质子泵抑制剂对高原地区慢阻肺合并胃食管反流患者的疗效观察

Effect of proton pump inhibitors on patients with chronic obstructive pulmonary disease and gastroesophageal reflux in plateau region

目的探讨口服质子泵抑制剂对高原地区慢性阻塞性肺疾病(慢阻肺)合并胃食管反流患者的治疗疗效的观察。方法本研究以西宁市第一人民医院呼吸内科诊治的稳定期C级和D级慢阻肺患者为研究对象,根据胃食管反流病问卷量表(GERDQ量表)问卷测试结果分组,无胃食管反流的患者不给予奥美拉唑(A组,50例),有胃食管反流的患者分为2组,一组给予奥美拉唑口服(B1组,36例),另一组患者不给予奥美拉唑(B2组,38例),3组患者每2月随访1次,共随访6个月。每次随访记录GERDQ量表问卷及慢阻肺评估测试(CAT)问卷、测定肺功能、6分钟步行距离;测定痰液IL-1β、IL-6、IL-8、TNF-α、GM-CSF浓度,记录6月内急性加重次数。结果 B2组患者6月内急性加重次数明显多于A组、B1组,差异有统计学意义(P<0.05)。入组时B1、B2组患者GERDQ问卷评分均明显高于A组(P<0.05),自2月以后的随访期内A组、B1组患者GERDQ问卷评分均明显低于B2组(P<0.05)。随访6个月后,B2组与A组、B1组相比较,CAT评分、FEV_1、6分钟步行距离、痰液IL-1β、IL-6、IL-8、TNF-α、GM-CSF等相关指标之间的差异均有统计学意义(P<0.05),而A组、B1组相比较,上述指标之间的差异均无统计学意义(P>0.05)。结论口服奥美拉唑可能通过减轻胃食管反流、降低痰液IL-1β、IL-6、IL-8、TNF-α、GM-CSF浓度,从而减少慢阻肺急性加重的次数。

Objective To investigate the effect of proton pump inhibitors on patients with chronic obstructive pulmonary disease and gastroesophageal reflux in plateau region. Methods The patients with grade C or D stable phase of COPD were divided into two groups： the group A without gastroesophageal reflux （50 cases） and the group B with gastroesophageal reflux （74 cases） , and the group B were sub-divided into two groups： the group B1 with omeprazole （36 cases） and the group B2 without omeprazole （38 cases）. The 3 groups were followed up 2 months/ time, for 3 times. The GERDQ table and COPD assessment test （CAT） questionnaire, pulmonary function test, 6 minutes walk test, and IL-1β, IL-6, IL-8, TNF-α, GM-CSF in sputum were tested at every follow-up. The times of exacerbation in the 6 months follow-up were also recorded. Results In the 6 months follow-up, the times of exacerbation of the group B2 was statistically more than in the group A and group B1 （ P 〈 0. 05 ）. The GERDQ scores in the group B1 and B2 were significantly higher than in the group A （ P 〈 0. 05 ） . After 2 months, the GERDQ scores of the group B2 were significantly higher than that of the group A and B1 （P 〈 0. 0 5 ） . After 6 months, the CAT scores,forced expiratory volume at first second （ FEV1 ）,6 minutes walk test, IL-1β, IL-6, IL-8, TNF-α and GM-CSF level of the group B2 showed significance with the group A and B1 （ P 〈 0. 05 ）. But the group A and the group B1 showed no statistical difference （P 〉0. 05）. Conclusion Omeprazole may reduce the times of acute exacerba-tion of COPD through alleviating gastroesophageal reflux.