补肺活血胶囊联合布地奈德福莫特罗及噻托溴铵治疗慢性阻塞性肺疾病稳定期的临床效果研究

目的 探索补肺活血胶囊联合布地奈德福莫特罗及噻托溴铵治疗慢性阻塞性肺疾病(COPD)稳定期患者的临床效果研究.方法 回顾性分析87例慢性阻塞性肺疾病稳定期患者临床资料,将所有患者根据治疗方法不同分为对照组(43例)和实验组(44例).对照组采用采取布地奈德福莫特罗联合噻托溴铵治疗,实验组在对照组的基础上结合补肺活血胶囊...     

桉柠蒎肠溶软胶囊联合多索茶碱治疗慢性阻塞性肺疾病急性发作的临床研究

目的探讨桉柠蒎肠溶软胶囊联合多索茶碱治疗慢性阻塞性肺疾病急性发作的临床效果。方法选取2017年1月—2018年6月濮阳市安阳地区医院收治的慢性阻塞性肺疾病急性发作患者108例,随机分成对照组(54例)和治疗组(54例)。对照组静脉滴注多索茶碱注射液,0.2 g加入100 mL葡萄糖液,1次/d。治疗组在对照组基础上餐前0.5 h口服桉柠蒎肠溶软胶囊,1粒/次,3次/d。两组患者连续治疗10 d。观察两组患者临床疗效,同时比较治疗前后两组患者主要症状体征缓解时间、肺功能、血气分析指标及呼出气冷凝液中白三烯B4(LTB4)、白介素-6(IL-6)浓度和血清C反应蛋白(CRP)水平。结果治疗后,对照组和治疗组临床总有效率分别为85.2%和96.3%,两组比较差异具有统计学意义(P0.05)。治疗后,治疗组患者咳嗽、咳痰、气短、肺部哮鸣音的缓解时间较对照组患者均显著缩短(P0.05)。治疗后,两组患者第1秒用力呼气容积占预计值百分比(FEV1%pred)、FEV1/用力肺活量(FVC)、每分钟最大通气量占预计值百分比(MVV%pred)和动脉血氧分压(pO_2)值显著升高(P0.05),动脉二氧化碳分压(pCO_2)值显著降低(P0.05),且治疗组患者这些肺功能和血气分析指标明显好于对照组(P0.05)。治疗后,两组呼出气冷凝液中LTB4、IL-6水平及血清CRP浓度显著下降(P0.05),且治疗组患者这些肺功能和血气分析指标明显低于对照组(P0.05)。结论桉柠蒎肠溶软胶囊联合多索茶碱治疗慢性阻塞性肺疾病急性发作可明显缓解患者症状,改善肺功能和动脉血气状态,且患者耐受性良好。     

Rapid Enhancement of Glutamatergic Neurotransmission in Bipolar Depression Following Treatment with Riluzole

Glutamatergic abnormalities may underlie bipolar disorder (BD). The glutamate-modulating drug riluzole may be efficacious in bipolar depression, but few in vivo studies have examined its effect on glutamatergic neurotransmission. We conducted an exploratory study of the effect of riluzole on brain glutamine/glutamate (Gln/Glu) ratios and levels of N-acetylaspartate (NAA). We administered open-label riluzole 100–200 mg daily for 6 weeks to 14 patients with bipolar depression and obtained imaging data from 8-cm³ voxels in the anterior cingulate cortex (ACC) and parieto-occipital cortex (POC) at baseline, day 2, and week 6 of treatment, using two-dimensional J-resolved proton magnetic resonance spectroscopy at 4 T. Imaging data were analyzed using the spectral-fitting package, LCModel; statistical analysis used random effects mixed models. Riluzole significantly reduced Hamilton Depression Rating Scale (HAM-D) scores (d=3.4; p<0.001). Gln/Glu ratios increased significantly by day 2 of riluzole treatment (Cohen''s d=1.2; p=0.023). NAA levels increased significantly from baseline to week 6 (d=1.2; p=0.035). Reduction in HAM-D scores was positively associated with increases in NAA from baseline to week 6 in the ACC (d=1.4; p=0.053), but was negatively associated in the POC (d=9.6; p<0.001). Riluzole seems to rapidly increase Gln/Glu ratios—suggesting increased glutamate–glutamine cycling, which may subsequently enhance neuronal plasticity and reduce depressive symptoms. Further investigation of the Gln/Glu ratio as a possible early biomarker of response to glutamate-modulating therapies is warranted.     

A Controlled Clinical Trial of A Novel Antivenom in Patients Envenomed by Bungarus multicinctus

In northern Vietnam, a majority of severely envenomed patients are bitten by Bungarus multicinctus. Hitherto, these victims have received supportive care only. The aims of this study were to assess the possible efficacy and side effects of a new antivenom. This trial (ClinicalTrials.gov Identifier: {"type":"clinical-trial","attrs":{"text":"NCT00811239","term_id":"NCT00811239"}}NCT00811239) was performed during 2004–2006 at an ICU in Hanoi. For ethical reasons, the study was not randomized. All patients who fulfilled the inclusion criteria during 2004–2005 were prospectively enrolled, carefully recorded, and treated with optimal supportive therapy (control group). The patients who entered the study 2006 were treated with antivenom in addition to supportive care (antivenom group). The inclusion criteria were: envenomation by B. multicinctus, presence of systemic envenomation, and (during 2006) provision of written informed consent. Predefined endpoints were number of patients requiring mechanical ventilation, duration of mechanical ventilation, length of ICU stay, duration of muscle paralysis, and number of patients with ventilator-associated pneumonia. Eighty-one patients were included, 54 during 2004–2005 and 27 during 2006. Baseline characteristics were similar in the groups. The antivenom-group patients had a shorter duration of muscle paralysis of the limbs (p < 0.001), of the diaphragm (p < 0.001), and of ptosis (p < 0.001). The duration of mechanical ventilation and length of ICU stay were shorter in the antivenom group (p < 0.001). The rate of ventilator-associated pneumonia was lower in the antivenom group (p < 0.02). However, the relative number of patients requiring mechanical ventilation was not reduced in the antivenom group. The rate of adverse reactions to the antivenom was 7.4%. A favorable efficacy and acceptable safety of this antivenom were demonstrated.     

盐酸氨溴索治疗慢性阻塞性肺疾病急性加重期的临床研究

目的：探讨雾化吸入盐酸氨溴索辅助治疗急性加重期慢性阻塞性肺疾病的临床效果。方法选取2011-2013年本院收治的55例急性加重期慢性阻塞性肺疾病患者,按不同治疗方案分为对照组和试验组,对照组给予常规治疗,试验组在常规治疗的基础上给予雾化吸入盐酸氨溴索,比较两组患者治疗效果及治疗前后的第一秒末用力呼气容积（FEV1）和FEV1/用力肺活量（FVC）。结果试验组患者治疗总有效率为93.10%（27/29）,高于对照组的65.38%（17/26）,差异有统计学意义（ P﹤0.05）。治疗后试验组患者FEV1、FEV1/FVC高于对照组,差异有统计学意义（ P﹤0.05）。结论在急性加重期慢性阻塞性肺疾病患者的常规对症治疗中在联合盐酸氨溴索雾化吸入,能明显提高治疗效果,改善患者肺功能指标。     

疏风解毒胶囊联合特布他林治疗慢性阻塞性肺疾病急性加重期的临床研究

目的探讨慢性阻塞性肺疾病急性加重期应用疏风解毒胶囊联合硫酸特布他林雾化液治疗的临床效果。方法选取2017年1月-2018年12月北京市大兴区中西医结合医院收治的309例慢性阻塞性肺疾病急性加重期患者,采取随机数字表法将其随机分成对照组(n=154)和治疗组(n=155)。对照组雾化吸入硫酸特布他林雾化液(5 mg/次,3次/d),治疗组在此基础上口服疏风解毒胶囊(2.08 g/次,3次/d),所有患者均治疗14 d。比较两组临床疗效及主要症状、体征的缓解时间。治疗前后,使用改良版英国医学研究委员会呼吸问卷(m MRC)评估两组患者呼吸困难的严重程度,采用慢性阻塞性肺疾病患者自我评估测试问卷(CAT)对受试者综合症状进行评价,常规测定肺功能参数[第1秒用力呼气容积(FEV1)与用力肺活量(FVC)比值(FEV1/FVC)、FEV1占预计值百分比(FEV1占预计值%)]及呼出气一氧化氮(FeNO)浓度,分别选用酶联免疫法、免疫透射比浊法检测血清白介素(IL)-8、C反应蛋白(CRP)水平,再利用流式细胞仪测定外周血辅助性T细胞(Th)1、Th2占CD^4+T细胞的比例。并统计两组药物不良事件发生情况。结果治疗组总有效率为95.5%,显著高于对照组(86.4%),两组比较差异有统计学意义(P<0.05)。治疗组主要症状(咳嗽、咳痰、喘息)及肺部哮鸣音的缓解时间较对照组均显著缩短(P<0.05)。两组治疗后m MRC、CAT评分均显著低于治疗前(P<0.05),而FEV1/FVC、FEV1占预计值%值均显著更高(P<0.05);且治疗后,治疗组以上问卷评分及肺功能指标的改善效果较对照组同期均更显著(P<0.05)。与治疗前对比,两组治疗后FeNO浓度及血清IL-8、CRP水平和外周血Th1、Th2细胞比例均显著降低(P<0.05);但治疗组上述指标的改善效果均更显著(P<0.05)。对照组和治疗组的不良反应发生率分别是2.6%、3.2%,两组比较差异无统计学意义。结论疏风解毒胶囊联合特布他林治疗慢性阻塞性肺疾病急性加重期的整体疗效确切,可迅速稳定患者病情,缓解气流受限,减轻气道炎症与系统性炎症,抑制免疫过激,具有一定的临床推广应用价值。     

布地奈德联合沙丁胺醇雾化吸入治疗慢性阻塞性肺疾病急性加重期的研究

目的研究布地奈德联合沙丁胺醇雾化吸入治疗慢性阻塞性肺疾病急性加重期的疗效。方法观察组22例慢性阻塞性肺疾病急性加重期患者吸入布地奈德混悬液和沙丁胺醇气雾剂治疗5天,与对照组20例吸入沙丁胺醇气雾剂治疗5天进行对比,观察第1秒用力呼气容积(FEV1)占预计值百分比(FEV1%)和FEV1与用力肺活量比值(FEV1/FVC),以及空腹血糖、电解质等变化情况。结果观察组治疗前后比较FEV1%与FEV1/FVC:FEV1%与FEV1/FVC均明显升高,差异有显著性意义(P<0.01);对照组治疗前后比较,FEV1%与FEV1/FVC均有明显上升(P<0.01),治疗组的改善情况优于对照组;两组空腹血糖、电解质未发生明显变化。结论沙丁胺醇联合布地奈德可降低气道阻力,改善肺通气功能,提高其抗炎活性,临床效果确切,吸入治疗不良反应小,给药方便,值得推广。     

布地奈德/福莫特罗粉吸入剂治疗AECOPD的疗效分析

目的观察布地奈德/福莫特罗粉吸入剂治疗慢性阻塞性肺疾病急性加重期（AECOPD）的效果。方法 98例AECOPD住院患者,随机分为两组,对照组49例给予常规治疗,治疗组49例给予常规治疗的同时,吸入布地奈德/福莫特罗粉吸入剂,每日2次。对比治疗后患者第一秒用力呼气容积（FEV1）占预计值百分比（FEV1%）、第一秒用力呼气容积与用力肺活量比值（FEV1/FVC）及圣乔治呼吸问卷（SGRQ）分值的变化。结果 FEV1、FEV1%、FEV1/FVC与呼吸问卷分值比较,治疗组治疗后比较治疗前明显升高,差异有统计学意义（P〈0.05）;对照组治疗后比较治疗前亦均有明显升高（P〈0.05）,但对照组的改善情况不如治疗组（P〈0.05）。结论布地奈德/福莫特罗粉吸入疗法对AECOPD疗效肯定,可改善肺功能并提高生活质量,可作为治疗AECOPD的有效方案。     

噻托溴铵粉雾剂联合丙酸氟替卡松吸入气雾剂对COPD稳定期患者肺功能及炎症反应的影响

目的:分析噻托溴铵粉雾剂联合丙酸氟替卡松吸入气雾剂对慢性阻塞性肺疾病(COPD)稳定期患者肺功能及炎症反应的影响.方法:选取平顶山市第二人民医院接收的106例COPD稳定期患者作为研究对象,依据随机数字表法分成观察组(53例)与对照组(53例),对照组接受丙酸氟替卡松吸入气雾剂治疗,观察组接受噻托溴铵粉雾剂联合丙酸氟替...     

吸入沙美特罗氟替卡松对COPD稳定期患者肺功能及气道炎症的影响

目的探讨吸入沙美特罗氟替卡松对慢性阻塞性肺疾病（COPD）稳定期患者肺功能及气道炎症的影响。方法将诊断明确的46例中、重度COPD稳定期患者随机分为观察组（n=23）和对照组（n=23）,对照组给予健康教育、合理氧疗、解痉平喘、化痰等治疗措施。观察组在以上基础上给予沙美特罗氟替卡松50／500μg,每次1吸,每天2次。分别观察治疗1年后患者的FEV1、FEV1／FVC（％）、FEV1占预计值百分比等肺功能指标及静脉血中细胞因子IL-8、TNF-α水平。结果观察组患者FEV1、FEV1／FVC、FEV1占预计值百分比等通气功能指标较治疗前均有不同程度提高（P均〈0．05）;患者外周血中细胞因αIL-8、TNF-α水平较治疗前有显著降低（P均〈0．05）。结论长期吸入沙美特罗氟替卡松可明显改善COPD患者肺功能指标降低气道的慢性炎症反应,与对照组相比有显著差异。     

A study investigating the level of satisfaction with the health services provided by the Pharmacist at ENT hospital,Eastern Region Alahsah,Kingdom of Saudi Arabia

The current study aims to evaluate the patient’s level of satisfaction with health care services provided by the pharmacist at Aljaber ENT hospital, Eastern Region Alahsah, Kingdom of Saudi Arabia. A cross sectional study was planned from 1st March 2011 until 31st May 2011. A 27 item questionnaire was used, scoring of the responses was done to classify the patient satisfaction into sublevels. The maximum possible score was 36; those scoring less than twenty were graded as poor satisfaction level followed by moderate satisfaction level 21–25, good satisfaction level 26–30 and high satisfaction level 31–36. Statistical package for social science version 13® was used to analyze data, One-way ANOVA and independent sample t-test were applied to see the differences in the level of satisfaction. Every third patient visiting pharmacy was given a chance to participate in this study. A total of N = 991 patients were randomized using the pharmacy appointment number. Of whom 657 patients have shown willingness to participate in this study. The response rate of this study was 66.30%, most of the respondents 383 (58.1%) were male ranging from the age group of 21–40 years with a mean age of 32 years SD 9.73. The mean score for all patients was 26.15 SD ±3.4. Among all the demographic variables a significant difference in satisfaction level was found among in terms of age (df = 8, F = 8.36, p = <0.001^∗), gender (t = −4.089, df = 656, p=<0.001^∗) and race (df = 2, F = 8.47, p = <0.001. The satisfaction level among Saudi nationals was least in comparison to Egyptians and others. In general, it is seen that respondents of age 56–60 years were most satisfied with the healthcare services provided by the pharmacist. In addition, the satisfaction level was higher among female patients in comparison to men.     

丹参注射液对COPD患者肺功能、痰生化指标及机体免疫功能的影响

目的:研究丹参注射液对慢性阻塞性肺疾病(COPD)患者痰生化指标及机体免疫功能的影响。方法:85例COPD缓解期患者分为丹参治疗组(治疗组)47例和对照组38例。两组均进行COPD常规治疗,治疗组除常规治疗外行丹参注射液10ml静脉滴入,每日1次。两组患者均在治疗前及治疗后(3个月)分别检测用力肺活量(FVC)、第一秒用力呼气量(FEV1.0)及1秒用力呼气量与用力肺活量比值(FEV1.0%),检测诱导痰液中IL-6、TNFα,血液IgG、IgM、IgA水平及CD3、CD4、CD8阳性细胞率。结果:与对照组比较,治疗组患者治疗后FEV1.0、FEV1.0%升高,痰液IL-6和TNF-α水平显著下降,血液IgG水平及CD3、CD4、CD4/CD8显著上升。结论:丹参治疗COPD具有减轻气道局部炎症、提高肺通气功能及机体免疫力的作用。     

Pulmonary function in cannabis users: Support for a clinical trial of the vaporizer

BackgroundDebates about cannabis policy often mention respiratory symptoms as a negative consequence of use. The cannabis vaporizer, a machine that heats the plant to release cannabinoids in a mist without smoke and other respiratory irritants, appears to have the potential to minimize respiratory complaints.MethodsTwenty frequent cannabis users (uninterested in treatment) reporting at least two respiratory symptoms completed subjective ratings of respiratory symptoms and spirometry measures prior to and following 1 month's use of a cannabis vaporizer in a pre/post-design. Outcome measures included self-reported severity of nine respiratory symptoms as well as spirometry measures, including the maximum amount of air exhaled in 1 s (forced expiratory volume; FEV1) and maximum total lung volume (forced vital capacity; FVC).ResultsThe 12 participants who did not develop a respiratory illness during the trial significantly improved respiratory symptoms (t(11) = 6.22, p = 0.000065, d = 3.75) and FVC, t(11) = 2.90, p = 0.007, d = 1.75. FEV1 improved but not significantly t(11) = 1.77, p = 0.053, d = 1.07.ConclusionsThese preliminary data reveal meaningful improvements in respiratory function, suggesting that a randomized clinical trial of the cannabis vaporizer is warranted. The vaporizer has potential for the administration of medical cannabis and as a harm reduction technique.     

肺力咳合剂联合布地奈德福莫特罗治疗慢性阻塞性肺疾病急性加重期的临床研究

目的 探讨肺力咳合剂联合布地奈德福莫特罗治疗慢性阻塞性肺疾病急性加重期（AECOPD）的临床效果。方法 选取2018年10月—2020年9月天津医科大学宝坻临床学院收治的102例AECOPD患者,随机分为对照组（51例）和治疗组（51例）。对照组吸入布地奈德福莫特罗吸入剂,2吸/次,2次/d。治疗组口服肺力咳合剂,20 mL/次,3次/d。两组连续治疗2周。观察两组患者临床疗效,比较治疗前后两组患者肺部哮鸣音、呼吸症状缓解时间,肺功能参数第1秒用力呼气容积与用力肺活量比值（FEV1/FVC）、深吸气量与肺总量比值（IC/TLC）、一氧化碳弥散量与肺泡通气量比值（DLCO/VA）和FEV1占预计值%,咳痰的评估问卷（CASA-Q）总分,中性粒细胞与淋巴细胞比值（NLR）和呼出气一氧化氮（FeNO）浓度及血清白细胞介素-17（IL-17）、淀粉样蛋白A（SAA）和肺表面活性蛋白D（SP-D）水平。结果 治疗后,治疗组临床有效率为96.1%,显著高于对照组的84.3%（P<0.05）。治疗后,治疗组肺部哮鸣音和呼吸症状缓解时间均显著短于对照组（P<0.05）。治疗后,两组肺功能参数FEV1/FVC、IC/TLC、DLCO/VA、FEV1占预计值%和CASA-Q总分均显著升高（P<0.05）,并均以治疗组改善更显著（P<0.05）。治疗后,两组患者NLR和FeNO浓度及血清IL-17、SAA、SP-D水平均显著低于治疗前（P<0.05）,且治疗组对NLR和FeNO浓度及血清IL-17、SAA、SP-D水平的降低作用较对照组更显著（P<0.05）。结论 肺力咳合剂联合布地奈德福莫特罗治疗AECOPD的整体疗效确切,可安全、有效且迅速地缓解患者症状,改善气流受限,抑制体内炎症反应。     

连花清瘟胶囊联合特布他林和布地奈德治疗慢性阻塞性肺疾病急性加重期的临床研究

目的探讨连花清瘟胶囊联合特布他林和布地奈德治疗慢性阻塞性肺疾病急性加重期的临床疗效。方法选取2015年5月—2016年1月在仙桃市中医医院呼吸内科进行治疗的慢性阻塞性肺疾病急性加重期患者80例,按照治疗方法的不同分为对照组和治疗组,每组各40例。对照组给予硫酸特布他林雾化液5 mg联合吸入用布地奈德混悬液1 mg与生理盐水10m L混合后进行雾化吸入,20 min/次,2次/d。治疗组在对照组治疗基础上口服连花清瘟胶囊,4粒/次,3次/d。两组患者均连续治疗14 d。观察两组的临床疗效,同时比较两组喘息、咳嗽、哮鸣音等临床症状改善时间;比较两组患者治疗前后病情积分、一秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、IL-8、pH值、血氧分压(pO_2)以及动脉血二氧化碳分压(pCO_2)的变化情况。结果治疗后,对照组和治疗组的总有效率分别为80.0%、95.0%,两组比较差异具有统计学意义(P0.05)。治疗后,治疗组患者喘息缓解时间、咳嗽消失时间、哮鸣音消失时间均显著短于对照组,两组比较差异有统计学意义(P0.05)。治疗后,两组患者病情积分、pCO_2、IL-6、IL-8、TNF-α均显著降低,pH值、pO_2、FEV1、FVC、FEV1/FVC均显著升高,同组治疗前后差异有统计学意义(P0.05),且治疗组这些观察指标的改善程度优于对照组,两组比较差异具有统计学意义(P0.05)。结论连花清瘟胶囊联合特布他林和布地奈德治疗慢性阻塞性肺疾病急性加重期具有较好的临床疗效,可明显改善患者的临床症状和肺功能,并可降低机体炎性反应,具有一定的临床推广应用价值。     

阿托伐他汀联合低分子肝素治疗慢性阻塞性肺疾病急性加重期疗效观察

目的 探讨阿托伐他汀联合低分子肝素治疗慢性阻塞性肺疾病急性加重期的疗效.方法 将64例慢性阻塞性肺疾病急性加重期的患者随机分为治疗组34例,对照组30例.对照组采用常规治疗,治疗组在常规治疗的基础上加用阿托伐他汀和低分子肝素治疗.2周为1个疗程.治疗前后两组同步检测凝血酶原时间（PT）、纤维蛋白原（FIB）、动脉血气、超敏C-反应蛋白（hs-CRP）和测定吸入支气管扩张剂后肺功能相关指标.结果 治疗组治疗后较治疗前FIB、hs-CRP、PaCO2显著降低（P＜0.01）,PT、PaO2、SO2%和FEV1/FVC显著升高（P＜0.05）;对照组治疗前后PT、FIB、hs-CRP各项指标略有改善,但差异无统计学意义（P＞0.05）;肺功（FEV1/FVC）、动脉血气（PaO2、PaCO2和SO2%）有改善（P＜0.05）;治疗后治疗组与对照组之间的检测指标比较,PT、FIB、hs-CRP、PaCO2、PaO2、SO2%和FEV1/FVC均有差异有统计学意义（P＜0.05或P＜0.01）.结论 慢性阻塞性肺疾病急性加重期的患者在常规治疗的基础上加用阿托伐他汀和低分子肝素降低血液粘度,抑制肺血管炎症反应,改善肺功能,进而延缓COPD的进程.     

护理干预对老年慢性阻塞性肺疾病患者治疗效果的影响

目的 观察护理干预对老年慢性阻塞性肺疾病（COPD）患者治疗效果的影响. 方法 60例老年COPD患者,病情稳定后在常规护理的基础上对患者进行针对性护理干预,观察干预前后患者治疗效果的差异. 结果 护理干预后12个月,患者咳嗽、咯痰、气短症状减轻或者消失,体力明显改善;干预后患者平均动脉血氧分压升高、二氧化碳分压降低,与干预前差异均有统计学意义（均P＜0.01）;肺功能FEV1（%）、FEV1/FVC改善、6 min步行距离干预后较干预前均有明显增加（均P＜0.01）. 结论 护理干预能改善老年COPD患者的肺功能和生活质量.     

The effect of inhaled corticosteroids on hypothalamic-pituitary-adrenal axis

Objectives:

The aim of this study was to compare systemic effects of high-dose fluticasone propionate (FP) and beclomethasone dipropionate (BDP) via pressurized metered dose inhaler on adrenal and pulmonary function tests.

Materials and Methods:

A total of 66 patients with newly diagnosed moderate persistent asthma without previous use of asthma medications participated in this single blind, randomized, parallel design study. FP or BDP increased to 1 500 μg/d in 62 patients who had not received oral or IV corticosteroids in the previous six months. Possible effects of BDP and FP on adrenal function were evaluated by free cortisol level at baseline and after Synacthen test (250 μg). Fasting plasma glucose and pulmonary function tests were also assessed. Similar tests were repeated 3 weeks after increasing dose of inhaled corticosteroids to 1 500 μg/d.

Results:

No statistically significant suppression was found in geometric means of cortisol level post treatment in both groups. After treatment in FP group, mean forced expiratory volume in one second (FEV1) and mean forced vital capacity (FVC) values improved by 0.17 l (5.66% ± 13.91, P=0.031) and 0.18 l (5.09% ± 10.29, P=0.010), respectively. Although FEV1 and FVC improved in BDP group but was not statistically significant. Oral candidiasis and hoarseness were observed in 6.5% patients receiving BDP, but hoarseness was found in 3.2% patients in FP group (P=0.288).

Conclusions:

The results indicate that safety profiles of high doses of BDP and FP with respect to adrenal function are similar, but FP is more efficacious than that of BDP in improving pulmonary function test.KEY WORDS: Adrenal cortex function tests, adrenal insufficiency, asthma, beclomethasone dipropionate, fluticasone     

糖皮质激素联合复方异丙托溴铵对慢阻肺急性加重期的疗效及安全性研究

目的探究糖皮质激素联合复方异丙托溴铵对慢性阻塞性肺疾病(慢阻肺)急性加重期的疗效及安全性.方法78例慢阻肺急性加重期患者,随机分为对照组与观察组,每组39例.对照组在常规治疗基础上给予单纯复方异丙托溴铵治疗,观察组患者在对照组治疗基础上联合糖皮质激素治疗.比较两组患者治疗前后肺功能[用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、FEV1/FVC]、治疗效果以及不良反应发生情况.结果治疗后,两组患者FVC、FEV1与FEV1/FVC水平均高于治疗前,且观察组的FVC(2.49±0.34)L、FEV1(1.49±0.51)L与FEV1/FVC(59.12±4.38)%均高于对照组的(2.33±0.21)L、(1.24±0.44)L、(52.90±4.17)%,差异均有统计学意义(P<0.05).观察组治疗总有效率为94.9%,高于对照组的79.5%,差异有统计学意义(P<0.05).治疗期间,两组患者均无不良反应出现.结论糖皮质激素联合复方异丙托溴铵治疗慢阻肺急性加重期患者疗效颇佳,且安全性较好,建议今后治疗中应用.     

N-acetylcysteine improves the clinical conditions of mustard gas-exposed patients with normal pulmonary function test

Administration of N-acetylcysteine may be effective in diseases caused by oxidative-antioxidative imbalance. We aimed to determine the effect administration for 4 months of N-acetylcysteine (1200 mg daily) on sulfur mustard-induced bronchiolitis obliterans in patients with normal pulmonary function test. In a double-blind clinical trial, 144 patients with bronchiolitis obliterans due to sulfur mustard and bronchiolitis obliterans syndrome class 0, randomly entered to group 1 (n = 72, N-acetylcysteine) and group 2 (n = 72, placebo). The changes in dyspnoea, wake-up dyspnoea, cough and sputum were measured after 4 months using a 'delta value' (i.e. symptom score after 4 months--symptom score before the trial). Spirometric findings were measured at the beginning of the trial, 2 months later and 4 months later. Dyspnoea (delta value: -0.78 (0.61), P < 0.001), wake-up dyspnoea (delta value: -0.57 (0.64), P < 0.001), and cough (delta value: -0.86 (0.63), P < 0.001) improved after 4 months of N-acetylcysteine administration compared to the control group. N-acetylcysteine reduced sputum from 76.9% (n = 40) of cases before the trial to 9.6% (n = 5) of cases after the trial. Spirometric components were significantly improved in N-acetylcysteine group compared to the placebo group: FEV1 (P < 0.0001), FVC (P = 0.014) and FEV1/FVC (P = 0.003). A 4-month trial with 1200 mg oral N-acetylcysteine per day can be used for treating bronchitis, but is also effective in treating bronchiolitis. It also prevents sulfur mustard-induced oxidative stress, and can be used in the treatment of sulfur mustard-induced pulmonary disease.