思力华联合信必可治疗慢性阻塞性肺疾病合并肺心病的效果观察

Effect of Spirva combined with Symbicort in treatment of chronic obstructive pulmonary disease patients complicated with pulmonary heart disease

目的探讨噻托溴铵粉吸入剂(思力华)联合布地奈德福莫特罗粉吸入剂(信必可)治疗慢性阻塞性肺疾病(COPD)合并肺心病的效果。方法选取106例COPD合并肺心病患者,随机分为对照组和观察组,每组53例。对照组采用思力华治疗,观察组采用思力华联合信必可治疗。治疗3个疗程后,评估患者临床疗效、肺功能指标[用力肺活量(FVC)、第1秒最大呼气量(FEV 1)、最大呼气流量(PEF)、肺总量(TLC)]、肺动脉压指标[肺动脉收缩压(PASP)、肺动脉舒张压(PADP)、平均肺动脉压(MPAP)]、炎症因子[肺表面活性物质相关蛋白A(SP-A)、肺部活化调节趋化因子(PARC)、Toll样受体2(TLR2)]、治疗安全性。结果观察组治疗总有效率为90.57%,高于对照组的73.58%,差异有统计学意义(P<0.05)。治疗后,2组患者FVC、FEV 1、PEF、TLC水平均升高,且观察组FVC、FEV 1、PEF、TLC水平均高于对照组,差异有统计学意义(P<0.05)。治疗后,观察组PASP、PADP、MPAP水平均低于对照组,差异有统计学意义(P<0.05)。治疗后,2组炎症因子水平均降低,且观察组SP-A、PARC、TLR2水平均低于对照组,差异有统计学意义(P<0.05)。观察组与对照组不良反应发生率分别为15.09%(8/53)和11.32%(6/53),差异无统计学意义(P>0.05)。结论思力华联合信必可治疗COPD合并肺心病的疗效显著,可改善患者的肺功能,降低患者肺动脉压,抑制炎症因子表达,治疗安全性较好。

Objective To explore the efficacy of Tiotropium Bromide Powder Inhalant(Spirva)combined with Budesonide/Formoterol Powder Inhalant(Symbicort)in the treatment of chronic obstructive pulmonary disease(COPD)patients complicated with pulmonary heart disease.Methods A total of 106 COPD patients complicated with pulmonary heart disease were selected and randomly divided into control group and observation group,with 53 cases in each group.The control group was treated with Spirva,while the observation group was treated with Spirva and Symbicort.After 3 courses of treatment,the clinical efficacy,pulmonary function indicators[forced vital capacity(FVC),forced expiratory volume in the first second(FEV 1),peak expiratory flow(PEF),total lung capacity(TLC)],pulmonary artery pressure indicators[pulmonary artery systolic pressure(PASP),pulmonary artery diastolic pressure(PADP),mean pulmonary artery pressure(MPAP)],inflammatory factors[pulmonary surfactant protein A(SP-A),pulmonary-activating regulated chemokine(PARC),Toll-like receptor 2(TLR2)]and therapeutic safety of the patients were evaluated.Results The total effective rate was 90.57%in the observation group,which was significantly higher than 73.58%in the control group(P<0.05).After treatment,levels of FVC,FEV 1,PEF and TLC increased significantly in both groups,and the levels of FVC,FEV 1,PEF and TLC in the observation group were significantly higher than those in the control group(P<0.05).After treatment,the levels of PASP,PADP and MPAP in the observation group were significantly lower than those in the control group(P<0.05).After treatment,the levels of inflammatory factors in both groups decreased significantly,and the levels of SP-A,PARC and TLR2 in the observation group were significantly lower than those in the control group(P<0.05).The incidence of adverse reactions in the observation group and the control group were 15.09%(8/53)and 11.32%(6/53)respectively,which showed no significant difference between two groups(P>0.05).Conclusion Spirva combined with Symbicort is effective in the treatment of COPD patients complicated with pulmonary heart disease,which can improve lung function,reduce pulmonary artery pressure,suppress the expression of inflammatory factors,and the safety is good.