沙美特罗替卡松对重度慢性阻塞性肺疾病患者心肺功能及6min步行距离的影响

Effect of Salmeterol and Fluticasone Propionate on Cardiopulmonary Function and 6 min Walking Distance in Patients with Severe COPD

目的探讨沙美特罗替卡松对重度慢性阻塞性肺疾病(COPD)患者心肺功能及6 min步行距离的影响。方法选取2013年3月至2015年5月收治的重度COPD患者100例,随机分为观察组和对照组,各50例。对照组患者给予茶碱缓释片及N-乙酰半胱氨酸治疗,观察组患者在对照组治疗基础上吸入沙美特罗替卡松粉吸入剂,均治疗6个月,比较治疗前后血清中白细胞介素8(IL-8)、肿瘤坏死因子-α(TNF-α)水平的变化,以评估抗炎疗效,并记录心肺功能的变化,同时观察并比较两组患者治疗前后6 min步行距离(6MWD)及不良反应发生率。结果治疗后,观察组IL-8为(133.5±32.1)ng/L,TNF-α为(140.9±21.3)mg/L,显著低于对照组的(156.8±28.4)ng/L和(181.2±25.4)mg/L(P<0.05);观察组心房钠尿钛(ANP)为(95.32±2.73)ng/L,明显高于对照组的(82.15±1.25)ng/L;观察组右室Tei指数为(0.26±0.09),明显低于对照组的(0.30±0.07),P<0.05;观察组1秒用力呼气容积占预计值百分比(FEV1%)预计值为(78.32±3.04)%,1秒用力呼气容积占用力肺活量百分比(FEV1/FVC)为(80.03±3.28)%,6MWD为(314.2±6.9)m,与对照组的(60.05±2.08)%,(73.56±2.35)%,(279.5±4.8)m比较,差异有统计学意义(P<0.05);观察组不良反应发生率为16.00%,与对照组的12.00%比较,差异无统计学意义(P>0.05)。结论沙美特罗替卡松对重度COPD患者肺功能及6MWD有一定影响,对患者的右心功能有明显改善作用,且安全性较好,值得临床应用。

Objective To investigate the effect of salmeterol and fluticasone propionate on cardiopulmonary function and 6 min walking distance in patients with severe COPD. Methods 100 cases of patients with severe COPD who were treated in the hospital from March2013 to May 2015 were selected as the study objects and were randomly divided into the observation group and the control group,50 cases in each group. The control group was treated with theophylline sustained- release tablets and N- acetylcysteine. Based on this,the observation group inhaled salmeterol and fluticasone propionate powder inhalant. All patients were treated for 6 months. Serum interleukin 8（ IL- 8） and tumor necrosis factor- α（ TNF- α） were compared before and after treatment between the two groups to evaluate the anti- inflammatory effect. The changes of cardiopulmonary function were recorded. Meanwhile,the 6 min walking distance（ 6MWD） and the incidence of adverse reactions were observed and compared between the two groups before and after treatment. Results After treatment,the IL- 8 was（ 133. 5 ± 32. 1） ng / L and TNF- α was（ 140. 9 ± 21. 3） mg / L in the observation group,which were significantly lower than（ 156. 8 ± 28. 4） ng / L and（ 181. 2 ± 25. 4） mg / L in the control group（ P〈0. 05）; the ANP was（ 95. 32 ± 2. 73） ng / L in the observation group,which was significantly higher than（ 82. 15 ± 1. 25） ng / L in the control group; the right ventricular Tei index was（ 0. 26 ± 0. 09） in the observation group,which was significantly smaller than（ 0. 30 ± 0. 07） in the control group（ P〈0. 05）; the predicted value of FEV1% was（ 78. 32 ± 3. 04） %,FEV1/ FVC was（ 80. 03 ± 3. 28） % and 6MWD was（ 314. 2 ± 6. 9） m in the observation group,which were significantly different from（ 60. 05 ± 2. 08） %,（ 73. 56 ± 2. 35） %,（ 279. 5 ± 4. 8） m in the control group（ P〈0. 05）; there was no significant difference in the incidence rate of adverse reactions between the two groups（ 16. 00% vs 12. 00%）（ P〉0. 05）. Conclusion Salmeterol and fluticasone propionate have certain effect on cardiopulmonary function and 6 min walking distance in patients with severe COPD. It has significant effect on improving right cardiac function,and the safety is better,which is worthy of clinical promotion.