天晴速乐联合信必可吸入治疗哮喘-慢性阻塞性肺疾病重叠综合征对患者FeNO、血清总IgE、气道炎症因子及肺功能的影响

Efficacy of aerosol inhalation of tiotropium and symbicort on FeNO,total IgE in serum,inflammatory factors and lung function in patients with asthma-chronic obstructive pulmonary disease overlap syndrome

目的观察天晴速乐联合信必可吸入治疗哮喘-慢性阻塞性肺疾病重叠综合征(ACOS)对患者呼出气一氧化氮(FeNO)、血清总IgE、气道炎症因子、肺功能等影响。方法回顾性分析2017年1月至2019年3月南阳医学高等专科学校第一附属医院收治的ACOS 124例患者的临床资料,根据治疗方式分为观察组与对照组,每组62例。对照组在常规对症治疗基础上给予信必可吸入治疗,观察组在对照组治疗基础上给予天晴速乐吸入治疗,连续治疗12周。比较两组FeNO、血清总IgE水平、气道相关炎症因子[白三烯B4(LTB4)、白细胞介素-6(IL-6)、髓过氧化物酶(MPO)、8-异前列腺素(8-isoPG)]水平、肺功能指标[第1秒用力呼气容积(FEV1)、用力呼气肺活量(FVC)、FEV1/FVC值]及症状评分[哮喘症状评分(ACT)、慢性阻塞性肺疾病症状评分(CAT)],并监测不良反应发生情况。结果治疗后,两组FeNO及血清总IgE水平低于治疗前(P<0.05),气道炎症因子(LTB4、IL-6、MPO、8-isoPG)水平低于治疗前(P<0.05),肺功能指标(FEV1、FVC、FEV1/FVC)高于治疗前(P<0.05),症状评分中ACT评分高于治疗前、CAT评分低于治疗前(P<0.05),且观察组上述指标降低或升高幅度大于对照组(P<0.05)。观察组不良反应总发生率为22.58%(14/62),与对照组的12.90%(8/62)比较差异未见统计学意义(P>0.05)。结论天晴速乐联合信必可吸入治疗ACOS,较单独应用信必可吸入治疗可更好改善患者变态反应、气道炎症反应、肺功能及症状,且不增加不良反应发生情况。

Objective To observe the efficacy of aerosol inhalation of tiotropium and symbicort on FeNO, total IgE in serum, inflammatory factors and lung function in patients with asthma-chronic obstructive pulmonary disease overlap syndrome(ACOS).Methods The clinical data of 124 ACOS patients admitted to the First Affiliated Hospital of Nanyang Medical College from January 2017 to March 2019 were retrospectively analyzed. According to the treatment methods, the patients were divided into observation group and control group, with 62 cases in each group. Patients in control group was given symbicort inhalation therapy on the basis of conventional symptomatic treatment, and patients in observation group was given tiotropium inhalation therapy on the basis of treatment of control group. All patients were continuously treated for 12 weeks. The (FeNO), serum total IgE, airway-related inflammatory factors, such as leukotriene B4 (LTB4), interleukin-6 (IL-6), myeloperoxidase (MPO), 8-isoprostanes (8-isoPG), lung function indicators, such as forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC value and symptoms scores, such as Asthma Control Test (ACT), chronic obstructive pulmonary disease (COPD) Assessment Test (CAT) were compared between the two groups, and the occurrence of adverse effects was monitored.Results After treatment, the levels of FeNO and serum total IgE in the two groups were significantly lower than those before treatment (P<0.05), while the levels of airway inflammatory factors (LTB4, IL-6, MPO and 8-isoPG) were significantly lower than those before treatment (P<0.05), and the lung function indexes (FEV1, FVC and FEV1/FVC) were significantly higher than those before treatment (P<0.05). The ACT scores in symptoms scores of the two group after treatment were significantly higher than those before treatment, while the CAT scores were significantly lower than those before treatment (P<0.05);and the decreases or increases of the above indicators in observation group were greater than those in control group (P<0.05). The total incidence of adverse effects in observation group (22.58%, 14/62) was not significantly different from that in control group (12.90%, 8/62), P>0.05.Conclusions Compared with symbicort inhalation therap, tiotropium combined with symbicort inhalation therapy for patients with ACOS can improve the allergic reactions, airway inflammatory response, lung function and symptoms without increasing incidence of adverse effects.