异丙托溴铵治疗COPD患者前后血清炎症因子水平、肺功能的变化及临床意义

Changes of Serum Inflammatory Cytokines and Pulmonary Function in Patients with COPD Before and After Treatment with Ipratropium Bromide and Its Clinical Significance

目的分析异丙托溴铵治疗COPD患者前后血清炎症因子水平、肺功能的变化及临床意义。方法选择2015年6月至2016年12月于我院就诊的90例COPD患者为研究对象,随机分成观察组、对照组各45例患者。在给予两组患者止咳化痰、吸氧、平喘、抗感染等常规治疗的基础上,对照组只给予常规治疗,观察组在此基础上给予异丙托溴铵辅助治疗。比较两组患者治疗后的临床效果、肺功能指标、血清炎症因子的变化情况。结果观察组经治疗后的总有效率(91.11%)高于对照组患者(68.89%),差异具有统计学意义(P<0.05);治疗后,两组患者肺功能指标FEV1、FVC及FEV1/FVC与治疗前比较有明显提高,观察组患者FEV1、FVC及FEV1/FVC指标均高于对照组,差异有统计学意义(P<0.05);治疗后,两组患者IL-8及TNF-α血清炎症因子出现下降,观察组IL-8及TNF-α低于对照组,差异具有统计学意义(P<0.05);治疗后,两组患者MMP-9和TGF-β出现下降,观察组MMP-9和TGF-β比对照组低,差异具有统计学意义(P<0.05)。治疗3个月内观察组患者发生自发性气胸1例,慢性呼吸衰竭1例,并发症发生率为4.45%;对照组发生自发性气胸3例,慢性呼吸衰竭2例,慢性肺源性心脏病2例,睡眠呼吸障碍1例,发生率为17.78%,二者比较差异具有统计学意义(P<0.05)。结论采用异丙托溴铵辅助治疗COPD的疗效较为显著,可有效缓解患者的相关临床症状和体征,改善肺功能指标,减轻炎症反应,改善预后,具有较高的临床应用价值。

Objective To investigate the changes of serum inflammatory cytokines and pulmonary function in patients with COPD before and after treatment with ipratropium bromide and its clinical significance. Methods 90 patients with COPD from June 2015 to December 2016 were enrolled in this study. Randomized grouping was divided into observation group and control group ,45 cases in each group. The control group were under cough and phlegm, asthma, oxygen, anti- infection and other conventional treatment, and the observation group were on this basis plus ipratropium bromide adjuvant therapy. The clinical effects, symptom score, pulmonary function, serum inflammatory cytokines,MMP-9 and TGF-β were compared between the two groups. Results The total effective rate （91. 11% ）in the observation group was higher than that in the control group （68.89%） ,and the difference was statistically significant（P 〈0.05 ）. After treatment symptoms and signs score in two groups of patients decreased, ; those in the observation group were lower than those in the control group, and the difference was statistically significant （ P 〈 0. 05 ）. After treatment, the pulmonary function indexes FEV1, FVC and FEV1 / FVC in the two groups were significantly improved, and those in the observation group was significantly higher than those in the control group （ P 〈 0.05 ）. After treatment,IL-8 and TNF-α serum inflammatory factors in the two groups decreased, and those in the observation group was significantly lower than those in the control group （P 〈 0.05 ）. After treatment, MMP-9 and TGF-β in the two groups of patients decreased, and those in the observation group was significantly lower than the control group （P 〈 0. 05 ）. Within 3 months of treatment of patients, the observation group had 1 cases with spontaneous pneumothorax and 1 cases with chronic respiratory failure, and the complication rate was 4.45 %. Control group had 3 cases with spontaneous pneumothorax, 2 cases with chronic respiratory failure, 2 cases with chronic pulmonary heart disease and 1 cases of sleep apnea; the incidence rate was 17.78% and there was statistical significance （ P 〈 0.05 ）. Conclusion Ipratropium bromide adjuvant treatment of COPD can effectively improve the symptoms and signs of patients, improve lung function, reduce inflammation, reduce serum MMP-9 and TGF-β patients, and have a high clinical application value.