糖皮质激素联合胰岛素泵对慢性阻塞性肺疾病急性期合并糖尿病患者临床疗效及炎性指标和肺功能的影响

Effects of Glucocorticoid Combined with Insulin Pump on Inflammatory Markers and Lung Function in Patients with Acute Phase of COPD and DM

目的:回顾性分析糖皮质激素联合胰岛素泵对慢性阻塞性肺疾病(COPD)急性期合并糖尿病(DM)患者的临床疗效及对炎性指标和肺功能的影响。方法:68例COPD急性期合并DM患者随机分为观察组和对照组,各34例。观察组采用甲泼尼松龙、布地奈德联合胰岛素泵治疗,对照组采用甲泼尼松龙、布地奈德联合常规胰岛素餐前注射治疗。比较两组患者治疗后症状改善及血糖控制效果,比较两组治疗前后血清炎性标志物白细胞介素(IL)-10、IL-18、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)及肺功能指标用力肺活量(FVC)、1秒钟用力呼气容积(FEV1)、FEV1/FVC及单位肺泡一氧化碳弥散量(DLCO/VA)水平。结果:观察组患者症状改善和血糖水平控制总有效率及显效率均显著高于对照组(P<0.01)。两组治疗后血清炎性标志物及肺功能多数指标均较治疗前明显改善(P<0.05或P<0.01)。观察组治疗后IL-10及FEV1水平明显高于对照组,IL-18、TNF-α及CRP水平明显低于对照组(P<0.05或P<0.01)。结论:糖皮质激素联合胰岛素泵可有效抑制炎症反应,改善肺功能,有效减少血糖波动,提高COPD急性期合并DM患者临床疗效。

Objective： To observe the clinical effects of glucocorticoid combined with insulin pump in patients with acute phase of chronic obstructive pulmonary disease（COPD） and diabetes mellitus（DM） as well as influence on inflammatory markers and lung function. Method： 68 patients with acute phase of COPD and DM were devided into observation group （n=34） and control group （n=34） at random. The observation group received methylprednisolone and budesonide combined with insulin pump, while control group received methylprednisolone and budesonide combined with routine insulin injection before meals. After treatment, symptom improvement and blood sugar control effect as well as the level of inflammtory marks [interleukin（IL）-10, IL-18, tumor necrosis factor（TNF）-α, C-reactive protein（CRP）]and lung function indexes[forced vital capacity（FVC）, forced expiratory volume in 1 second（FEV1）, FEV1/FVC, unit alveolar carbon monoxide diffusing capacity（DLCO/VA）] of two groups were compared. Results： The total effective rate of symptoms improvement and blood sugar levels control in observation group were markedly higher than that in control group （ P 〈0.01）. After treatment, the level of inflammatory marks and majority lung function indexes of both group were obviously ameliorated. The level of IL-10 and FEV1 in observation group were higher than those in control group while the level of IL-18, TNF-α and CRP were lower than those in control group with significant difference（ P 〈0.05 or P 〈0.01）. Conclusion： Glucocorticoid combined with insulin pump can effectively inhibit inflammation, improve lung function, reduce blood sugar fluctuation and enhance therapeutic effect in patients with acute phase of COPD and DM.