吸入激素联合噻托溴铵治疗哮喘-慢性阻塞性肺疾病重叠综合征的效果及对血清炎症因子水平的影响

Effect of inhaled steroid combined with tiotropium on asthma-chronic obstructive pulmonary disease overlap syndrome and its effect on serum inflammatory factor levels

目的探讨吸入激素联合噻托溴铵治疗哮喘-慢性阻塞性肺疾病重叠综合征的效果及对血清炎症因子水平的改善作用。方法前瞻性选取2016年10月至2018年9月徐州医科大学附属医院收治的哮喘-慢性阻塞性肺疾病重叠综合征患者80例,随机将患者平均分为观察组和对照组,每组各40例。对照组患者选择布地奈德激素喷雾吸入治疗(每日早晚各1次,300μg/次,4周为1个疗程,持续3疗程),观察组患者在对照组治疗的基础上增加噻托溴铵喷雾吸入治疗(每日1次,18μg/次,4周为1个疗程,持续3疗程)。对比两组患者的临床疗效、TNF-α水平、IL-6水平、肺功能指标以及症状评分。结果观察组患者治疗显效率(62.5%vs.35.0%)以及总有效率(95.0%vs.77.5%)均明显高于对照组(P<0.05);治疗后的用力肺活量(FVC)(1.97±0.23 L vs.1.54±0.22 L)、第1秒用力呼气容积(EFV1)(2.34±0.31 L vs.1.87±0.24 L)、第1秒用力呼气容积与用力肺活量比值(FEV1/FVC)(68.49±6.84 vs.54.31±6.25)%均明显高于对照组(P<0.05),呼出一氧化氮(Fe NO)(18.17±10.13 ppb vs.25.94±15.38 ppb)明显低于对照组(P<0.05);观察组患者治疗后的IL-6(11.34±3.57 ng/ml vs.18.95±5.23 ng/ml)、TNF-α(15.15±3.61 ng/ml vs.20.14±11.37 ng/ml)均明显低于对照组(P<0.05)。观察组患者治疗后慢性阻塞性肺疾病症状评分(CAT)(16.44±2.71分vs.21.35±3.25分)均明显低于治疗前以及对照组(P<0.05),哮喘症状评分(ACT)(22.63±3.18分vs.16.94±2.53分)均明显高于治疗前以及对照组(P<0.05)。结论吸入激素联合噻托溴铵治疗哮喘-慢性阻塞性肺疾病重叠综合征的临床疗效值得肯定,对于患者呼吸功能改善有良好的作用,同时还可以降低炎症因子水平,是一种值得推广的治疗方案。

Objective To investigate the effect of inhaled steroid combined with tiotropium on asthma-chronic obstructive pulmonary disease overlap syndrome and the improvement of serum inflammatory factor levels.Methods A prospective study was conducted to select 80 patients with asthma-chronic obstructive pulmonary disease overlap syndrome admitted to the Affiliated Hospital of Xuzhou Medical University from October 2016 to September 2018.The patients were equally divided into observation groups according to a simplified randomized grouping method.The control group consisted of 40 patients in each group.Patients in the control group were treated with budesonide spray inhalation(1 day in the morning and evening,300μg/time,4 weeks for 1 course,3 courses).The patients in the observation group were given tiotropium bromide on the basis of the control group.Spray inhalation therapy included once a day,18μg/time,4 weeks for 1 course,for 3 courses.The clinical efficacy,TNF-αlevel,IL-6 level,lung function index and symptom score between the two groups were compared.Results The effective rate of treatment(62.5%vs.35.0%)and total effective rate(95.0%vs.77.5%)were significantly higher in the observation group than in the control group(P<0.05).The forced vital capacity(FVC)after treatment(1.97±0.23 vs.1.54±0.22)L,forced expiratory volume in the first second(EFV1)(2.34±0.31 vs.1.87±0.24)L,forced expiratory volume in the first second and forced vital capacity ratio(FEV1/FVC)(68.49±6.84 vs.54.31±6.25)%was significantly higher than the control group(P<0.05),exhaled nitric oxide(Fe NO)(18.17±10.13 vs.25.94±15.38)ppb was significantly lower than the control group(P<0.05);observed group of patients after treatment IL-6(11.34±3.57 vs.18.95±5.23)ng/ml and TNF-α(15.15±3.61 vs.20.14±11.37)ng/ml were significantly lower than those of the control group(P<0.05).Patients in the observation group had a significantly lower score of symptom score(CAT)(16.44±2.71 vs.21.35±3.25)after treatment than before treatment and control group(P<0.05).The asthma symptom score(ACT)was(22.63±3.18),which was significantly higher than those before treatment and the control group(16.94±2.53)(P<0.05).Conclusion The clinical efficacy of inhaled hormone combined with Tiotropium bromide in the treatment of asthma-copd overlap syndrome is worthy of affirmation,and it has a good effect on the improvement of respiratory function in patients,and can also reduce inflammatory factors,so it is a treatment scheme worthy of promotion.