慢性阻塞性肺疾病患者经倍氯米松、福莫特罗和格隆溴铵联合治疗对炎症因子及认知功能的影响

Inflammation and cognitive function in COPD patients treated with beclomethasone,formoterol,and clonium bromide

目的探讨倍氯米松、福莫特罗和格隆溴铵联合治疗慢性阻塞性肺疾病(COPD)的炎症和认知功能。方法前瞻性连续选取2017年1月~2019年12月江南大学附属医院(无锡市第四人民医院)收治的急性加重期COPD患者120例,随机数表法分为研究组(60例)和对照组(60例)。对照组采用福莫特罗和格隆溴铵联合治疗6个月。研究组采用福莫特罗、倍氯米松和格隆溴铵联合治疗6个月。检测比较两组干预前、干预1、3和6个月的1秒用力呼出量(FEV1)、用力肺活量(FVC)等肺功能指标、氧分压(PaO2)、二氧化碳分压(PaCO2)等血气参数、6 min步行距离(6 MWD)、血清肿瘤坏死因子α(TNF-α)、白介素6(IL-6)、C反应蛋白(CRP)等炎症指标水平。采用蒙特利尔认知评估量表(MoCA)评估两组认知功能状况,统计比较两组认知功能障碍(MoCA<26分)发生率,并分析两组炎症指标与认知功能的关系。并统计比较两组患者消化道反应、排尿困难、心血管系统反应等不良反应发生率。结果与对照组比较,研究组干预1、3和6个月的FEV1、FVC、PaO2、6 MWD均升高而PaCO2、血清TNF-α、IL-6、CRP等炎症指标水平均降低(P<0.05)。与同组治疗前比较,研究组干预1、3和6个月FEV1、FVC、PaO2、6 MWD均升高而同期PaCO2、血清TNF-α、IL-6、CRP等炎症指标水平均降低;对照组干预3和6个月FEV1、FVC、PaO2、6MWD均升高而同期PaCO2、血清TNF-α、IL-6、CRP等炎症指标水平均降低,差异有统计学意义(P<0.05)。研究组认知功能障碍发生率为3.33%(2/60),低于对照组的15.00%(9/60),差异有统计学意义(P<0.05)。Pearson相关分析结果显示,两组血清TNF-α、IL-6、CRP等炎症指标水平与其MoCA评分均呈负相关(P<0.05)。研究组和对照组不良反应发生率比较差异无统计学意义(P>0.05)。结论COPD倍氯米松、福莫特罗和格隆溴铵三联治疗可安全有效控制炎症反应,改善肺功能以及认知功能,且其炎症与认知功能状况相关。

Objective To investigate the inflammation and cognitive function in chronic obstructive pulmonary disease(COPD)patients treated with beclomethasone,formoterol,and clonium bromide.Methods 120 patients with acute exacerbation of COPD admitted to our hospital from January 2017 to December 2019 were randomly divided into study group(n=60)and control group(n=60).The control group was treated with formoterol,and clonium bromide for 6 months.The study group was treated with beclomethasone,formoterol,and clonium bromide for 6 months.Before the intervention,1 month after intervention,3 months after intervention and 6 months after intervention lung function indexes such as forced expiratory volume(FEV1),forced vital capacity(FVC),partial pressure of oxygen(PaO2)and partial pressure of carbon dioxide(PaCO2)and other blood gas parameters,6-minute walking distance(6MWD),serum tumor necrosis factor-alpha(TNF-α),interleukin-6(IL-6),and C-reactive protein(CRP)between the two groups were measured and compared.Cognitive function was assessed by Montreal Cognitive Assessment Scale(MoCA),and the cognitive impairment(MoCA<26)rate between the two groups was compared.The relationship between airway inflammation and cognitive function was analyzed.The incidence of adverse reactions such as digestive tract reaction,dysuria,cardiovascular system reaction between the two groups were compared.Results Compared with those of the control group,the 1 month after intervention,3 months after intervention and 6 months after intervention FEV1,FVC,PaO2 and 6MWD in the study group increased,while in the same time PaCO2,serum TNF-α,IL-6 and CRP level in the study group decreased(P<0.05).Compared with those of before treatment,the 1 month after intervention,3 months after intervention and 6 months after intervention FEV1,FVC,PaO2 and 6MWD in the study group increased,while in the same time PaCO2,serum TNF-α,IL-6 and CRP level in the study group decreased;the 3 months after intervention and 6 months after intervention FEV1,FVC,PaO2 and 6MWD in the control group increased,while in the same timePaCO2,serum TNF-α,IL-6 and CRP level in the control group decreased(P<0.05).The cognitive dysfunction rate in the study group was 3.33%(2/60),which was lower than the 15.00%(9/60)in the control group(P<0.05).Pearson correlation analysis showed that serum TNF-α,IL-6 and CRP level in the 2 groups were negatively correlated with the MoCA score(P<0.05).There was no significant difference in the adverse reactions rate between the study group and the control group(P>0.05).Conclusion beclomethasone,formoterol,and clonium bromide combined appling in COPD can effectively and safely control inflammation,improve lung function and cognitive function,and airway inflammation is related to cognitive function.