肺康复对慢性阻塞性肺疾病稳定期患者BODE指数和血清炎症因子的影响

目的观察肺康复治疗对中重度慢性阻塞性肺疾病（COPD）患者稳定期BODE指数和血清炎症因子的影响。 方法2016年1月至2017年12月期间在江苏省苏北人民医院诊断为中重度COPD稳定期患者65例，随机分为肺康复组（33例）和对照组（32例），2组均给予常规药物干预，肺康复组同时进行12周的肺康复治疗。年龄、病程，BODE各项指标及BODE指数，血清超敏C-反应蛋白（hs-CRP），白介素-6（IL-6）和肿瘤坏死因子（TNF-α）水平和成人COPD生存质量评分（COPD-QOL量表）等属于计量资料，2组治疗前、治疗12周后上述相关指标比较采用配对样本t检验，组间比较采用独立样本t检验；采用χ²检验比较性别、COPD临床严重程度分级的组间差异。 结果最终有63例患者完成研究。治疗后肺康复组BODE指标中体质量指数（BMI）、改良呼吸困难指数（MMRC分级）、6 min步行距离（6MWD）均较治疗前有改善［（21.5±1.4）kg/m² vs（18.7±1.2）kg/m²；（1.6±0.3）分 vs （2.1±0.3）分；（270.3±37.8）m vs （158.3±42.4）m］，差异均具有统计学意义（t=2.125、2.036、5.021，P=0.036、0.046、<0.001）。对照组6MWD治疗后较治疗前有改善［（188.3±40.3）m vs （160.1±39.7）m］，差异具有统计学意义（t=2.659，P=0.009)。组间比较，肺康复组治疗后BMI、MMRC和6MWD均优于对照组［（21.5±1.4）kg/m² vs（18.6±1.3）kg/m²；（1.6±0.3）分 vs （2.1±0.4）分；（270.3±37.8）m vs （188.3±40.3）m］，差异均具有统计学意义（t=2.124、2.031、4.568，P=0.038、0.016、<0.001）；BODE指数比较，肺康复组改善优于对照组［（3.9±0.9）分 vs （4.5±1.3）分］，差异具有统计学意义（t=2.131，P=0.037）。治疗后肺康复组IL-6、TNF-α较治疗前均降低［（62.1±6.4）pg/ml vs （95.9±5.9）pg/ml；（48.5±7.3）pg/ml vs （73.3±10.1）pg/ml］，差异均具有统计学意义（t=7.872、7.136，P均<0.001）；COPD-QOL总分较治疗前提高［（110.5±17.8）分 vs （96.2±20.4）分］，差异具有统计学意义（t=7.521，P<0.001）；组间比较，肺康复组治疗后IL-6、TNF-α和COPD-QOL总分优于对照组［（62.1±6.4）pg/ml vs （94.6±6.3）pg/ml；（48.5±7.3）pg/ml vs （71.7±7.5）pg/ml；（110.5±17.8）分 vs （96.3±21.3）分］，差异均具有统计学意义（t=7.981、7.328、7.526，P均<0.001）。 结论肺康复可以明显改善中重度COPD患者稳定期BODE指数和降低血清IL-6、TNF-α炎症因子水平，提高其生活质量。

Effect of pulmonary rehabilitation on BODE index and serum inflammatory factors in patients with stable chronic obstructive pulmonary disease

ObjectiveTo observe the effect of pulmonary rehabilitation on BODE index and serum inflammatory factors in patients with moderate to severe chronic obstructive pulmonary disease (COPD). MethodsFrom January 2016 to December 2017, 65 patients with stable COPD at our hospital were randomly divided into two groups: pulmonary rehabilitation group (n=33) and control group (n=32). Age, disease duration, BODE index and its individual components, serum high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and tumor necrosis factor (TNF-α), and COPD quality of life score (Chinese version of the COPD-QOL scale) were measured. The relevant indicators were compared between before and after 12 weeks of treatment and between two groups by the paired sample t-test and independent sample t-test. Gender and clinical severity of COPD were compared using the χ² test between groups. ResultsSixty-three patients completed the study. The body mass index (BMI), modified dyspnea index (MMRC grade), and 6-minute walk test (6MWD) of the BODE index in the post-treatment group were improved compared with those before treatment (21.5±1.4) kg/m² vs (18.7±1.2) kg/m²; (1.6±0.3) vs (2.1±0.3); (270.3±37.8) m vs (158.3±42.4), t=2.125, 2.036, and 5.021, P=0.036, 0.046, and <0.001, respectively]. 6MWD in the control group was statistically significantly improved after treatment (188.3±40.3) m vs (160.1±39.7) m, t=2.659, P=0.009]. The improvements of BMI, MMRC, and 6MWD in the lung rehabilitation group were significantly better than those in the control group (21.5±1.4) kg/m² vs (18.6±1.3) kg/m², (1.6±0.3) vs (2.1±0.4), (270.3±37.8) m vs (188.3±40.3) m, t=2.124, 2.031, and 4.568, P=0.038, 0.016, and <0.001, respectively]. The BODE index was also significantly improved in the lung rehabilitation group than in the control group (3.9±0.9) scores vs (4.5±1.3) scores, t=2.131, P=0.037]. After treatment, IL-6 and TNF-α in the lung rehabilitation group were significantly lower than those before treatment (62.1±6.4) pg/ml vs (95.9±5.9) pg/ml; (48.5±7.3) pg/ml vs (73.3±10.1) pg/ml, t=7.872 and 7.136, P<0.001 for both], and the total score of COPD-QOL was significantly higher than that before treatment (110.5±17.8) scores vs (96.2±20.4) scores, t=7.521, P<0.001). Compared with the control group, IL-6, TNF-α, and total COPD-QOL improved significantly in the lung rehabilitation group (62.1±6.4) pg/ml vs (94.6±6.3) pg/ml, (48.5±7.3) pg/ml vs (71.7±7.5) pg/ml, (110.5±17.8) vs (96.3±21.3), t=7.981, 7.328, and 7.526, P<0.001 for all]. ConclusionPulmonary rehabilitation can significantly improve the BODE index, reduce serum IL-6 and TNF-α, and improve the quality of life in patients with moderate to severe COPD.