 g/次,2次/d,连用16周。观察组患者予以噻托溴铵干粉剂1粒/次,1次/d,睡前吸入,连用16周。观察两组治疗前和治疗16周后血清hs-CRP、TNF-α及肺功能的变化。结果治疗16周后,观察组与对照组患者血清hs-CRP、TNF-α水平[（1.07±0.23）mg/L,（1.45±0.27）ng/mL;（1.42±0.31）mg/L,（2.16±0.45）ng/mL]均较前[（2.05±0.46）mg/L,（2.92±0.52）ng/mL;（1.97±0.45）mg/L,（2.87±0.57）ng/mL]明显下降（t=3.02、3.17、2.39、2.31,P〈0.01或P〈0.05）,且观察组下降幅度明显大于对照组（t=2.27、2.45,P〈0.05）;同时观察组与对照组患者治疗后用力肺活量（FVC）、第1秒用力呼气量（FEV1）和FEV1/FVC[（1.77±0.34）L,（1.21±0.25）L,（0.70±0.19）;（1.58±0.32）L,（0.99±0.23）L,（0.63±0.15）]均较前[（1.41±0.24）L,（0.80±0.15）L,（0.57±0.12）;（1.42±0.26）L,（0.79±0.18）L,（0.56±0.13）]明显提高（t=2.45、2.89、2.44、2.16、2.41、2.18,P〈0.05或P〈0.01）,且观察组提高幅度明显大于对照组（t=2.18、2.37、2.15,P〈0.05）。结论噻托溴铵吸入治疗COPD稳定期具有较好的效果,能明显改善患者的肺功能,其作用机制与其能降低血清炎症因子hs-CRP、TNF-α水平,抑制慢性炎性反应过程密切相关。

Objective To discuss influence of Tiotropium Bromide on serum high sensitive C-reactive protein（hs-CRP）and tumor necrosis factor-α（TNF-α） levels and lung function of patients with stable chronic obstructive pulmonary disease（COPD）. Methods 70 cases of patients with stable COPD, who were treated in Pneumology Department, Beilun District People＇s Hospital in Ningbo City from August 2012 to September 2013 were selected and divided into observation group（n=35） and control group（n=35） at random. The patients in control group were given Theo-Dur through the mouth, 0.1 g per time, twice a day for 16 weeks. The patients in observation group were given Tiotropium Bromide Dry Powder, one tablet per time, which was inhaled before going to bed for 16 weeks. The changes of serum hs-CRP, TNF-αand lung function of patients in two groups were observed before and 16 weeks after medical treatment. Results After16 weeks＇ medical treatment, serum hs-CRP and TNF-α levels of patients in observation group and control group[（1.07±0.23） mg/L,（1.45±0.27） ng/mL;（1.42±0.31） mg/L,（2.16 ±0.45） ng/mL] obviously declined than before [（2.05 ±0.46） mg/L,（2.92±0.52） ng/mL;（1.97±0.45） mg/L,（2.87±0.57） ng/mL]（t = 3.02, 3.17, 2.39, 2.31, P 0.01 or P 0.05）,and the declining rate in observation group was much higher than that in control group（t = 2.27, 2.45, P 0.05）.Meanwhile, FVC, FEV1and FEV1/FVC of patients in observation group and control group [（1.77±0.34） L,（1.21±0.25） L,（0.70±0.19）;（1.58±0.32） L,（0.99±0.23） L,（0.63±0.15）]obviously rose than before [（1.41±0.24） L,（0.80±0.15） L,（0.57±0.12）;（1.42±0.26） L,（0.79±0.18） L,（0.56±0.13）]（t = 2.45, 2.89, 2.44, 2.16, 2.41, 2.18, P 0.05 or P 0.01）, and the rising rate in observation group was much higher than that in control group（t = 2.18, 2.37, 2.15, P 0.05）. Conclusion The inhalation of Tiotropium has reliable curative effect on stable COPD, and can obviously improve the lung function of patients, whose mechanism of action has close effect on reducing the hs-CRP and TNF-α levels of serum inflammatory factors, and inhibiting the chronic inflammatory process.