不同剂量甲泼尼龙治疗老年AECOPD的疗效及其对炎症因子水平的影响比较

Comparison of the Curative Effects of Different Doses of Methylprednisolone in the Treatment of Elderly Patients with AECOPD and Its Influence on the Serum Inflammatory Factors Levels

目的:观察和比较不同剂量甲泼尼龙治疗老年慢性阻塞性肺疾病急性加重(AECOPD)的疗效及其对炎症因子的影响。方法:选取2014年1月到2017年1月收治的114例老年AECOPD患者,随机将患者分为A组、B组和C组各38例。A组采用甲泼尼龙40 mg/d静脉推注,B组采用甲泼尼龙80 mg/d静脉推注,C组不使用甲泼尼龙。对比三组患者的临床疗效以及治疗前后的改良版英国医学研究委员会呼吸问卷(mMRC)评分、动脉血氧分压(PaO_2)、动脉二氧化碳分压(PaCO_2)、下去白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)以及C反应蛋白(CRP)水平的变化。结果:治疗后,A组的总有效率为89.47%,B组的总有效率为92.11%,均显著高于C组(均P<0.05)。A组和B组治疗后的mMRC评分、PaCO_2水平均显著低于C组,而PaO_2水平显著高于C组(均P<0.05);B组治疗后的m MRC评分、PaCO_2均显著低于A组,而PaO_2显著高于A组(均P<0.05);A组和B组治疗后的血清IL-6、IL-8、TNF-α以及CRP水平均显著低于C组(均P<0.05);B组治疗后的血清IL-6、IL-8、TNF-α、CRP水平均显著低于A组(均P<0.05)。三组患者不良反应发生率的对比差异均无统计学意义(均P>0.05)。结论:与40 mg/d甲泼尼龙相比,短期80 mg/d甲泼尼龙静脉推注可更显著减轻AECOPD患者的炎症反应,提高临床疗效,同时具有良好的安全性。

Objective： To observe and compare the curative effects of different doses of methylprednisolone in the treatment of elderly patients with AECOPD and the influence on the serum inflammatory factors levels. Methods： 114 cases of elderly patients with AECOPD were selected from January 2014 to January 2017 and randomly divided into group A, group B and group C, 38 in each group.Group A was treated with methylprednisolone 40 mg/d intravenous injection. Group B was treated with methylprednisolone 80 mg/d intravenous injection. Group C was treated without methylprednisolone. The curative effects were compared among the three groups. The changes of mMRC, PaO_2 and PaCO_2, serum IL-6, IL-8, TNF-α, and CRP levels were compared among the three groups before and after treatment. Results： The total efficiency of group A was 89.47 %, the total effective rate of group B was 92.11 %, which were significantly higher than that of group C（P〈0.05）. After treatment, the mMRC scores and PaCO_2 of group A and group B were significantly lower than those of Group C, while the PaO_2 were significantly higher than that of group C（P〈0.05）. After treatment, the m MRC score and PaCO_2 of group B were significantly lower than that of group A, and PaO_2 was significantly higher than that of group A（P〈0.05）. After treatment,the levels of IL-6, IL-8, TNF-α and CRP of group A and group B were significantly lower than those of group C（P〈0.05）. After treatment, the levels of IL-6, IL-8, TNF-α and CRP of group B were significantly lower than those of group A（P〈0.05）. Conclusion：Short-term intravenous injection with 80 mg/d methylprednisolone could more significantly reduce the inflammation in patients with AECOPD than 40 mg/d methylprednisolone, improve the clinical efficacy, and had good safety.