糖皮质激素对慢性阻塞性肺疾病稳定期不同皮质醇水平患者的干预作用观察

Intervention Study of Glucocorticoid on Different Cortisol Level Patients with Chronic Obstructive Pulmonary Disease on the Stable Phase

目的:探讨慢性阻塞性肺疾病(COPD)稳定期患者血清皮质醇(Cor)不同水平患者,短期全身使用小剂量糖皮质激素后血清Cor变化及临床疗效。方法:将COPD稳定期且Cor减低患者126例随机分为A组和B组;COPD稳定期且Cor正常患者128例随机分为C组和D组。各组患者均予常规治疗,A组和C组在此基础上加用泼尼松片10 mg.d^(-1),连用4周后逐渐停药.比较各组患者治疗前后肺功能、血清Cor水平、生活质量评分(圣乔治呼吸问卷总评分)、药品不良反应等指标。结果:治疗后,4组圣乔治呼吸问卷总评分均较前下降,肺功能明显改善(P<0.05);A组总评分与肺功能指标均明显优于B组(P<0.05),而C组与D组的总评分与肺功能比较差异无统计学意义(P>0.05)。治疗后A组患者血清Cor水平较治疗前升高(P<0.01)。结论:Cor正常患者不建议使用全身糖皮质激素治疗,对治疗无明显获益。Cor减低患者在常规治疗基础上短期加用全身小剂量糖皮质激素,可改善肺通气功能,提升生活质量,升高血清Cor水平,且不良反应小。

Objective：To discuss the serum cortisol changes and clinical curative effect on different serum cortisol （Cot） level patients with chronic obstructive pulmonary disease （COPD） on the stable phase after short-term systemic using small doses of corticosteroid. Methods： 126 cases of patients with cortisol decreased COPD stable stage were randomly divided into group A and group B. 128 cases of patients with normal cortisol COPD stable stage were randomly divided into group C and group D. All groups were given routine therapy, group A and group C were added with prednisone tablets of 10 mg · d^ - 1, withdrew drug application gradually after 4 weeks. The pulmonary function, cortisol level, quality of life score （ St George＇ s Respiratory Questionnaire total score） and adverse reactions of those groups before and after the treatment were recorded and compared. Results ：After treatment, the of St George＇ s Respiratory Questionnaire total score of the four groups were all decreased than before, while pulmonary function were all improved （ P 〈0.05 ） ; total score in group A were declined and lung function were improved more significantly than group B after treatment（ P 〈0.05） ; There was no statistical difference in the total score and pulmonary function of group C and group D after treatment （ P 〉0.05 ）. The level of Cor in group A after treatment were higher than before（ P 〈0.01 ）. Conclusion： COPD stable stage patients with normal cortisol were not recommended to use systemic corticosteroids for treatment, and had no significant benefit. On the basis of routine treatment, the patients with cortisol decrease short-term added systemic low dose glucocorticoid, which could improve the pulmonary ventilation function, improve the quality of life, increase the level of cortisol, and the adverse reactions were less.