慢性阻塞性肺疾病合并肺结核吸入糖皮质激素治疗的安全性研究

目的:观察合并肺结核的慢性阻塞性肺疾病(cOPD)患者吸入糖皮质激素(Ics)治疗的疗效及是否会导致肺结核复发或恶化。方法:将COPD并肺结核患者100例随机分为治疗组与对照组各50例。两组均予抗痨治疗,治疗组给予沙美特罗/氟替卡松(50/250μg)吸入,2次/日,对照组则予口服班布特罗胶囊10 mg,1次/日。比较两组治疗前、治疗后3月、6月、9月及12月的外周血T细胞亚群,治疗前后的肺功能及在观察期间的入院次数和住院时间。结果:治疗组平均住院人次及平均时间均低于对照组(P0.05);治疗组FEV1治疗后较治疗前明显改善且试验结束时高于对照组(P0.05);两组间及同组间治疗前后T细胞亚群均无显著差异;两组均未出现结核复发或恶化。结论:COPD并肺结核患者在规范抗痨治疗的基础上应用ICS并未增加结核复发或恶化风险,且可改善肺功能并减少入院率及平均住院时间;应用ICS对外周血T细胞亚群无明显影响。

Study on Safety of Inhaled Corticosteriod in Chronic Obstructive Pulmonary Disease complicated with Pulmonary Tuberculosis

Objective： To observe the effect and whether it will lead to tuberculosis recurrence or deterioration of patients with chronic obstructive pulmonary disease （COPD） complicated with pulmonary tuberculosis treated by inhaled corticosteriod （ICS）. Methods： 100 patients with COPD complicated with pulmonary tuberculosis were randomly divided into treatment group and control group, and each group was 50 cases. The treatment group was given Salmeterol/fluticasone （50/250 μg） inhalation of 2 times/day, the control group was given oral Bambuterol Capsule 10 mg,1 times/day based on the treatment of anti tuberculosis. The number of readmissions and hospitalization time were compared between the two groups during the observation period. The pulmonary function was compared between the two groups before and after the treatment 12 months. The peripheral blood T cell subsets were compared between the two groups before the treatment and after the treatment 3, 6, 9 and 12 months. Results： The average times of inhospital and hospitalization duration in the treatment group during the observation period were significantly lower than those in the control group （P〈0.05）.FEV1 was significantly improved after treatment compared with before treatment in treatment group and was significantly higher than that in the control group at the end of the test（P〈0.05）. T lymphocyte subsets were not significantly different between the two groups before and after treatment. The tuberculosis was no recurrence or deterioration between the two groups. Conclusion： Anti tuberculosis treatment in patients with COPD complicated with pulmonary tuberculosis in the standard application of ICS did not increase the risk of tuberculosis recurrence or deterioration, and can improve lung function and reduce the admission rate and the average hospitalization time, and application of ICS on peripheral blood T cell subsets had no obvious effect.