噻托溴铵对COPD急性加重期肺部感染患者气道重塑情况及JAK/STAT通路蛋白的影响

Effect of Tiotropium Bromide on Airway Remodeling and JAK/STAT Pathway Protein in Patients with Acute Exacerbation of COPD with Pulmonary Infection

研究噻托溴铵对慢性阻塞性肺疾病(COPD)急性加重期肺部感染患者气道重塑情况及Janus激酶(JAK)/信号转导及转录活化因子(STAT)通路蛋白的影响。将2022年1月至2023年1月医院收治的268例COPD急性加重期肺部感染患者分为进行常规治疗的常规组(134例)和联合噻托溴铵进行治疗的噻托溴铵组(134例),分组方法为随机抽签法,两组均治疗1个月。统计两组治疗1个月后的临床疗效、症状消失时间及治疗期间不良反应发生情况,比较两组治疗前和治疗1个月后JAK/STAT通路蛋白、炎症指标、感染严重程度、免疫功能、血气指标及气道重塑指标。治疗1个月后,噻托溴铵组总有效率高于常规组(P<0.05)。噻托溴铵组咳嗽、发热、肺部啰音消失时间均短于常规组(P<0.05)。两组治疗1个月后血清Janus激酶1(JAK1)、信号转导及转录活化因子1(STAT1)、Janus激酶2(JAK2)、信号转导及转录活化因子2(STAT2)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)、白介素-8(IL-8)、可溶性细胞间黏附分子1(sICAM-1)、超敏C反应蛋白(hs-CRP)、外周血白细胞(WBC)、外周血CD8^(+)水平及临床肺部感染(CPIS)评分、二氧化碳分压(PaCO_(2))、气管管壁厚度与外径比值(T/D)、气道壁面积占气道总横截面面积比(WA)与治疗前比较均降低,噻托溴铵组低于常规组(P<0.05);外周血CD3^(+)、CD4^(+)水平、CD4^(+)/CD8^(+)、氧合指数、氧分压(PaO_(2))与治疗前比较均升高,噻托溴铵组高于常规组(P<0.05)。治疗期间,噻托溴铵组总不良反应发生率与常规组比较,差异无统计学意义(P>0.05)。噻托溴铵可调节COPD急性加重期肺部感染患者JAK/STAT通路蛋白水平,降低其机体炎症反应,改善患者机体免疫功能及血气指标,缓解其气道重塑,有助于促进患者临床症状消失,具有较好的治疗效果,同时不会增加不良反应的发生,安全性良好。

To study the effects of tiotropium bromide on airway remodeling and Janus kinase(JAK)/signal transducer and activator of transcription(STAT)pathway protein in patients with acute exacerbation of chronic obstructive pulmonary disease(COPD),from January 2022 to January 2023,268 patients with acute exacerbation of COPD pulmonary infection admitted to the hospital were divided into a conventional group(134 cases)receiving conventional treatment and a combination of tiotropium bromide group(134 cases)receiving treatment with tiotropium bromide.The grouping method was random drawing,and both groups were treated for 1 month.The clinical efficacy after 1 month of treatment,symptom disappearance time and adverse reactions of the two groups were counted,and the JAK/STAT pathway protein,inflammation index,infection severity,immune function,blood gas index and airway remodeling index were compared between the two groups before and after 1 month of treatment.After 1 month of treatment,the total effective rate of the tiotropium bromide group was higher than that of the conventional group(P<0.05).The disappearance time of cough,fever and lung rales in the tiotropium bromide group was shorter than that in the conventional group(P<0.05).After 1 month of treatment,levels of serum Janus kinase 1(JAK1),signal transduction and transcription activating factor 1(STAT1),Janus kinase 2(JAK2),signal transduction and transcription activating factor 2(STAT2),procalcitonin(PCT),and tumor necrosis factor-α(TNF-α),interleukin-8(IL-8),soluble intercellular adhesion molecule-1(sICAM-1),hypersensitive C-reactive protein(hs-CRP),peripheral blood leukocytes(WBC),peripheral blood CD8^(+),score of clinical pulmonary infection score(CPIS),partial pressure of carbon dioxide(PaCO_(2)),tracheal wall thickness to outer diameter ratio(T/D),and airway wall area to total cross-sectional area ratio(WA)in the two groups decreased compared to before treatment,and the tiotropium bromide group was lower than the conventional group(P<0.05).The levels of peripheral blood CD3^(+),CD4^(+),CD4^(+)/CD8^(+),oxygenation index,and partial pressure of oxygen(PaO_(2))increased compared to before treatment,and the tiotropium bromide group was higher than the conventional group(P<0.05).During the treatment period,there was no statistically significant difference in the total incidence of adverse reactions between the tiotropium bromide group and the conventional group(P>0.05).Tiotropium bromide could regulate the protein level of JAK/STAT pathway in COPD patients with acute exacerbation of pulmonary infection,reduce their inflammatory reaction,improve their immune function and blood gas index,and relieve their airway remodeling,which was helpful to promote the disappearance of clinical symptoms,with good therapeutic effect and good safety.