吸人噻托嗅铵对慢性阻塞性肺疾病合并肺动脉高压患者的治疗作用

目的观察噻托嗅铵对慢性阻塞性肺疾病（COPD）合并肺动脉高压患者的影响。方法收集2010年1月至2011年6月经呼吸内科治疗后的76例合并肺动脉高压的COPD稳定期患者，其中男51例，女25例。按照随机数字表法分为试验组和对照组，对照组38例（男25例，女13例），规律吸入福莫特罗干粉吸入剂（每吸4．5肛g，每日2吸）、口服茶碱缓释片（0．1g，每日2次），并根据病情需要使用抗感染药物及黏痰溶解剂；试验组38例（男26例，女12例），在上述治疗基础上，每日一次吸人噻托嗅铵干粉18肛g。观察16周后所有患者6min步行距离、心脏彩色超声间接测定肺动脉收缩压及喘息症状评分的变化。将6min步行距离和肺动脉收缩压的变化作为主要终点，同时观察药物的安全性和耐受性，并对试验数据进行意向性分析和符合方案数据分析。结果第16周随访观察结束时，试验组患者肺动脉收缩压下降（17．4±4．8）mmHg（1mmHg=0．133kPa）]；6min步行距离增加（45±16）in；喘息症状评分降低（1．6±0．7）分，与对照组的差异有统计学意义（P〈0．05），且未发生明显不良反应。结论合并肺动脉高压的COPD稳定期患者吸入噻托嗅铵治疗，可不同程度降低肺动脉压力、提高运动耐量、改善喘息症状，并有良好的耐受性。

Inhaled tiotropium in the treatment of stable chronic obstructive pulmonary disease patients complicated with pulmonary hypertension

Objective To explore the curative effect of inhaled tiotropium upon patients of stable chronic obstructive pulmonary disease （COPD） complicated with pulmonary hypertension. Methods A total of 76 patients （Male/Female = 51/25 ） of stable COPD complicated with pulmonary hypertension were recruited from January 2010 to June 2011. According to table of random digit, they were divided into test group （n = 38, M/F = 26/12） and control group （n = 38, M/F = 25/13）. Patients of control group inhaled formoterol powder 4. 5 μg bid, took oral theophylline sustained-release tablets 0. 1 g bid. According to the demand of patient＇s condition, anti-infective agents and sticky phlegm lyticagent were used. Patients of test group inhaled tiotropium dry powder （18 ~g,qd） in addition to the above regimen. All changes in six-minute walk test （SMWT）, pulmonary arterial systolic pressure and panting symptom score were recorded at the end of 16 weeks and compared with the baseline. The primary endpoint was the changes in exercise capacity as assessed by SMWT and pulmonary arterial systolic pressure. Safety and tolerance were also investigated. Intent- to-treat and per-protocol analyses were performed. Results After a follow-up period of 16 weeks, both pulmonary ＇arterial systolic pressure and panting symptom score decreased and SMWT walking distance increased （45 ± 16） m in the test group. Compared with the control group, the difference had statistical significance （P 〈 0. 05 ） and obvious adverse reaction did not occur. Conclusions For patients of stable COPD complicated with pulmonary hypertension, inhaled tiotropium dry powder decreases pulmonary pressure to various extents and improves exercise tolerance and panting symptom. And tolerance is satisfactory.