比较固定剂量和递减剂量的ICS联合LABA吸入治疗对慢性阻塞性肺疾病患者生活质量的影响

Comparison on the effect between fixed dosage and step-down dosage of ICS combined with LABA on quality of life in patients with chronic obstructive pulmonary disease

目的探究采用固定剂量与递减剂量吸入性糖皮质激素(ICS)联合长效β2受体激动剂(LABA)的治疗方案对慢性阻塞性肺疾病(COPD)患者生活质量的影响。方法回顾性选取2016年3月至2017年3月同济大学附属同济医院收治的70例COPD患者作为研究对象进行分析,按照治疗方案的不同,将患者分为对照组和观察组,每组各35例。对照组患者采用吸入固定剂量的ICS联合LABA进行治疗,观察组患者采用吸入递减剂量的ICS联合LABA进行治疗。对比两组患者的治疗效果(治疗12周前后咳痰、气喘、咳嗽的变化,急性加重的次数,肺功能变化,中性粒细胞和巨噬细胞占比变化,以及细胞因子IL-6、IL-8和TNF-α水平),以及治疗前及治疗后12周、1年、2年患者的不良反应发生情况。结果与治疗前相比,治疗后两组患者的咳、痰、喘等症状均出现了显著好转(P<0.05),但是两组之间比较差异无统计学意义(P>0.05)。观察组患者发生的急性加重次数为(2.46±0.74)次,显著高于对照组的(1.32±0.68)次(P<0.05)。治疗12周后,两组患者的第一秒时间肺活量水平(FEV1)、第一秒时间肺活量/用力肺活量(FEV1/FVC)以及慢性阻塞性肺疾病评分(CAT)较治疗前均有显著升高(P<0.05);组间比较,治疗后的FEV1水平、FEV1/FVC水平差异并无统计学意义(P>0.05);观察组患者的平均CAT评分略高,但与对照组相比,差异并无统计学意义(P>0.05)。两组患者经过治疗后,中性粒细胞与巨噬细胞均发生了显著降低(P<0.05),而组间比较发现,差异并无统计学意义(P>0.05);白细胞介素-6(IL-6)、白细胞介素-8(IL-8)和肿瘤坏死因子-α(TNF-α)均发生了显著降低(P<0.05),而组间比较发现,差异并无统计学意义(P>0.05)。观察组患者治疗12周时发生肺炎2例;随访1年时发生结核病1例,肾上腺抑制1例;随访2年时发生白内障1例;并发症发生率为14.29%(5/35)。对照组患者治疗12周时发生肺炎2例,口咽念珠菌病1例;随访1年时发生结核病1例,肾上腺抑制1例,骨质疏松1例;随访2年时发生骨质疏松1例,白内障1例;并发症发生率为22.86%(8/35),显著高于观察组(P<0.05)。结论采取递减剂量的ICS联合LABA治疗COPD患者的临床疗效与固定剂量治疗所产生的疗效相近,长远来看,递减剂量治疗可有效降低ICS治疗过程中带来的不良反应,相较而言,递减剂量的ICS联合LABA治疗后,COPD患者的生活质量更高,值得临床参考。

Objective To explore the effect of combined application of inhaled corticosteroid(ICS)combined with long-acting beta-agonist LABA with a fixed dosage or a step-down dosage on the quality of life of patients with COPD(chronic obstructive pulmonary disease).Methods Retrospectively selected 70 patients with COPD admitted to this hospital during March 2016 to March 2017 as study subjects.According to different treatment methods,35 patients in control group and observation group were included.Patients in control group were treated with fixed dosage of ICS combined with LABA.Patients in observation group were treated by ICS and LABA with step-down dosages.In comparison with therapeutic effect of patients in these two groups(clinical coughing,asthma,changes in coughing,number of acute exacerbation,changes in lung function,changes in number of neutrophils and macrophages,and cytokine IL-6 levels,before and after 12 weeks of treatment).The levels of IL-8 and TNF-α,as well as the incidence of adverse reactions in patients before and in 12 weeks,1 year,and 2 years after the treatment.Results After treatment,coughing,asthma,and chronic coughing in patients were significantly decreased in these two groups(P<0.05),but there was no significant statistical difference between these two groups(P>0.05).The acute exacerbation occurred in patients of observation group.The frequency was(2.46±0.74)times,which were significantly higher than those of control group(P<0.05).After 12 weeks of treatment,the forced expiratory volume in one second(FEV1),Forced expiratory volume in one second/forced expiratory volume in one second,(FEV1/FVC)and COPD Assessment Test scores(CAT scores)of these two groups were significantly increased(P<0.05).There was no significant difference in FEV1 levels and FEV1/FVC levels among these groups after treatment;the mean CAT scores were slightly higher in observation group,but there was no significant difference compared with those of control group(P>0.05).After treatment,the levels of neutrophils and macrophages were significantly decreased in both groups(P<0.05),but there was no significant difference between these two groups(P>0.05).There was significant decrease in levels of IL-6,IL-8 and TNF-αin both groups after treatment(P<0.05),but there was no significant difference between these two groups(P>0.05).In observation group,2 patients developed pneumonia in 12 weeks of treatment,and tuberculosis occurred in 1 year follow-up period,1 case with adrenal suppression,cataract occurred in 1 case in 2 years follow-up period,and the complication rate was 14.29%(5/35).In control group,pneumonia occurred in 2 cases in 12 weeks of treatment,1 case with oropharyngeal candidiasis during the follow-up period,tuberculosis occurred in 1 case in 1 year later,1 case with adrenal suppression,1 case with osteoporosis,and 1 case with cataract occurred in 2 years of follow-up period,the complication rate was 22.86%(8/35),it was significantly higher than that of patients in observation group(P<0.05).Conclusion The clinical efficacy of ICS combined with LABA in treatment of patients with COPD is similar to that of fixed-dosage therapy.In long term,step-down dosage of ICS combined with LABA therapy can effectively reduce the side effects caused by ICS treatment.The quality of life of COPD patients after step-down dosage therapy is raised,hence it is worthy to be applied for clinical reference.