他汀类药对稳定期不同程度老年COPD患者下呼吸道细菌定植的影响

目的 探讨稳定期不同程度老年COPD患者下呼吸道细菌定植的细菌学变化特点, 及其与急性加重、炎性反应、肺功能损害之间的关系, 从而研究他汀类药对稳定期老年COPD患者LABC的影响.方法 选择稳定期老年COPD患者96例, 进行痰液及支气管肺泡灌洗液 (BALF) 细菌学定量, 定性分析, 根据结果分为LABC阳性联合他汀治疗、常规治疗组及LABC阴性联合他汀治疗组及常规治疗组, 测定实验前后血清白介素6 (IL-6) 、白介素8 (IL-6) 、hs-CRP及TNF-α水平及肺功能.结果 87例患者有40例存在LABC (45.98%) , LABC阳性患者血清IL-6, IL-8, TNF-α、hs-CRP高于LABC阴性 (P<0.05) , 肺功能较LABC阴性明显下降 (P<0.05) , 随访1 a联合他汀治疗组血清IL-6, IL-8, TNF-α、hs-CRP低于常规治疗组 (P<0.05) ;肺功能改善优于常规治疗组 (P>0.05) ;急性加重风险低于常规治疗组 (P<0.05) ;LABC阳性患者联合他汀治疗组抑制细菌定植高于常规治疗组 (P<0.05) ;LABC阴性患者联合他汀治疗组细菌定植低于常规治疗组.结论 稳定期老年COPD患者LABC阳性患者血清IL-6, IL-8, TNF-α、hs-CRP高于LABC阴性者, 联合他汀治疗有利于抑制LABC或增殖, 减轻炎性反应, 减少急性加重, 延缓肺功能下降, 改善临床症状.

Effect of Statins on Lower Airway Bacterial Colonization in Elderly Patients with Stable Chronic Obstructive Pulmonary Disease of Different Severity

Objective To explore the effect of statins on lower airway bacterial colonization (LABC) in elderly patients with stable chronic obstructive pulmonary disease (COPD) of different severity by analyzing the bacteriological changes of LABC in those patients and its relationship with acute exacerbation, inflammatory reaction and lung function impairment.Methods A total of 96 patients with stable COPD were enrolled and quantitative and qualitative bacteriological analysis of patients' sputum and bronchoalveolar lavage fluid (BALF) were performed.According to the test results, patients were divided into four groups: patients with LABC positive receiving statin treatment, patients with LABC positive receiving conventional therapy, patients with LABC negative receiving statin treatment, and patients with LABC negative receiving conventional therapy.The serum levels of IL-6, IL-8, hs-CRP, TNF-α and lung function were examined before and after the experiment.Results There were 40 patients with LABC positive in 96 patients, with bacterial colonization rate of 45.98%.The serum level of IL-6, IL-8, TNF-α and hs-CRP in patients with LABC positive were significantly higher than those in patients with LABC negative (P <0.05) .Lung function in patients with LABC positive was significantly poorer than that in patients with LABC negative (P <0.05) .One-year follow-up showed that the serum levels of IL-6, IL-8, TNF-α and hs-CRP in patients with statin treatment were significantly lower than those in patients with conventional therapy (P<0.05) and better improvements of lung function were observed in patients with statin treatment (P>0.05) .The risk of acute exacerbation in patients with statin treatment was significantly higher than those in patients with conventional treatment (P<0.05) .The bacteria engraftment rate of the patients with LABC positive receiving statin treatment was significantly higher than that in patients with conventional therapy (P<0.05) while it was lower in the patients with LABC negative receiving statin treatment.Conclusion The levels of IL-6, IL-8, TNF-α, hs-CRP in elderly patients with stable COPD and LABC positive are higher than those with LABC negative.Treatment combined with statins helps to inhibit LABC or proliferation, reduce inflammatory reaction and acute exacerbation, delay the decline of lung function, and improve clinical symptoms.