布地奈德联合噻托溴铵在COPD稳定期治疗的疗效观察

Observation of the curative effect of Budesonide combined with tiotropium on the treatment of stable stage of COPD

目的观察布地奈德联合噻托溴铵对慢性阻塞性肺疾病(COPD)稳定期患者的肺功能及慢性炎症的影响。方法将该院2013年3月至2014年3月门诊及住院的160例COPD稳定期患者随机分为A、B、C、D组,各40例;A组患者在既往维持治疗方案上加用布地奈德+噻托溴铵吸入治疗;B组患者采用布地奈德+沙丁胺醇;C组患者采用氨茶碱+噻托溴铵;D组患者按需采用氨茶碱+沙丁胺醇治疗,观察1年,比较两组患者治疗前及治疗后1、3、6个月,1年的肺功能、症状评分和血清中白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、基质金属蛋白酶-9(MMP-9)水平。结果 B组中有1例、D组2例因失联未能连续随访;A组1例未能遵医嘱规律服用药物,退出观察。两组患者治疗后肺功能、COPD评估测试(CAT)症状评分及血清中IL-6、TNF-α、MMP-9水平均较治疗前有所改善;A组患者治疗后上述指标均明显优于B、C、D组,差异均有统计学意义(P<0.05)。结论采用布地奈德联合噻托溴铵吸入治疗COPD稳定期患者能够显著改善患者静态和动态肺充气状况,改善患者症状,控制呼吸道慢性炎症,作为COPD稳定期治疗的一线用药值得推广。

Objective To observe the effect of budesonide combined with tiotropium on pulmonary function and chronic inflammation in patients with chronic obstructive pulmonary disease（COPD）.Methods A total of 160 patients out patien and inpatient in our hospital from March 2013 to March 2014 patients with stable COPD were randomly divided into A,B,C,and D group,40 cases in each group.Group A were maintained in previous treatment with budesonide and tiotropium bromide inhalation treatment,B group were treated with budesonide and salbutamol,C group were treated with aminophylline plus tiotropium and D group with aminophylline salbutamol.Comparison between each group of patients before and after treatment in January,March,June,1 years of lung function,symptom score and serum IL-6,TNF-alpha,MMP-9 levels were performed.Results After treatment,two groups of patients with pulmonary function,symptom score and serum CAT in IL-6,TNF-alpha and MMP-9 levels were better than that before treatment.Budesonide and tiotropium group（A group） were treated after the index was significantly higher than the control group and the other two groups and the difference was statistically significant（P〈0.05）.Conclusion Budesonide-combined with tiotropium bromide inhalation can significantly improve the static and dynamic status of patients with lung inflation and improve symptoms and control of chronic inflammation of respiratory tract in the treatment of patients with stable COPD,as first-line treatment for patients with stable COPD worthy of promotion.