乌苯美司对慢性阻塞性肺疾病急性加重期患者免疫功能的影响

目的:观察乌苯美司对慢性阻塞性肺疾病急性加重期(AECOPD)患者免疫功能的影响。方法:将110例AECOPD患者采用随机数字表法分为对照组和观察组,各55例。2组患者均给予常规对症治疗,对照组在常规对症治疗基础上给予上给布地奈德福莫特罗粉吸入剂雾化吸入治疗,每喷2次,bid,共12d;静脉滴注甲泼尼龙40mg·d-1,qd,共12d;观察组在对照组基础上每次口服乌苯美司,10mg,tid。共12d。记录患者住院时间,检测治疗前后T淋巴细胞功能(CD4+T细胞、CD8+T细胞、CD4+/CD8+)、白介素8(IL-8)、肿瘤坏死因子(TNF-α)及肺功能指标[第1s用力呼气量(FEV1)、用力呼气量(FVC)、FEV1占预计值百分比(FEV1%)、第1秒用力呼气量(FEV1)/用力呼气量(FVC)],随访6个月内急性加重次数、住院次数。结果:观察组治疗后CD4+T细胞、CD4+/CD8+水平高于对照组,差异有显著性(P<0.05);观察组治疗后IL-8、TNF-α水平低于对照组,差异有显著性(P<0.05);观察组治疗后FEV1、FVC、FEV1%、FEV1/FVC值高于对照组,差异有显著性(P<0.05),观察组住院时间(8.81±1.64)d短于对照组(11.94±1.87)d,随访6个月内急性加重次数及住院次数分别为(0.75±0.31)次、(0.34±0.28)次少于对照组的(1.08±0.41)次、(0.71±0.33)次,差异有显著性(P<0.05)。2组不良反应比较差异无显著性(P>0.05)。结论:常规对症治疗、糖皮质激素治疗基础上加用乌苯美司可调节AECOPD患者机体免疫功能,降低IL-8、TNF-α水平,减轻炎症程度,缩短病程,减少急性发作次数和住院时间,且不会增加不良用药反应。

The effect of ubenimex on the immune function in patients with acute exacerbation of chronic obstructive pulmonary disease

OBJECTIVE To observe the effect of ubenimex on the immune function in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS Totally 110 patients with AECOPD were divided into the control group and the observation group by the random number table method, 55 cases in each group. All patients were given routine symptomatic treatment. On this basis, patients in the control group were treated with budesonide and formoterol fumarate powder for inhalation, twice/spray, bid., for 12 d, and intravenous infusion of methylprednisolone, 40 mg·d^-1, qd, for 12 d. On the basis of treatments for control group, patients in the observation group were treated with ubenimex, 10 mg/time, tid., for 12 d. The length of hospital stay of patients was recorded. T lymphocytes (CD4⁺T cells, CD8⁺T cells, CD4⁺/CD8⁺), interleukin 8 (IL-8), tumor necrosis factor alpha (TNF-α) and lung function indexes[forced expiratory volume in 1s (FEV₁), forced vital capacity (FVC), the percentage of FEV₁ in predicted value (FEV₁%), FEV₁/FVC] were detected before and after the treatment. The times of acute exacerbation and hospitalization within 6 months of follow-up were recorded. RESULTS Levels of CD4⁺ T cells and CD4⁺/CD8⁺ in the observation group after treatment were higher than those in the control group (P<0.05), while levels of IL-8 and TNF-α were lower than those in the control group (P< 0.05). The FEV₁, FVC, FEV₁% and FEV₁/FVC in the observation group after treatment were higher than those in the control group (P<0.05). The length of hospital stay of the observation group was shorter than that of the control group[(8.81±1.64) d vs (11.94±1.87) d], and the frequency of exacerbation and hospitalization was lower than that of the control group in 6 months of follow-up[(0.75±0.31) times and (0.34±0.28) times vs. (1.08±0.41) times and (0.71±0.33) times] (P<0.05). There was no significant difference in adverse reactions between the two groups (P>0.05). CONCLUSION Routine symptomatic treatment and glucocorticoid treatment combined with ubenimex can regulate the immune function, reduce levels of IL-8 and TNF-α, reduce the degree of inflammation, shorten the course of disease, reduce the frequency of acute attack and length of hospital stay in patients with AECOPD, without increasing adverse drug reactions.