吸入性糖皮质激素联合沙丁胺醇治疗对慢性阻塞性肺疾病患者肺功能的改善作用及对免疫因子的影响

Effects of inhaled Corticosteroids combining Salbutamol Treatment on the Improving Pulmonary Function and Immune Factors of the Patients with Chronic Obstructive Pulmonary Disease

目的观察吸入性糖皮质激素(ICS)联合沙丁胺醇治疗对慢性阻塞性肺疾病(C0PD)患者肺功能的改善作用及对免疫因子的影响。方法选取70例C0PD患者为研究对象,随机分为对照组和观察组(各35例)。对照组给予沙丁胺醇治疗,观察组在对照组基础上联合ICS治疗。比较治疗前及治疗7d后两组患者临床疗效、肺功能及免疫因子INF-γ、IL-6、TNF-α水平变化情况。结果治疗后,两组患者肺功能较治疗前均有明显改善(P<0.05);观察组患者FEV_(1),、FVC及FEV_(1)/FVC分别为(1.42±0.10)L、(1.85±0.18)L和(58.31±7.46)%,显著高于对照组,差异均有统计学意义(P<0.05).两组患者T淋巴细胞CD_(4)^(+)及CD_(4)^(+)/CD_(8)^(+)比值较治疗前显著升高(P<0.05),CD_(8)^(+)比例明显下降。观察组患者T淋巴细胞CD_(4)^(+)、CD_(8)^(+)百分比及CD_(4)^(+)/CD_(8)^(+)比值分别为(32.94±2.05)%、(28.16±1.77)%、(1.41±0.13)%,和对照组比较差异有统计学意义(P<0.05)。两组患者治疗后INF-γ、TNF-α、IL-6水平和治疗前比较均明显降低,且观察组患者免疫炎性因子改善情况显著优于对照组(P<0.05)。观察组患者发生咳痰、气喘和呼吸困难等症状较对照组显著减轻,CAT得分为(6.94±1.64)分,明显低于对照组,差异有统计学意义(P<0.05)。结论氟替卡松联合沙丁胺醇治疗C0PD急性加重期临床效果更显著,能有效改善患者肺功能,通过调节CD_(4)^(+)/CD_(8)^(+)T淋巴细胞失衡降低免疫炎性因子水平促进预后。

Objective To observe the improvement of inhaled corticosteroids(ICS)combined with Salbutamol treatment for lung function of patients with chronic obstructive pulmonary disease(COPD),and to analyze its influence on immune factors.Methods 70 cases of COPD patients in our hospital were selected as the research object,from April 2019 and April 2020,they were randomly divided into control group and observation group(35 cases).The control group was given the Salbutamol treatment,and observation group was jointly treated with ICS+Salbuta-mol therapy on the basis of the control group.Clinical efficacy of two groups of patients,the pulmonary function,immune factors,such as Interferon-γ(INF-γ),Interliukin-6(IL-6)and Tumor necrosis factor-α(TNF-α)level changes were compared with before and after treatment.Results After treatment for 7d compared with the before one,lung function of patients in two groups were obviously improved(P<0.05).FEV,,FVC and FEV_(1)/FVC in patients with observation group were(1.42±0.10)L,(1.85±0.18)and L(58.31±7.46)%Respectively,which were all significantly higher than that in the control group.The difference showed statistical significance(P<0.05).CD_(4)^(+)T lymphocytes and CD_(4)^(+)/CD_(8)^(+)ratio were significantly increased compared to before treatment(P<0.05),and CD_(8)^(+)ratio decreased obviously.CD_(4)^(+),CD8+T lymphocytes percentage and CD_(4)^(+)/CD_(8)^(+)ratio in the observation group were(32.94±2.05)%,(28.16±1.77)%and(1.41±0.13),respectively.The difference was statistically significant compared with that in the control group(P<0.05).INF-γ,IL-6,TNF-αlevels of patients in two groups were significantly decreased after treatment,the improvements were significantly better than that of control group(P<0.05).Meanwhile,symptoms such as cough and expectoration,asthma and dyspnea in observation group were reduced.The CAT score was(6.94±1.64),significantly lower than that in the control group with statistically significant differ-ence(P<0.05).Conclusion Inhaled corticosteroids combined with Salbutamol in the treatment of COPD presents a more significant clinical effect,which can effectively improve the pulmonary function of patients,reduces the level of immune inflammatory factors by regulating CD_(4)^(+)/CD_(8)^(+)T lymphocyte imbalance,and have a beneficial effect for prognosis.