布地奈德福莫特罗联合孟鲁司特治疗哮喘-慢阻肺重叠综合征患者的效果分析

Effect analysis of budesonide formoterol combined with montelukast in the treatment of asthma-chronic obstructive pulmonary overlap syndrome

目的探讨布地奈德福莫特罗联合孟鲁司特治疗哮喘-慢阻肺重叠综合征(athma-chronic obstructive pulmonary overlap syndrome,ACOS)对炎症因子及血管内皮功能的影响。方法选取2019年1月至2022年1月浙江大学附属邵逸夫医院龙游分院呼吸科门诊治疗的ACOS患者70例,采用随机数字表法分为两组,每组各35例。对照组患者予布地奈德福莫特罗1吸/次,2次/d,干预组患者在对照组基础上加孟鲁司特,两组均连续用药12周,比较两组患者治疗前后血气指标[动脉氧分压(arterial partial pressure of oxygen,PaO_(2))、动脉二氧化碳分压(arterial carbon dioxide,PaCO_(2))和血氧饱和度(blood oxygen saturation,SpO_(2))]、血清炎症因子[血清超敏C反应蛋白(high-sensitivity c-reactive protein,hs-CRP)和肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)]和血管内皮功能[血栓调节蛋白(thrombomodulin,TM)和血管假血友病因子(von willebrand factor,vWF)]指标,并评估其临床疗效。结果治疗12周后,两组患者PaO_(2)和SpO_(2)较治疗前明显上升,PaCO_(2)较治疗前明显下降(P<0.05),且干预组患者变化幅度较对照组更明显;两组患者血清hs-CRP、TNF-α和TM水平较治疗前明显下降,血清vWF水平较治疗前明显上升(P<0.05),且干预组患者变化幅度较对照组更明显(P<0.05);同时干预组患者临床总有效率(94.29%)明显高于对照组(77.14%),差异有统计学意义(χ^(2)=4.201,P<0.05)。结论布地奈德福莫特罗联合孟鲁司特治疗ACOS患者的疗效确切,能明显改善患者的血气指标,其作用机制可能与其能控制炎症反应和改善血管内皮功能紊乱,减轻气道损伤有关。

Objective To investigate the effect of budesonide formoterol combined with montelukast in the treatment of asthma-chronic obstructive pulmonary overlap syndrome(ACOS)on inflammatory factors and vascular endothelial function.Methods A total of 70 patients with ACOS who were treated in Department of Respiratory in Affiliated to Zhejiang University from January 2019 to January 2022 were selected and divided into two groups by random number table,35 cases in each group.The control group was given budesonide formoterol 1 inhalation/time,2times/d.The intervention group was given montelukast on the basis of the control group,both groups were treated for 12weeks.The blood gas indexes[arterial partial pressure of oxygen(PaO_(2)),arterial carbon dioxide(PaCO_(2))and blood oxygen saturation(SpO_(2))],serum inflammatory factors[serum high-sensitivity C-reactive protein(hs-CRP)and tumor necrosis factor-α(TNF-α)]and vascular endothelial function[thrombomodulin(TM)and von Willebrand factor(vWF)]indicators were compared between the two groups before and after treatment,and clinical efficacies were evaluated.Results After 12 weeks of treatment,PaO_(2) and SpO_(2) in two groups increased significantly,PaCO_(2) decreased significantly(P<0.05),and the change range in intervention group was more obvious.The levels of serum hs-CRP,TNF-α and TM in two groups were significantly lower than before,and the level of serum vWF was significantly higher than before(P<0.05 or P<0.01),and the changes in intervention group were more obvious(P<0.05).At the same time,the total clinical effective rate(94.29%)in intervention group was better than that in control group(77.14%),and the difference was statistically significant(χ^(2)=4.201,P<0.05).Conclusion Budesonide formoterol combined with montelukast has definite curative effect in the treatment of ACOS patients,and can significantly improve blood gas indexes,and its mechanism of action may be related to its ability to control inflammatory response,improve vascular endothelial dysfunction,and reduce airway damage.