布地奈德联合甘露聚糖肽胶囊治疗AECOPD的疗效及对患者免疫功能、氧化应激水平的影响

Effect of budesonide combined with mannan peptide capsule in the treatment of acute exacerbation of chronic obstructive pulmonary disease and its effect on immune function and oxidative stress level of patients

目的观察布地奈德联合甘露聚糖肽胶囊治疗慢性阻塞性肺疾病急性发作期(AECOPD)患者的临床疗效,并探讨其对患者免疫功能、氧化应激水平的影响。方法选取2018年1月至2019年10月期间陕西省第四人民医院收治的120例AECOPD患者,根据随机数表法分为对照组和观察组,每组60例。对照组患者给予布地奈德治疗,给药方式为雾化给药,疗程14 d。观察组患者在对照组治疗的基础上增加口服甘露聚糖肽胶囊,疗程14 d。比较两组患者的治疗效果和安全性,以及治疗前后的肺功能变化[第1秒用力呼气量(FEV1)、呼气高峰流量(PEF)、第1秒用力呼气量/用力肺活量(FEV1/FVC)]、免疫功能变化[外周静血中的T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))、自杀伤细胞(NK)、免疫球蛋白(Ig)及血清炎症因子8(IL-8)]及氧化应激水平[血清超氧化物歧化酶(SOD)活力及丙二醛(MDA)浓度]。结果观察组患者的治疗总有效率为96.7%,明显高于对照组的81.7%,差异有统计学意义(P<0.05);治疗后,观察组和对照组患者的FEV1[(2.69±0.39)L/s vs(2.28±0.89)L/s]、PEF[(2.99±0.78)L·S vs(2.48±0.38)L·S]、FEV1/FVC[(78.19±7.89)%vs(60.49±4.90)%]比较,观察组明显高于对照组,差异均有统计学意义(P<0.05);治疗后,观察组和对照组患者的CD3^(+)[(62.09±2.89)%vs(52.09±3.98)%]、CD4^(+)[(38.01±2.38)%vs(31.08±2.89)%]、NK细胞[(27.12±3.90)%vs(20.01±4.96)%]、CD4^(+)/CD8^(+)[(1.52±0.18)g/L vs(1.11±0.20)g/L]和Ig G[(17.09±1.05)g/L vs(12.01±2.01)g/L]、IgA[(3.21±0.29)g/L vs(2.61±0.19)g/L]、IgM[(1.71±0.10)g/L vs(1.46±0.22)g/L]水平比较,观察组明显高于对照组,差异均有统计学意义(P<0.05);治疗后,观察组和对照组患者的IL-8[(82.23±27.89)ng/mL vs(182.22±61.33)ng/mL]、TNF-α[(16.79±3.47)ng/mL vs(23.19±3.79)ng/mL]比较,观察组明显低于对照组,差异均有统计学意义(P<0.05);治疗后,观察组患者痰液中的MDA为(4.01±0.22)nmol/L,明显低于对照组的(5.01±0.22)nmol/L,SOD为(99.08±6.99)U/mL,明显高于对照组的(78.64±5.01)U/mL,差异均有统计学意义(P<0.05)。结论布地奈德联合甘露聚糖肽胶囊治疗AECOPD患者能明显提高患者的免疫功能,降低其炎症细胞因子和机体氧化应激水平,从而改善患者的肺功能指标,安全有效,值得临床推广应用。

Objective To observe the clinical efficacy of budesonide combined with mannan peptide capsule in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),and to explore the effect of budesonide combined with mannan peptide capsule on the immune function and oxidative stress level of patients.Methods A total of 120 patients with AECOPD admitted in the Fourth Peoples’s Hospital of Shaanxi Province from Jan.2018 to Oct.2019 were divided into control group and observation group according to the random number table,with 60 patients in each group.The patients in the control group were treated with budesonide by atomization.On the basis of the control group,the observation group applied oral mannan peptide capsule additionally.The therapeutic effect and safety of the two groups were evaluated and compared.Before and after treatment,the pulmonary function changes were compared,including forced expiratory volume in 1 second(FEV1),peak expiratory flow(PEF),forced expiratory volume in 1 second/forced vital capacity(FEV1/FVC).The changes of immune function,including T lymphocyte subsets(CD3^(+),CD4^(+),CD4^(+)/CD8^(+)),autokiller cells(NK),immunoglobulin(Ig),serum inflammatory factor 8(IL-8)were compared.Oxidative stress levels were also compared before and after treatment,including serum superoxide dismutase(SOD)activity and malondialdehyde(MDA)concentration in peripheral blood.The immune function and oxidative stress level of the two groups before and after treatment were detected and compared.Results The effective rate of the observation group was 96.7%,which was significantly higher than 81.7%of the control group(P<0.05).The FEV1,PEF,FEV1/FVC in the observation group were significantly higher than those in the control group after treatment(P<0.05):FEV1,(2.69±0.39)L/s vs(2.28±0.89)L/s;PEF,(2.99±0.78)L·S vs(2.48±0.38)L·S;FEV1/FVC,(78.19±7.89)%vs(60.49±4.90)%.The levels of CD3^(+),CD4^(+),NK cell,CD4^(+)/CD8^(+),IgG,IgA,IgM in the observation group were significantly higher than those in the control group after 3 months of treatment(P<0.05):CD3^(+),(62.09±2.89)%vs(52.09±3.98)%;CD4^(+),(38.01±2.38)%vs(31.08±2.89)%;NK cell,(27.12±3.90)%vs(20.01±4.96%);CD4^(+)/CD8^(+),(1.52±0.18)vs(1.11±0.20);Ig G,(17.09±1.05)g/L vs(12.01±2.01)g/L;Ig A,(3.21±0.29)g/L vs(2.61±0.19)g/L;IgM,(1.71±0.10)g/L vs(1.46±0.22)g/L.The levels of IL-8 and TNF-αin the observation group were significantly lower than those in the control group after treatment(P<0.05):IL-8,(82.23±27.89)ng/mL vs(182.22±61.33)ng/mL;TNF-α,(16.79±3.47)ng/mL vs(23.19±3.79)ng/mL.The MDA level of sputum in the observation group was significantly lower than that in the control group:(4.01±0.22)nmol/L vs(5.01±0.22)nmol/L,and SOD was significantly higher than that in the control group:(99.08±6.99)U/mL vs(78.64±5.01)U/mL,with statistically significant differences(P<0.05).Conclusion Budesonide combined with mannan peptide capsule is more safe and effective in the treatment of AECOPD patients.Combined with mannan peptide capsule,it can significantly improve the immune function of patients,reduce the level of inflammatory cytokines and oxidative stress of the body,and thus improve the lung function index of patients,which is worthy of clinical promotion.