噻托溴铵联合双水平气道正压通气对稳定期慢性阻塞性肺疾病患者疗效及外周血SOD、LPO的影响

目的观察噻托溴铵联合双水平气道正压通气(Bi PAP)对稳定期慢性阻塞性肺疾病(慢阻肺)患者疗效及外周血超氧化物歧化酶(SOD)、脂质过氧化物(LPO)的影响。方法选取240例稳定期慢阻肺患者随机分为噻托溴铵组,Bi PAP组和联合组各80例,另选同期健康体检者80例为对照组,噻托溴铵组在常规治疗基础上加用噻托溴铵治疗,而Bi PAP组则加用Bi PAP通气治疗,联合组加用噻托溴铵联合Bi PAP治疗,分析三组治疗前及治疗后14d,3个月外周血SOD,LPO水平,以及治疗后1年内复发人数及不良反应发生情况;将噻托溴铵组按慢阻肺中重度,极重度分为A1,B1亚组,Bi PAP组同理分为A2,B2亚组,联合组为A3,B3亚组,A1-A3亚组均有55例,B1-B3亚组均有25例,分析A1-3,B1-3亚组治疗前与治疗后14d,3个月慢阻肺疾病评估测试问卷评分(CAT)及症状评分。结果 3组治疗前SOD均远低于而LPO则远高于对照组(P0.05);治疗后较治疗前均有显著改善,但治疗后联合组改善幅度均显著大于噻托溴铵组和Bi PAP组(P0.05)。治疗后A1-3亚组无论是CAT还是症状评分均较治疗前有明显改善,且治疗后3个月又明显优于14d时,但改善幅度上,另两亚组明显不如A3亚组;而B1亚组治疗后14d相对于治疗前上述评分均未见显著变化,但治疗后3个月相较于治疗前及治疗后14d则有明显改善;而B2,B3亚组则治疗后分值较治疗前均有明显降低,但B3亚组变化幅度均远大于另外两亚组(P均0.05)。治疗后联合组复发率远低于噻托溴铵及BiPAP组(7.5%vs 35%vs 38.8%);而联合组与另两组在不良反应发生率上未见显著差异(P0.05)。结论噻托溴铵联合Bi PAP治疗稳定期慢阻肺疗效确切,且能够有效改善外周血SOD,LPO,值得临床推广。

Analysis of effect and influence of SOD and LPO by BiPAP combined with tiotropium inhalation in the treat-ment of COPD at stable phase

Objective To analyze the effect and influence of SOD and LPO by BiPAP combined with tiotro-pium inhalation in the treatment of COPD at stable phase. Methods 240 COPD patients were randomly and evenly divided into 3 groups. The group A was given tiotropium inhalation therapy, the group B was given BiPAP therapy, and the combined group received BiPAP combined with tiotropium inhalation. And 80 health people were selected as the control group. The changes in SOD and LPO of the 3 groups before and 14d, 3 months after the treatment were analyzed. According to the severity of COPD ( moderate and serious severity=A;critical serious severity=B) , the 3 groups were sub-divided into A1-3 and B1-3 subgroups. The changes of CAT and symptom score of the 6 subgroups before and 14d, 3 months after the treatment were compared. Results Before treatment, SOD was obviously lower and LPO was higher in the treatment group than in the control group ( P<0. 05 ) . Both indicators of the 3 groups changed significantly (P<0. 05), and the changes in the combined group were pronounced (P<0. 05). The sub-group A3 and B3 improved more significantly than the other 4 subgroups (A1,2;B1,2) in CAT and symptom scores. Conclusion BiPAP combined with tiotropium inhalation is safe and effective in the treatment of COPD at stable phase, and it can influence a lot on SOD and LPO.