异丙托溴铵治疗慢性阻塞性肺疾病—哮喘重叠综合征患者临床效果及对痰液细胞因子的影响

Effects of ipratropium bromide in treatment of chronic obstructive pulmonary asthma syndrome and its effect on sputum VEGF,ICAM-1,IL-13 and IL-17

目的观察异丙托溴铵治疗慢性阻塞性肺疾病——哮喘重叠综合征的疗效及对痰液血管内皮生长因子(VEGF)、细胞间黏附分子(ICAM-1)、白介素-13(IL-13)、IL-17的影响。方法选取2015年3月—2016年2月四川省德阳市人民医院呼吸内科收治的慢性阻塞性肺疾病—哮喘重叠综合征患者84例作为研究对象,根据患者入院顺序分为2组,每组42例。对照组传统治疗联合布地奈德福莫特罗粉治疗,观察组在对照组治疗基础上加以异丙托溴铵治疗。比较2组患者临床疗效,痰液VEGF、ICAM、IL-13、IL-17等因子,肺通气功能,记录不良反应发生情况。结果治疗后,观察组临床总有效率高于对照组(92.86%vs.73.81%,χ~2=5.485,P=0.019)。治疗后,2组患者痰液VEGF、ICAM-1、IL-13.、IL-17水平降低(P均<0.01),且观察组低于对照组(t=16.544、12.678、13.405、26.290,P=0.000、0.000、0.000、0.000)。治疗后,2组患者肺活量(FVC)、用力呼吸容积占预计值百分比(FEV_1%)、最大呼气中段流量(MMEF)、呼气峰值流速(PEF)水平高于治疗前(P均<0.01),且观察组高于对照组(t=11.178、6.994、10.516、15.511,P=0.000、0.000、0.000、0.000)。2组不良反应发生率比较无显著差异(χ~2=0.064,P>0.05)。结论异丙托溴铵应用于慢性阻塞性肺疾病—哮喘重叠综合征患者中,能有效降低患者痰液VEGF、ICAM-1、IL-13、IL-17水平,改善患者肺通气功能,临床疗效良好,安全性高。

Objective To study the effect of ipratropium bromide in the treatment of chronic obstructive pulmonary asthma syndrome and the effect of sputum vascular endothelial growth factor （VEGF）, intercellular adhesion molecule （ICAM-1）, interleukin 13 （IL-13）, IL-17.Methods From March 2015 to February 2016, 84 patients with chronic obstructive pulmonary asthma syndrome were enrolled from department of respiratory medicine, Deyang people＆#39;s hospital of Sichuan province hospital.According to the order of admission, the patients were divided into observation group and control group, 42 cases in each group.The control group was treated with conventional treatment combination of budesonide dermotam powder inhalation, and the observation group was treated with ipratropium bromide on the basis of the control group.The clinical effects, levels of VEGF, ICAM-1, IL-13, IL-17, lung function and adverse effects were compared between the two groups.Results After treatment, the total effective rate of the observation group was significantly higher than that of the control group[92.86% vs.73.81%,χ2=5.485, P =0.019].The levels of VEGF, ICAM-1, IL-13 and IL-17 in the sputum of the observation group were significantly lower than those in the control group[（56.32±5.15）ng/L,（101.34±9.43）μg/L,（66.21±6.24）ng/L,（16.98±1.43）ng/L vs.（78.98±7.23） ng/L,（135.21±14.52）μg/L,（87.59±8.24）ng/L,（32.13±3.45）ng/L, t =16.544, t =12.678, t =13.405, t =26.290, P =0.000, P =0.000, P =0.000, P =0.000].The observation group with vital capacity （FVC）, the percentage of forced respiration volume （FEV1%）, the maximum expiratory flow （MMEF） and the peak expiratory flow velocity （PEF） were higher than those in the control group[（3.32±0.37） L, （74.21±7.43）%, （169.18±18.76） L/min, （253.32±23.65） L/min vs.（2.53±0.27） L, （63.76±6.21）%, （131.43±13.76） L/min, （181.56±18.43） L/min, t =11.178, t =6.994, t =10.516, t =15.511, P =0.000, P =0.000, P =0.000, P =0.000].There was no significant difference in the adverse reaction rate between the two groups （26.19% vs 23.81%,χ2=0.064, P 〉0.05）.Conclusion Ipratropium bromide in patients with chronic obstructive pulmonary asthma overlap syndrome, which can decrease the levels of VEGF, ICAM-1, IL-13 and IL-17, which can improve the pulmonary ventilation function of patients with good clinical efficacy and high safety.