布地奈德福莫特罗粉吸入剂联合噻托溴铵粉吸入剂治疗ACOS的疗效及其对患者血清hs-CRP、EOS的影响

目的 探讨布地奈德福莫特罗粉吸入剂联合噻托溴铵粉吸入剂治疗哮喘慢阻肺重叠综合征(ACOS)的效果及其对患者血清超敏C-反应蛋白(hs-CRP)和嗜酸性粒细胞计数(EOS)的影响.方法 回顾性分析2015年1月至2017年1月北京市东城区北京市和平里医院和北京京煤集团总医院收治的100例ACOS患者的临床资料,将其中使用布地奈德福莫特罗粉吸入剂治疗的48例患者作为对照组,联合使用布地奈德福莫特罗粉吸入剂与噻托溴铵粉吸入剂治疗的52例患者作为观察组,比较两组患者的临床疗效[哮喘控制试验(ACT)、慢性阻塞性肺病评估测试(CAT)评分,急性加重次数与生活质量评分、多导睡眠检测(PSG)指标[SLT90％:静脉饱和度(SaO2)低于90％的时间占总睡眠时间百分比、TDB:总暂停时间占总睡眠时间百分比、SEF:总睡眠总时间占总监测时间百分比]、血清hs-CRP、EOS水平、治疗有效率等.结果 (1)治疗前,两组患者的ACT评分、CAT评分、急性加重次数与生活质量评分、PSG检测指标比较差异均无统计学意义(P>0.05);治疗后,观察组和对照组患者的CAT评分[(15.32±3.21)分vs(20.26±4.32)分]、急性加重次数[(0.33±0.12)次vs(0.52±0.28)次]、SLT90％[(40.56±4.65)vs(44.74±3.48)]及TDB[(28.76±3.65)％vs(34.57±4.12)％]水平比较,观察组均明显低于对照组,而ACT评分[(23.43±4.54)vs(19.21±3.75)分]、生活质量评分[(92.67±10.65)分vs(74.45±9.87)分]、SEF水平[(51.36±4.64)％vs(45.64±3.63)％]比较,观察组均明显高于对照组,差异均有统计学意义(P<0.05);(2)观察组患者的治疗总有效率为90.38％,明显高于对照组的62.50％,差异有统计学意义(P<0.05);(3)治疗前,两组患者的血清hs-CRP和EOS比较差异均无统计学意义(P>0.05),治疗后,观察组和对照组患者的hs-CRP[(3.43±1.13)mg/L vs(5.65±1.58)mg/L]和EOS[(1.76±0.65)％vs(4.53±1.78)％]比较,观察组均明显低于对照组,差异均有统计学意义(P<0.05).结论 布地奈德福莫特罗粉吸入剂联合噻托溴铵粉吸入剂治疗ACOS能降低患者血清hs-CRP、EOS水平,提高患者生活质量,疗效显著.

Effect of tiotropium bromide combined with tiotropium bromide dehydrate on hs-CRP and EOS in serum in the treatment of ACOS

Objective To study on the efficiency of tiotropium bromide combined with budesonide and for-moterol fumarate dehydrate in the treatment process of ACOS (asthma-chronic obstructive pulmonary disease overlap syndrome) and their effect on the hs-CRP (high-sensitivity C-reactive protein) and EOS (eosinophil count) in serum. Methods The clinical data of 100 patients with ACOS who admitted to Beijing He Ping Li Hospital and General Hospi-tal of Jingmei Group from January 2015 to January 2017 were retrospectively analyzed. The patients who treated with tiotropium bromide combined with budesonide and formoterol fumarate dehydrate were selected as the observation group (n=52), while the patients who treated with budesonide and formoterol fumarate dehydrate were enrolled into the control group (n=48). The treatment effects (ACT and CAT score, times of acute exacerbation as well as quality of life score, PSG indexes, the level of hs-CRP and EOS in serum, treatment efficiency) were observed and com-pared. Results (1) Before treatment, these was no significant difference in ACT (asthma control test), CAT (COPD as-sessment test), times of acute exacerbation as well as quality of life score, polysomnography (PSG) indexes between the two groups (P>0.05);but after treatment, the CAT score, times of acute exacerbation, SLT90％and TDB in the experi-mental group were (15.32±3.21), (0.33±0.12), (40.56±4.65), (28.76±3.65)％, respectively, which were significantly low-er than corresponding (20.26±4.32), (0.52±0.28), (44.74±3.48) and (34.57±4.12)％in the control group (P<0.05), and the values of index such as ACT score, quality of life score and SEF were (23.43±4.54), (92.67±10.65), (51.36±4.64)％, re-spectively, which were significantly higher than corresponding (19.21±3.75), (74.45±9.87), (45.64±3.63)％in the control group (P<0.05). (2) After treatment, the rate of efficiency in the observation group was significantly higher than the con-trol group (90.38％ vs 62.50％, P<0.05). (3) Before treatment, there were no significant difference between these two groups about the hs-CRP and EOS (P>0.05);after treatment, the hs-CRP and EOS in the observation group were (3.43± 1.13) mg/L and (1.76 ± 0.65)％, which were significantly lower than (5.65 ± 1.58) mg/L and (4.53 ± 1.78)％in the control group (P<0.05). Conclusion Tiotropium bromide combined with budesonide and formoterol fumarate dehydrate it can reduce the levels of hs-CRP and EOS in serum in the treatment of ACOS. This treatment can improve the quality of life of patients, and the effect is significant, it is worth clinical application.