噻托溴铵对老年慢性阻塞性肺疾病稳定期患者肺功能及气道重塑的影响

Effect of tiotropium bromide on pulmonary function and airway remodeling in elder chronic obstructive pulmonary disease stabilization patients

目的探讨噻托溴铵对老年慢性阻塞性肺疾病（COPD）稳定期患者肺功能及气道重塑的影响。方法将92例老年COPD稳定期患者按随机数字表法分为治疗组（50例）和对照组（42例），两组患者均予以COPD常规治疗，包括止咳、平喘、抗感染等治疗。治疗组在常规治疗基础上给予噻托溴铵吸入，疗程为12个月。同时选择与COPD稳定期患者年龄匹配的健康体检者40例作为健康对照组。应用高分辨率CT（HRCT）测定治疗前后气道壁厚度、气道内外径、气道腔面积等参数以评估气道重塑的程度，同时测定患者肺功能、血清炎性细胞因子[白细胞介素（IL）-8、肿瘤坏死因子（TNF）-α]水平及T淋巴细胞亚群，并与健康对照组进行比较。结果治疗组治疗后各项肺功能指标明显改善，且改善程度优于对照组，差异均有统计学意义（P〈0．05）。治疗组治疗后气道壁厚度与治疗前比较差异无统计学意义（P〉0．05），其余气道重塑指标均较治疗前明显改善，差异有统计学意义（P〈0．05）。治疗组治疗后6min步行试验距离明显高于对照组，差异有统计学意义（P〈0．05）。两组COPD患者治疗前血清IL-8、TNF-α水平比较差异无统计学意义（P〉0．05），治疗后两组血清IL-8、TNF-α水平均较治疗前下降（P〈0．05），治疗组治疗后血清IL-8、TNF-α水平明显低于对照组（P〈0．05）。治疗组和对照组治疗前CD3^＋、CD4^＋、CD4^＋／CD8^＋较健康对照组明显降低，CD8^＋较健康对照组明显增高，差异有统计学意义（P〈0．05）。治疗后两组CD3^＋、CD4^＋、CD4^＋／CD8^＋升高，CD8^＋降低，与治疗前比较差异有统计学意义（P〈0．05），并且治疗组变化更为明显（P〈0．05）。结论噻托溴铵对老年COPD稳定期患者的肺功能及气道重塑具有显著的改善作用。

Objective To analyze the effect of tiotropium bromide on pulmonary function and airway remodeling in elder chronic obstructive pulmonary disease （COPD） stabilization patients. Methods Ninety-two elder patients diagnosed as COPD stabilization were divided into treatment group （50 patients） and control group （42 patients） by random digits table method. The patients in two groups were given basic treatment such as antimicrobial therapy, spasmolysis,antiasthma,expelling phlegm, and the patients in treatment group were given tiotropium bromide every day for 12 months besides the basic treatment. Meanwhile, 40 healthy persons whose ages matched with those of COPD stabilization patients were as healthy control group. High resolution computerized tomography （HRCT） was employed to measure the parameters such as the airway wall thickness, the outer and inner diameter of the airway, airway wall area to assessed the airway remodeling before and after treatment in order to evaluate the drug efficacy. Meanwhile, the lung function,the inflammatory eytokines [interleukin （IL）-8,tumor necrosis factor （TNF）-α ] in blood plasma and T lymphocyte subsets were also determined. Results The index of lung function in treatment group was significantly better than that before treatment and control group,and there was significant difference （P 〈 0.05）. The airway wall thickness in treatment group had no significant difference before and after treatment （P 〉 0.05）,and other index of airway remodeling was significantly improved compared with that before treatment （P 〈 0.05）. After treatment, the distance of 6 min walk test in treatment group was significantly longer than that in control group, and there was significant difference （P 〈 0.05 ）. The level of serum IL-8 and TNF-α before treatment had no significant difference between two groups （P 〉O.05）,and decreased significantly after treatment and the improvement was more pronounced in treatment group compared with that in control group （P 〈 0.05 ）. Compared with that in healthy control group, the level of CD3^＋, CD4^＋, CD4^＋/CD8^＋ was significantly lower and the level of CD8＋ was significantly higher before treatment in treatment group and control group （P 〈 0.05）. After treatment, the level of CD3^＋, CD4^＋, CD4^＋/CD8^＋ was significantly increased and the level of CD8^＋ was significantly decreased （P 〈 0.05）, and the improvement was more pronounced in treatment group compared with that in control group （P 〈 0.05）. Conclusion Tiotropium bromide can improve airway remodeling and lung function in elder COPD stabilization patients.