噻托溴铵联合布地奈德治疗哮喘-慢性阻塞性肺疾病重叠综合征疗效观察

Effect of tiotropium bromide combined with budesonide in the treatment of asthma-chronic obstructive pulmonary disease overlap syndrome

目的探讨噻托溴铵联合布地奈德治疗哮喘-慢性阻塞性肺疾病重叠综合征(ACOS)的临床效果。方法选择2016年11月至2018年11月首都医科大学大兴教学医院收治的100例ACOS患者为研究对象,根据治疗方法将患者分为观察组(n=51)和对照组(n=49)。2组患者均给予止咳、抗感染等常规治疗,在常规治疗基础上,对照组患者给予噻托溴铵治疗,观察组患者给予噻托溴铵和布地奈德联合治疗。分别于治疗前及治疗后,应用呼出气一氧化氮(FeNO)测定系统检测FeNO水平;使用肺功能检测仪检查患者肺功能,包括用力肺活量(FVC)、第1秒用力呼气容积(FEV 1)、FEV 1/FVC;应用慢性梗阻性肺疾病评估测试(CAT)评分和哮喘控制测试(ACT)评分评估患者病情;应用心率变异分析仪检查患者心率变异性(HRV),包括全部窦性心搏间期的标准差(SDNN)、全部相邻窦性心搏间期差值的均方根(RMSSD)、相邻窦性心搏间期的差值大于50 ms的心搏数占总心搏数的百分比(PNN50);采用酶联免疫吸附法检测血清内皮素-1(ET-1)水平。治疗后评估2组患者临床疗效,并观察2组患者治疗期间不良反应发生情况。结果治疗前2组患者FeNO、血清ET-1水平比较差异无统计学意义(P>0.05),2组患者治疗后FeNO、血清ET-1水平显著低于治疗前(P<0.05);治疗后,观察组患者FeNO、血清ET-1水平显著低于对照组(P<0.05)。治疗前2组患者FVC、FEV 1、FEV 1/FVC比较差异无统计学意义(P>0.05),2组患者治疗后FVC、FEV 1、FEV 1/FVC显著大于治疗前(P<0.05);治疗后,观察组患者FVC、FEV 1、FEV 1/FVC显著大于对照组(P<0.05)。治疗前2组患者CAT评分、ACT评分比较差异无统计学意义(P>0.05);与治疗前比较,2组患者治疗后CAT评分显著降低,ACT评分显著升高(P<0.05);治疗后,观察组患者CAT评分显著低于对照组,ACT评分显著高于对照组(P<0.05)。治疗前2组患者SDNN、RMSSD、PNN50比较差异无统计学意义(P>0.05),2组患者治疗后SDNN、RMSSD、PNN50显著高于治疗前(P<0.05);治疗后,观察组患者SDNN、RMSSD、PNN50显著高于对照组(P<0.05)。观察组和对照组患者治疗总有效率分别为92.16%(47/51)、77.55%(38/49),观察组患者治疗总有效率显著高于对照组(χ2=4.181,P<0.05)。观察组和对照组患者不良反应发生率分别为13.73%(7/51)、16.33%(8/49),2组患者不良反应发生率比较差异无统计学意义(χ2=0.133,P>0.05)。结论噻托溴铵联合布地奈德可以显著减轻ACOS患者的临床症状,改善肺功能。

Objective To investigate the clinical effect of tiotropium bromide combined with budesonide in the treatment of asthma-chronic obstructive pulmonary disease overlap syndrome(ACOS).Methods A total of 100 patients with ACOS admitted to Daxing Teaching Hospital of Capital Medical University from November 2016 to November 2018 were selected as the research subjects,and the patients were divided into observation group(n=51)and control group(n=49)according to the treatment methods.The patients in the two groups were given cough relieving,anti-infection and other conventional treatment.On the basis of conventional treatment,the patients in the control group were treated with tiotropium bromide,and the patients in the observation group were treated with tiotropium bromide combined with budesonide.Before and after treatment,the fractional exhaled nitric oxide(FeNO)level was detected by FeNO measuring system;the pulmonary function was measured by pulmonary function detector,including forced vital capacity(FVC),forced expiratory volume in one second(FEV 1)and FEV 1/FVC;the pathogenetic condition of patients was evaluated by chronic obstructive pulmonary disease assessment test(CAT)and asthma control test(ACT);the heart rate variability(HRV)was measured by heart rate variability analyzer,including the standard deviation of NN intervals(SDNN),the root mean square of successive differences in adjacent NN intervals(RMSSD)of all adjacent sinus intervals,and the percent of the number whose difference between adjacent NN interval more than 50 ms(pNN50);the level of serum endothelin-1(ET-1)was detected by enzyme-linked immunosorbent assay.The clinical efficacy of patients in the two groups was evaluated after treatment,and the adverse reactions of patients in the two groups were observed.Results There was no significant difference in the levels of FeNO and serum ET-1 between the two groups before treatment(P>0.05).The levels of FeNO and serum ET-1 after treatment were significantly lower than those before treatment in the two groups(P<0.05).The levels of FeNO and serum ET-1 in the observation group were significantly lower than those in the control group after treatment(P<0.05).There was no significant difference in the FVC,FEV 1 and FEV 1/FVC between the two groups before treatment(P>0.05).The FVC,FEV 1 and FEV 1/FVC of patients after treatment were significantly higher than those before treatment in the two groups(P<0.05).The FVC,FEV 1 and FEV 1/FVC in the observation group were significantly higher than those in the control group after treatment(P<0.05).There was no significant difference in the CAT score and ACT score between the two groups before treatment(P>0.05).Compared with before treatment,the CAT score decreased significantly,and the ACT score increased significantly in the two groups after treatment(P<0.05).After treatment,the CAT score in the observation group was significantly lower than that in the control group,and the ACT score in the observation group was significantly higher than that in the control group(P<0.05).There was no significant difference in the SDNN,RMSSD and PNN50 between the two groups before treatment(P>0.05).The SDNN,RMSSD and PNN50 of patients in the two groups after treatment were significantly higher than those before treatment(P<0.05).The SDNN,RMSSD and pNN50 in the observation group were significantly higher than those in the control group after treatment(P<0.05).The total effective rate in the observation group and the control group was 92.16%(47/51)and 77.55%(38/49),respectively.The total effective rate in the observation group was significantly higher than that in the control group(χ2=4.181,P<0.05).The incidence of adverse reactions in the observation group and the control group was 13.73%(7/51)and 16.33%(8/49),respectively.There was no significant difference in the incidence of adverse reactions between the two groups(χ2=0.133,P>0.05).Conclusion Tiotropium bromide combined with budesonide can significantly reduce the clinical symptoms and improve lung function in patients with ACOS.