联合吸入糖皮质激素及长效β2-受体激动剂对COPD患者肺功能和气道炎症影响的比较

目的 比较长期联合吸入糖皮质激素（ISC）及长效β2-受体激动剂（LABA）与单药吸入糖皮质激素或长效β2-受体激动剂对改善慢性阻塞性肺疾病（COPD）患者肺功能及气道炎症的作用。方法 将60例中度COPD患者随机分为4组：治疗1组吸入沙莫特罗/氟替卡松，治疗2组吸入福莫特罗，治疗3组吸入布地奈德，对照组按需应用氨荼碱、短效β2受体激动剂。分别在治疗前及治疗后3、6、12、24个月检查动脉血气分析、第1秒用力呼气容量占用力肺活量的百分比（FEV1.0%）、血清肿瘤坏死因子α（TNF-α）和血清转化生长因子-β（TGF-β）。结果 各治疗组患者的急性发作次数均明显减少，与对照组比较差异有统计学意义（P<0.05），治疗1组效果更为显著（P<0.01）。6个月后各治疗组FEV1.0%、TGF β、TNF-α较对照组改善显著（P<0.05），治疗1组改善更为显著（P<0.01）；但治疗24个月较12个月未见继续改善（P>0.05）。对照组较治疗前无显著性变化（P>0.05）。4组患者的PaO2 较治疗前差异无统计学意义（P>0.05）。结论 长期联合吸入ISC+LABA、单一吸入ISC或LABA均可以减少COPD患者急性发作次数，改善肺功能，降低血清TGF-β、血清TNF-α的浓度。联合吸入ISC+LABA较单一吸入ISC或LABA效果更显著。

Inhalation of long-term glucocorticoid and long-acting β2-agonists in improving lung function and airway inflammation in chronic obstructive pulmonary disease

Objective    To explore the improvement of lung function and airway inflammation by using glucocorticoid and long-acting β2-agonists (CABA)or by using a single drug for chronic obstructive pulmonary disease(COPD). Methods    60 moderate COPD patients were randomly divided  into four groups: the treatment group 1 inhaled shamoteluo / fluticasone and formoteroln, the treatment group 2 inhaled formoterol, the treatment group 3 inhaled budesonide, and the control group used ammonia Tualkali and short-acting β2 receptor agonists on-demand applications. Blood gas analysis, FEV1.0%, serum tumor necrosis factor (TNF-α) and transforming growth factor (TGF-β) were determined before the treatment and at 3, 6, 12, 24 months during the treatment. Results    Acute attacks in the treatment groups were significantly reduced. Compared with the control group there were significant differences (P<0.05), and in the treatment group 1, the difference was the most significant (P<0.01). At 6 months, FEV1.0%, TGF-β, and TNF-α had more significant differences in the treatment groups than in the control group (P<0.05), but there were no significant difference between the  24 months  group and the 12 months(P> 0.05), while there were no significant changes both before and after the treatment in the treatment groups (P> 0.05). PaO2 of the four groups had no significant changes from that before the treatment (P>0.05). Conclusion     Inhalation of both long term glucocorticoid and LABA, or single glucocorticoids or single LABA can reduce acute attacks of COPD, improves patients‘ lung functions, and reduces concentrations of serum TGF-β and TNF-α. The effect of inhaled glucocorticoid in combination with LABA is more valuable than single inhalation of glucocorticoids or LABA.