沙美特罗氟替卡松对急性加重期COPD患者骨代谢以及气道重塑的影响分析

The analysis of the influence of inhaled salmeterol fluticason in both bone metabolism and airway remodeling in patients with acute COPD

目的探讨沙美特罗氟替卡松对急性加重期慢性阻塞性肺疾病(COPD)患者骨代谢及气道重塑的影响。方法对2013年1月至2015年1月住院治疗的急性加重期COPD患者130例进行回顾性研究,分为两组:观察组(常规治疗基础上加用沙美特罗氟替卡松)和对照组(常规治疗)。测定并比较两组患者血清碱性磷酸酶(ALP)、骨钙素(BGP)、钙与肌酐比值(Ca/Cr)、甲状旁腺素(PTH)、睾酮(T)、BODE指数、基质金属蛋白酶9(MMP-9)以及炎症转化生长因子β(TGF-β)和血清肿瘤坏死因子α(TNF-α)。结果观察组与对照组Ca/Cr、PTH、T在治疗前后比较差异均无统计学意义(P>0.05);治疗前两组患者骨形成指标ALP、BGP比较差异无统计学意义(P>0.05),观察组治疗后ALP、BGP含量显著高于其治疗前和对照组治疗后ALP、BGP含量(P<0.05)。对照组BODE指数各单项FEV1%、6MWD、MMRC得分及BODE指数治疗前后差异均无统计学意义(P>0.05);观察组治疗前后BMI指标差异无统计学意义(P>0.05),观察组治疗后FEV1%、6MWD显著高于治疗前,MMRC、BODE指数显著低于治疗前(P<0.05);观察组治疗后FEV1%、6MWD、BMI显著高于对照组治疗后,MMRC、BODE指数显著低于对照组治疗后(P<0.05)。观察组治疗后TGF-β、TNF-α、MMP-9指标显著低于对照组(P<0.05);对照组治疗前后MMP-9指标无显著差异(P>0.05),观察组和对照组患者治疗后TGF-β、TNF-α指标以及观察组治疗前MMP-9指标显著低于治疗前(P<0.05)。结论应用沙美特罗氟替卡松治疗急性加重期COPD患者易出现骨质疏松,需适当控制血药浓度,补充钙、磷元素,对气道炎症有较好的作用,能够有效改善患者气道重塑,并能够有效影响患者预后,值得推广应用。

Objective To investigate the influence of the effect of inhaled salmeterol fluticason on acute COPD patients on bone metabolism and airway remodeling.Methods 130 cases with acute COPD in January 2013 to 2015 years January in our hospital were included into the present study.The present investigate was a retrospective study.All cases of present study were divided into two groups： observation group（conventional therapy plus uses inhaled salmeterol fluticason） and control group（conventional therapy）,with determination of two groups of patients with ALP, BGP, calcium, PTH, t, BODE index, MMP-9, TGF-β, TNF-α.Results There was no significant difference in gender, age and course of disease between the two groups.Bone absorption index Ca/Cr, PTH and T to maintain bone mass index, the difference before and after treatment in the observation group and the control group had no statistical significance （P〉0.05）.There was no significant difference between the two groups before treatment （P〉0.05） in bone formation index ALP and BGP.The ALP, BGP content difference of observation group after treatment did not have statistical significance （P〈0.05）.The each individual score and BODE index BODE index of treatment group before and after had no statistical significance （P〉0.05）.The differences of BMI index in the observation group were not statistically significant, the differences were statistically significant （P〈0.05）.The airway inflammation in two groups of patients were not statistically significance （P〉0.05）.The TGF-beta, TNF-alpha index in each group before and after treatment were statistically significant （P〈0.05）.Conclusion Inhaled salmeterol fluticason treated acute COPD patients may result in osteoporosis.This method should be properly controlled blood drug concentration, supplement of calcium and phosphorus elements, there is proper effect on airway inflammation.This method can effectively improve the patients with airway remodeling, and can effectively influence the prognosis of the patients.It is worthy of popularization and application.