阿法骨化醇对慢性阻塞性肺疾病患者肺功能、CAT评分、6min步行距离的影响

Effects of Alfacalcidol soft capsules on lung function,CAT score and 6-minute walking distance in patients with chronic obstructive pulmonary disease

目的:探讨口服阿法骨化醇软胶囊对慢性阻塞性肺疾病(COPD)患者肺功能、CAT评分、6 min步行距离的影响。方法:本研究以240例存在骨量减少(骨密度T值为-2.5~-1.0)的C、D级COPD患者为研究对象,按照随机数字表法分为对照组(A组)、阿法骨化醇组(B组)、阿法骨化醇联合碳酸钙组(C组)(每组均为80例患者)。3组患者均随访1年,随访期间3组患者每天均常规吸入噻托溴铵,B组每天加服阿法骨化醇,C组每天加服阿法骨化醇及碳酸钙。患者入组时、随访第6个月及第12个月均测定患者的骨密度、肺功能、CAT评分、6 min步行距离,比较3组患者不同时间点各观察指标的差异,计算骨密度与肺功能、CAT评分、6 min步行距离之间的相关性。结果:3组患者入院时骨密度、FEV1/FVC、FEV1%、CAT评分、6 min步行距离等指标之间的差异均无统计学意义(均P>0.05)。3组患者在随访6、12个月时,B、C组骨密度、FEV1/FVC、FEV1%、6 min步行距离均明显高于A组、而CAT评分明显低于A组(均P<0.05)。各组内之间比较,A组患者随访12个月时骨密度、FEV1/FVC、FEV1%、6 min步行距离均明显低于入院时、而CAT评分明显高于入院时(均P<0.05)。B、C两组患者随访12个月时骨密度、FEV1/FVC、FEV1%、6 min步行距离均明显高于入院时、而CAT评分明显低于入院时(均P<0.05)。A、B、C 3组患者入院时、随访6、12个月时骨密度均与FEV1/FVC、FEV1%、6 min步行距离呈正相关(均P<0.05),与CAT评分呈负相关(均P<0.05)。结论:阿法骨化醇可以增加COPD患者的骨密度、改善肺功能、降低CAT评分、增加6 min步行距离。

Objective:To investigate the effects of Alfacalcidol on lung function,CAT score and 6-minute walking distance in patients with chronic obstructive pulmonary disease(COPD).Methods:In this study,240 patients with Grade C and D COPD with reduced bone mass[bone mineral density(BMD)T value ranging from-2.5 to-1.0]were randomly divided into control group(group A),Alfacalcidol soft capsules group(group B),Alfacalcidol soft capsules combined with calcium carbonate group(group C)(80 patients in each group)according to random number table.All patients in the 3 groups were followed up for 1 year.During the follow-up period,all patients in the 3 groups were routinely inhaled tiotropium bromide every day,group B was given Alfacalcidol soft capsules daily,and group C was given Alfacalcidol soft capsules and calcium carbonate daily.BMD,lung function,CAT score and 6-minute walking distance were measured at the time of enrollment,and at the 6th and 12th month of follow-up.The differences of observation indexes at different time points in the 3 groups were compared,and the correlation between BMD and lung function,CAT score and 6-minute walking distance was calculated.Results:There were no significant differences in BMD,FEV1/FVC,FEV1%,CAT score and 6-minute walking distance among 3 groups at admission(all P>0.05).After 6 and 12 months of follow-up,BMD,FEV1/FVC,FEV1%and 6-minute walking distance in groups B and C were significantly higher than those in group A,while CAT score was significantly lower than that in group A(all P<0.05).Within each group BMD,FEV1/FVC,FEV1%and 6-minute walking distance in group A were significantly lower than those at admission at 12 months follow-up,while CAT score was significantly higher than that at admission(all P<0.05).BMD,FEV1/FVC,FEV1%and 6-minute walking distance in group B and C were significantly higher than those at admission at 12 months follow-up,while CAT score was significantly lower than that at admission(all P<0.05).The BMD of group A,B and C was positively correlated with FEV1/FVC,FEV1%and 6-minute walking distance at admission,6 months'follow-up and 12 months'follow-up(all P<0.05),and negatively correlated with CAT score(P<0.05).Conclusion:Alfacalcidol increases BMD,improves lung function,reduces CAT score,and increases 6-minute walking distance in patients with COPD.