茚达特罗/格隆溴铵与沙美特罗/氟替卡松治疗慢性阻塞性肺疾病的临床疗效对比研究

Clinical efficacy of indacaterol/glycopyrronium versus salmeterol/fluticasone in the treatment of chronic obstructive pulmonary disease

目的观察茚达特罗/格隆溴铵(IND/GLY)和沙美特罗/氟替卡松(SFC)对中重度慢性阻塞性肺疾病(COPD)患者肺功能、血气指标及血清炎症因子水平的影响。方法将120例中重度COPD患者采用随机数字表法分为实验组和对照组,每组60例。所有患者入组后均给予常规治疗,实验组在常规治疗基础上给予IND/GLY治疗,对照组在常规治疗基础上给予SFC治疗。2组患者均连续治疗3个月,比较治疗前后各组治疗有效率、肺功能、血气指标、血清炎症因子水平以及不良反应发生率。结果治疗后,实验组治疗总有效率为91.67%,高于对照组的75.00%,差异有统计学意义(P<0.05)。治疗后,实验组和对照组的肺功能指标第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)和第1秒用力呼气量与用力肺活量的比值(FEV_(1)/FVC)均高于治疗前,且实验组各项肺功能指标改善情况优于对照组,差异有统计学意义(P<0.05)。治疗后,实验组和对照组的动脉血氧分压[p_(a)(O_(2))]、动脉血二氧化碳分压[p_(a)(CO_(2))]和动脉血氧饱和度(SaO_(2))与治疗前比较均改善,且实验组各项血气指标改善情况优于对照组,差异有统计学意义(P<0.05)。治疗后,实验组和对照组白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、超敏C反应蛋白(hs-CRP)和肿瘤坏死因子-α(TNF-α)水平均低于治疗前,且实验组以上血清炎症因子水平均低于对照组,差异有统计学意义(P<0.05)。随访期间,实验组药物不良反应发生率为20.00%,与对照组的21.67%比较,差异无统计学意义(P>0.05)。结论与SFC比较,IND/GLY能显著改善中重度COPD患者的肺功能、血气指标及血清炎症因子水平。本研究能够给临床医生为COPD患者选择个体化药物治疗方案提供参考。

Objective To observe the effects of indacaterol/glycopyrronium(IND/GLY)versus salmeterol/fluticasone(SFC)on pulmonary function,blood gas indexes and serum levels of inflammatory factors in patients with moderate to severe chronic obstructive pulmonary disease(COPD).Methods A total of 120 patients with moderate to severe COPD were randomly divided into experimental group and control group using a random number table method,with 60 patients in each group.All the patients were given usual care after enrollment,the experimental group received IND/GLY treatment on the basis of routine treatment,and the control group received SFC treatment on the basis of routine treatment.All the patients in the two groups were continuously treated for 3 months.The response rate,pulmonary function,blood gas indexes,serum levels of inflammatory factors and incidence of adverse reactions were compared between the two groups before and after treatment.Results After treatment,the total effective rate of the experimental group was 91.67%,which was higher than 75.00%of the control group,and the difference was statistically significant(P<0.05).After treatment,the first-second forced expiratory volume(FEV_(1)),forced vital capacity(FVC)and the ratio of forced expiratory volume to forced vital capacity(FEV_(1)/FVC)of the experimental group and the control group were all higher than before treatment,and the improvement of various pulmonary function indicators of the experimental group was better than that of the control group(P<0.05).After treatment,the partial pressure of arterial blood oxygen[p_(a)(O_(2))],partial pressure of arterial blood carbon dioxide[p_(a)(CO_(2))]and arterial blood oxygen saturation(SaO_(2))of the experimental group and the control group were all improved compared with before treatment,and the improvement of various blood gas indexes of the experimental group was better than that of the control group(P<0.05).After treatment,the levels of interleukin-6(IL-6),interleukin-8(IL-8),hypersensitive C-reactive protein(hs-CRP)and tumor necrosis factor-α(TNF-α)in the experimental group and the control group were lower than before treatment,and the levels of serum inflammatory factors in the experimental group were lower than those in the control group(P<0.05).During the follow-up period,the incidence of adverse drug reactions in the experimental group was 20.00%,which showed no difference when compared with 21.67%in the control group(P>0.05).Conclusion Compared with SFC,IND/GLY can significantly improve pulmonary function,blood gas indexes and serum inflammatory factors levels in patients with moderate to severe COPD.This study can provide references for clinicians for selection of individual drugs for treatment in patients with COPD.