沙美特罗替卡松联合常规治疗对重度慢性阻塞性肺疾病患者气道重塑及骨代谢的影响

Effect of Salmeterol and Fluticasone Propionate Combined with Conventional Therapy on Airway Remodeling and Bone Metabolism in Patients with Severe Chronic Obstructive Pulmonary Disease

目的:观察沙美特罗替卡松联合常规治疗对急性加重期慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者气道重塑及骨代谢的影响。方法:重度COPD患者90例,按入院先后顺序分为观察组和对照组。对照组患者实施常规治疗方法,观察组在对照组基础上加用沙美特罗替卡松治疗。两组疗程均为8周。观察比较两组患者治疗前,治疗后3个月、12个月股骨颈骨密度(BMD)、血骨钙素(BGP)、碱性磷酸酶(AKP),诱导痰细胞总数、中性粒细胞百分比和1s用力呼气容积(FEV1),白细胞介素8(IL-8)、基质金属蛋白酶9(MMP-9)等指标的水平变化。结果:治疗后3个月两组患者的BMD、BGP、AKP均无明显变化(P>0.05),治疗后12个月观察组BMD明显低于治疗前与对照组同期,BGP和AKP明显高于治疗前与对照组同期(P<0.05)。治疗后12个月两组患者的诱导痰细胞总数、中性粒细胞百分比、FEV1、MMP-9和IL-8均较治疗前明显改善,且观察组除IL-8外其他指标均较对照组改善更显著(P<0.05)。结论:沙美特罗替卡松联合常规治疗能有效改善重度COPD患者的气道重塑,短时间使用对患者骨代谢无不良影响,但长期使用会导致骨密度下降。

Objective： To observe the effects of salmeterol and fluticasone combined with the conventional treatment on the airway remodeling and bone metabolism in the patients with severe chronic obstructive lung disease（ chronic obstructive pulmonary disease,COPD. Methods： Totally 90 patients with severe COPD were divided into the observation group and the control group according to the order of admission. The control group was received the conventional treatment,and the observation group was treated with salmeterol and fluticasone additionally. The course of treatment was 8 weeks. Before the treatment and in the 3（rd） and 12 thmonth after the treatment,the changes in the levels of bone mineral density（ BMD） in femoral neck bone,serum osteocalcin（ BGP）,alkaline phosphatase（AKP）,the total number of induced sputum cells,neutrophils percentage,forced expiratory volume in one second（FEV1）,leukocyte mediated element 8（ IL-8）,matrix metalloproteinase 9（ MMP-9） and other indicators were detected and compared. Results： BGP,AKP and BMD of the two groups in the 3（rd）month after the treatment were not significantly changed（ P 〉0. 05）,while in the 12（th） month after the treatment,BMD in the observation group was significantly lower than that in the control group and that before the treatment,and BGP and AKP in the observation group were significantly higher than those in the control group and that before the treatment（P 〈0. 05）. The total number of induced sputum cells,the percentage of neutrophils,FEV1,MMP-P and IL-8 in the two groups were significantly improved in the 12（th） month after the treatment（ P 〈0. 05）,and the difference between the two groups was statistically significant except IL-8（ P 〈0. 05）. Conclusion： Salmeterol and fluticasone propionate can effectively improve airway remodeling in the patients with COPD. Short time use of salmeterol and fluticasone propionate shows no adverse effect on the bone metabolism,while long-term use would lead to reduced bone mineral density.