小剂量阿奇霉素联合噻托溴铵粉吸入剂治疗稳定期COPD临床可行性分析及对炎症细胞因子的影响

目的：研究小剂量阿奇霉素联合噻托溴铵粉吸入剂治疗稳定期 COPD 临床可行性分析及对炎症细胞因子的影响。方法选取2014年3月至2016年3月在我院进行治疗的100例稳定期COPD 患者,根据治疗方案的不同将患者随机分为噻托溴铵单药组(A 组)50例,阿奇霉素联合噻托溴铵组(B 组)50例。另选择同期健康体验者50名为正常对照组(NS 组)提供血液样本。按照2013版 COPD 诊疗指南,在常规治疗的基础上,A 组给予噻托溴铵粉吸入剂吸入治疗,B 组给予阿奇霉素口服联合噻托溴铵粉吸入剂吸入治疗。治疗1年后观察各组急性加重住院次数和治疗前后的肺功能、呼吸困难评分和 C 反应蛋白等指标的变化,并分别于治疗前和治疗后12、24、48 h 取各组患者血清进行酶联免疫吸附测定试验(enzyme linked immunosorbent assay,ELISA)检测患者血液中炎症细胞因子 PTX3、肿瘤坏死因子α(TNF-α)、干扰素-γ(IFN-γ)、IL-2、IL-6的含量并与 NS 组进行对比。结果各组患者的不良反应较轻,差异无统计学意义(P >0.05)；与 A 组比较,B 组1年后发作频率、FEV1%、FEV1/FVC 相对较低,差异具有统计学意义(P <0.05)；C 反应蛋白和呼吸困难评分 B 组改善高于 A 组,组间比较差异有统计学意义(P <0.05)；与 NS 组相比,A、B 组患者 TNF-α、PTX3明显增高,差异有统计学意义(P <0.05)；A 组治疗后12、24、48 h 的炎症细胞因子 TNF-α、PTX3与治疗前相比,差异无统计学意义(P >0.05),B 组治疗后 TNF-α和 PTX3逐渐降低并恢复至正常值,差异有统计学意义(P <0.01)；其他炎症细胞因子虽有稍微降低,但是差异无统计学意义(P >0.05)。结论服用小剂量阿奇霉素联合噻托溴铵粉吸入剂治疗可以改善稳定期 COPD 患者的肺功能和活动耐力,提高生活质量,减少急性发作频率,其机制可能与其能够降低血液中的 PTX3、TNF-α含量有关。

Low-dose azithromycin combine with tiotropium powder inhalants therapy of stable chronic obstructive pulmonary disease clinical feasibility analysis and impact of inflammatory cytokine

Abstract ] Objective To research low-dose azithromycin combine with tiotropium powder inhalants therapy of stable COPD clinical feasibility analysis and impact of inflammatory cytokine. Methods 100 patients from March 2014 to March 201 6 in our hospital with stable COPD and 50 volunteers (NS group) were selected.100 patients were randomly divided into tiotropium group (A group) and combined treatment group (B group),A group were given tiotropium bromide inhalation powder therapy and B group received azithromycin oral plus tiotropium inhalation powder therapyon in the basis of routine treatment.Observe the frequency of acute exacerbation of hospitalization,pulmonary function,an C-reactive protein indicators after one year,A group and B group patients were enzyme linked immunosorbent assay(ELISA) to detect the expression of patient′s blood cytokine PTX3,TNF-α,IFN-γ, IL-2,IL-6 after the treatment of 12,24,48 h,which were compared with NS group.Results Adverse reactions in each group of patients with mild,which had no significant difference (P >0.05);Compared with A group,B group aseizure frequency,lung function and inflammatory indicators showed statistically significant difference(P < 0.05);Dyspnea score and C-reactive protein was less than A group (P <0.05).Compared with NS group,the expression of PTX3,TNF-α was relatively lower and was statistically significant(P <0.05),Compared with before the treatment,A group of TNF-α,PTX3 was sustain higher and is no statistically significant difference(P >0.05) in 12,24,48 h.B group of TNF-α, PTX3 was sustain lower and was statistically significant difference (P < 0.01) in 12,24,48 h;Other inflammatory factors was slightly lower,but the difference was not statistically significant (P >0.05). Conclusions Low-dose of azithromycin combine with tiotropium powder inhalation therapy can improve lung function in patients with stable COPD and endurance activities to improve the quality of life and reduce the frequency of acute attacks,the expression of the blood PTX3,TNF-αis relatively more lower.