糖皮质激素联合多索茶碱治疗慢阻肺急性加重期的疗效及安全性分析

Efficacy and safety analysis of glucocorticoid combined with doxofylline in the treatment of acute exacerbation of chronic obstructive pulmonary disease

目的探讨糖皮质激素联合多索茶碱在慢性阻塞性肺疾病(慢阻肺)急性加重期患者中的临床疗效和安全性。方法60例慢阻肺急性加重期患者为研究对象,采用简单化随机法分为对照组和观察组,每组30例。对照组患者实施糖皮质激素[注射用甲泼尼龙琥珀酸钠(商品名:米乐松)]治疗,观察组患者在对照组的基础上联用多索茶碱进行治疗。比较两组患者的临床疗效、肺功能指标[呼气峰值流速(PEF)、用力肺活量(FVC)、第1秒用力呼气容积(FEV1)]、临床症状评分、慢阻肺评估测试(CAT)评分、血清炎性因子[白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)]水平及不良反应发生率。结果观察组患者的临床总有效率96.7%明显高于对照组的80.0%,差异具有统计学意义(P<0.05)。治疗后,两组患者的PEF、FEV1、FVC均高于本组治疗前,且观察组患者的PEF(7.12±1.38)L/s、FEV1(2.35±1.33)L、FVC(3.54±1.67)L均高于对照组的(6.32±1.31)L/s、(1.57±1.29)L、(2.15±0.48)L,差异具有统计学意义(P<0.05)。治疗后,两组患者的临床症状评分、CAT评分均低于本组治疗前,且观察组患者的临床症状评分(1.48±0.19)分、CAT评分(9.94±1.62)分均低于对照组的(3.59±0.27)、(15.59±2.38)分,差异具有统计学意义(P<0.05)。治疗后,两组患者的IL-6、TNF-α、IL-8水平均低于本组治疗前,且观察组患者的IL-6(33.32±4.31)ng/L、TNF-α(12.27±2.09)ng/L、IL-8(21.64±3.85)ng/L均低于对照组的(56.92±5.38)、(35.85±4.63)、(38.48±4.69)ng/L,差异具有统计学意义(P<0.05)。两组患者的不良反应发生率比较,差异无统计学意义(P>0.05)。结论糖皮质激素联合多索茶碱在慢阻肺急性加重期患者中的临床效果显著,经药物联合治疗后,患者的临床症状明显好转,肺功能明显改善,血清中炎性指标IL-6、IL-8和TNF-α水平明显降低,且药物不良发生发生率明显降低,具有临床应用价值。

Objective To discuss the clinical efficacy and safety of glucocorticoid combined with doxofylline in the treatment of acute exacerbation of chronic obstructive pulmonary disease.Methods A total of 60 patients with acute exacerbation of chronic obstructive pulmonary disease were divided into the control group and the observation group by simple random method,with 30 cases in each group.The control group was treated with glucocorticoid[methylprednisolone sodium succinate for injection(trade name:Miloxone)],and the observation group was treated with doxofylline on the basis of the control group.Both groups were compared in terms of clinical efficacy,lung function indexes[peak expiratory flow rate(PEF),forced vital capacity(FVC),and forced expiratory volume in one second(FEV1)],clinical symptom score,COPD assessment test(CAT)score,serum levels of inflammatory factors[interleukin-6(IL-6),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α)],and incidence of adverse reactions.Results The total clinical effective rate of 96.7%in the observation group was significantly higher than that of 80.0%in the control group,and the difference was statistically significant(P<0.05).After treatment,PEF,FEV1 and FVC in both groups were higher than those before treatment in this group;the observation group had PEF of(7.12±1.38)L/s,FEV1 of(2.35±1.33)L and FVC of(3.54±1.67)L,which were higher than those of(6.32±1.31)L/s,(1.57±1.29)L and(2.15±0.48)L in the control group;the differences were statistically significant(P<0.05).After treatment,the clinical symptom score and CAT score in both groups were lower than those before treatment in this group;the clinical symptom score of(1.48±0.19)points and CAT score of(9.94±1.62)points in the observation group were lower than those of(3.59±0.27)and(15.59±2.38)points in the control group;the differences were statistically significant(P<0.05).After treatment,the levels of IL-6,TNF-αand IL-8 in both groups were lower than those before treatment in this group;the observation group had IL-6 of(33.32±4.31)ng/L,TNF-αof(12.27±2.09)ng/L and IL-8 of(21.64±3.85)ng/L,which were lower than those of(56.92±5.38),(35.85±4.63)and(38.48±4.69)ng/L in the control group;the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion The clinical effect of glucocorticoid combined with doxofylline in patients with acute exacerbation of chronic obstructive pulmonary disease is significant.After drug combination treatment,the clinical symptoms and lung function of the patients are significantly improved,the levels of serum inflammatory indicators of IL-6,IL-8 and TNF-αare significantly reduced,and the incidence of drug adverse events is significantly reduced,which has clinical application value.