不同剂量维生素D辅助布地奈德福莫特罗吸入粉雾剂联合阿奇霉素治疗慢性阻塞性肺疾病急性加重患者的效果

Curative effect of Budesonide/Formoterol aerosol for inhalation combined with Azithromycin assisted with different doses of vitamin D on patients with acute exacerbation of chronic obstructive pulmonary disease

目的探讨不同剂量维生素D辅助布地奈德福莫特罗吸入粉雾剂联合阿奇霉素治疗慢性阻塞性肺疾病急性加重(AECOPD)患者的效果。方法选取2019年1月至2022年12月九江市第一人民医院收治的84例AECOPD患者作为研究对象,按照随机数字表法将其分为低剂量组和高剂量组,每组各42例。低剂量组采用低剂量维生素D联合布地奈德福莫特罗吸入粉雾剂与阿奇霉素序贯治疗,高剂量组采用高剂量维生素D联合布地奈德福莫特罗吸入粉雾剂与阿奇霉素序贯治疗,均持续治疗8周,记录并比较两组患者的临床疗效、肺功能指标、炎症指标、免疫功能指标、疾病加重率和病死率。结果两组患者的总有效率比较,差异无统计学意义(P>0.05)。治疗前,两组患者的1 s用力呼气容积(FEV_(1))、1 s用力呼气容积占预计值百分比(FEV_(1)%pred)和1 s用力呼气容积占用力肺活量比值(FEV_(1)/FVC)比较,差异无统计学意义(P>0.05);治疗后,两组患者的FEV_(1)大于治疗前,FEV_(1)%pred和FEV_(1)/FVC高于治疗前,且高剂量组患者的FEV_(1)大于低剂量组,FEV_(1)%pred和FEV_(1)/FVC高于低剂量组,差异有统计学意义(P<0.05)。治疗前,两组患者的25羟维生素D(25-OH-D)、C反应蛋白(CRP)、降钙素原(PCT)水平比较,差异无统计学意义(P>0.05);治疗后,两组患者的25-OH-D水平高于治疗前,CRP和PCT水平低于治疗前,且高剂量组患者的25-OH-D水平高于低剂量组,CRP和PCT水平低于低剂量组,差异有统计学意义(P<0.05)。治疗前,两组患者的CD3^(+)、CD4^(+)和CD8^(+)比较,差异无统计学意义(P>0.05);治疗后,两组患者的CD3^(+)、CD4^(+)高于治疗前,CD8^(+)低于治疗前,且高剂量组患者的CD3^(+)、CD4^(+)高于低剂量组,CD8^(+)低于低剂量组,差异有统计学意义(P<0.05)。两组患者的疾病加重率比较,差异无统计学意义(P>0.05)。两组患者的病死率比较,差异无统计学意义(P>0.05)。结论AECOPD患者应用高剂量维生素D联合布地奈德福莫特罗吸入粉雾剂与阿奇霉素序贯治疗可以改善其肺部功能,降低机体炎症状态。

Objective To investigate the curative effect of Budesonide/Formoterol aerosol for inhalation combined with Azithromycin assisted with different doses of vitamin D on patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 84 patients with AECOPD who were admitted to Jiujiang First People's Hospital were enrolled between January 2019 and December 2022.According to random number table method,they were divided into low-dose group and high-dose group,with 42 cases in each group.The low-dose group received sequential treatment with low-dose vitamin D combined with Budesonide/Formoterol aerosol for inhalation and Azithromycin,while the high-dose group received sequential treatment with high-dose vitamin D combined with Budesonide/Formoterol aerosol for inhalation and Azithromycin for 8 weeks.The clinical efficacy,pulmonary function index,inflammatory index,immune function index,disease aggravation rate and fatality rate of the two groups were recorded and compared.Results There was no significant difference in the total effective rate between the two groups(P>0.05).Before treatment,there was no significant difference in forced expiratory volume in 1 second(FEV_(1)),1 s forced expiratory volume as a percentage of predicted value(FEV_(1)%pred)and 1 s forced expiratory volume as a ratio of forced vital capacity(FEV_(1)/FVC)between the two groups(P>0.05).After treatment,FEV_(1) in the two groups was higher than before treatment,FEV_(1)%pred and FEV_(1)/FVC were higher than before treatment,and FEV_(1) in high-dose group was higher than that in low-dose group,and FEV_(1)%pred and FEV_(1)/FVC were higher than those in low-dose group,the differences were statistically significant(P<0.05).Before treatment,there was no significant difference in the levels of 25-hydroxyvitamin D(25-OH-D),C-reactive protein(CRP)and procalcitonin(PCT)between the two groups(P>0.05).After treatment,the 25-OH-D level in the two groups was higher than before treatment,the CRP and PCT levels were lower than before treatment,and the 25-OH-D level in high-dose group was higher than that in low-dose group,and the CRP and PCT levels were lower than those in low-dose group,with statistical significances(P<0.05).Before treatment,there was no significant difference in CD3^(+),CD4^(+)and CD8^(+)between the two groups(P>0.05).After treatment,CD3^(+)and CD4^(+)in two groups were higher than before treatment,and CD8^(+)was lower than before treatment,and CD3^(+)and CD4^(+)in high-dose group were higher than those in low-dose group,and CD8^(+)was lower than that in low-dose group,with statistical significances(P<0.05).There was no significant difference in the rate of disease exacerbation between the two groups(P>0.05).There was no significant difference in mortality between the two groups(P>0.05).Conclusion The sequential treatment of high dose vitamin D combined with Budesonide/Formoterol aerosol for inhalation and Azithromycin can improve the lung function and reduce the inflammatory state of AECOPD patients.