吸烟对老年慢性阻塞性肺疾病患者ICS/LABA治疗疗效的影响

Effect of Smoking on ICS/LABA Therapy for Elderly Patients with COPD

目的:观察吸烟对吸入性糖皮质激素联合长效β2受体激动剂(ICS/LABA)治疗中重度慢性阻塞性肺病(COPD)患者的影响。方法:选取2013年1月—2013年12月在复旦大学附属上海市第五人民医院老年呼吸科门诊和住院就诊的老年中、重度COPD稳定期患者,依照吸烟情况分为现吸烟组98例和曾吸烟组98例,两组患者均吸入福莫特罗/布地奈德,共治疗6个月。分别于治疗前和治疗3个月、6个月测定患者肺功能[第1秒用力呼气容积(FEV1)占预计值百分比、FEV1/用力肺活量(FVC)百分比],检测血中白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)浓度,测定糖皮质激素受体(GR)-α和GR-β免疫阳性外周血单个核细胞(PBMC)比例,并进行呼吸困难评分。结果:曾吸烟组、现吸烟组患者与治疗前相比,治疗3个月、6个月的FEV1%、FEV1/FVC%逐渐上升(P<0.05),呼吸困难评分逐渐下降(P<0.05);治疗后血中的TNF-α、IL-8水平逐渐下降(P<0.05);治疗前后外周血有核细胞GR-α阳性PBMC数无显著变化(P>0.05),曾吸烟组治疗6个月GR-β免疫阳性PBMC显著下降(P<0.05)。与现吸烟组相比,曾吸烟组治疗3个月、6个月后FEV1%、FEV1/FVC%上升的幅度更大(P<0.05),呼吸困难评分下降幅度更大(P<0.05);曾吸烟组治疗3个月、6个月后TNF-α、IL-8下降幅度更大(P<0.05);曾吸烟组治疗3个月、6个月后GR-α阳性PBMC数上升的幅度更大,GR-β阳性PBMC数下降的幅度更大(P<0.05)。结论:对现吸烟及曾吸烟的COPD患者,ICS/LABA都能够改善患者肺功能、缓解呼吸症状、减轻炎症反应、调节糖皮质激素受体。吸烟对ICS/LABA治疗COPD的疗效存在不良影响。

Objective：To observe the effect of smoking on inhaled corticosteroids and long-acting beta-2 agonists（ICS/LABA）therapy for patients with moderate to severe chronic obstructive pulmonary disease（COPD）.Methods：Elderly patients with moderate to severe COPD in stable stage,who consulted doctors at Department of Geriatric Respiratory Disease in our hospital or were admitted to our hospital during January2013 and December 2013,were selected and allocated to smoking group（n=98）or ex-smoker group（n=98）.All subjects were treated with inhaled formoterol and budesonide,and the treatment lasted for 6months.Before treatment and at the 3rd and 6th month of treatment,pulmonary function（FEV1 pred%,FEV1/FVC %）,concentration of interleukin-8（IL-8）and tumor necrosis factor-α（TNF-α）in the blood,and glucocorticoid receptor（GR）-αand GR-βpositive peripheral blood mononuclear cells（PBMC）were determined,and meanwhile dyspnea score was evaluated.Results：In both smoking group and ex-smoker group,compared with that before treatment,at the 3rd and 6th month of treatment,the FEV1% and FEV1/FVC% gradually increased（P〈0.05）,dyspnea score decreased（P〈0.05）.Blood concentrations of TNF- αand IL-8 decreased gradually after treatment（P〈0.05）.The percentage of GR-αpositive PBMC didn＇t change significantly（P〉0.05）,while the percentage of GR-βpositive PBMC decreased significantly at the 6th month of treatment in ex-smoker group（P〈0.05）.Compared with that in smoking group,FEV1% and FEV1/FVC% in ex-smoker group increased more at the 3rd and 6th month of treatment,while dyspnea score declined more（P〈0.05）,as well as the TNF-αand IL-8（P〈0.05）.At the 3rd and 6th month of treatment,GR-αpositive PBMCs increased more in ex-smoker group,while GR-βpositive PBMCs decreased more（P〈0.05）.Conclusions：For both smokers and ex-smokers with CODP,ICS/LABA can improve pulmonary function,relieve respiratory symptoms,reduce inflammatory reaction,and regulate glucocorticoid receptor.Smoking has negative effect on ICS/LABA treatment.