不同容量肺灌洗术对合并COPD的尘肺病患者血清炎性因子和肺功能的影响

目的比较大容量肺灌洗术与小容量肺灌洗术治疗对尘肺病合并慢性阻塞性肺疾病(COPD)患者血清炎性因子及肺功能的改善效果。方法回顾性选取2017年8月至2019年7月首都医科大学附属北京世纪坛医院收治的90例尘肺合并COPD患者,根据不同容量肺灌洗治疗方案分为2组,每组各45例,对照组采用小容量肺灌洗术治疗,观察组采用大容量肺灌洗术。比较2组患者治疗前和治疗后30 d血清炎性因子白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)、转化生长因子β1(TGF-β1)]、肺功能第1秒用力呼气量(FEV1)、第1秒用力呼气量占用力肺活量比值(FEV1/FVC)、最大呼气流量(PEF)]以及随访6个月运动耐量及生活质量变化,记录2组患者术后不良反应发生情况。结果治疗前,2组患者血清IL-6、TNF-α、TGF-β1水平、FEV1、FEV1/FVC、PEF、6 min步行距离(6MWD)、圣乔治呼吸问卷(SGRQ)评分比较,差异无统计学意义(P> 0.05)。观察组患者治疗后30 d的血清IL-6、TNF-α、TGF-β1含量分别为(0.35±0.08)μg/m L、(150.35±25.63) ng/L、(41.25±5.32) ng/L,均明显低于对照组(0.43±0.09)μg/m L、(182.76±24.17) ng/L,(50.37±5.17) ng/L],差异有统计学意义(P <0.05)。观察组患者治疗后30 d的FEV1、FEV1/FVC、PEF分别为(1.72±0.13) L、(69.59±5.23)%、(371.59±10.58) L/min,均明显高于对照组(1.46±0.12) L、(61.03±5.17)%、(347.02±9.27) L/min],差异有统计学意义(P <0.05)。随访6个月,观察组患者SGRQ评分为(41.39±3.02)分,明显低于对照组(49.27±3.08)分],6MWD为(381.75±18.31) m,明显远于对照组(307.51±17.59) m],差异均有统计学意义(P <0.05)。2组患者不良反应发生率比较(35.6%vs. 31.1%),差异无统计学意义(P> 0.05)。结论与小容量肺灌洗方案相比,采用大容量肺灌洗术治疗尘肺合并COPD可进一步抑制血清炎性因子表达,有助于增强肺通气功能,并有利于改善运动耐量及生活质量,且其治疗安全性与小容量肺灌洗方案相当。

Effects of different volume pulmonary lavage on serum inflammatory factors and pulmonary function in patients with pneumoconiosis complicated with chronic obstructive pulmonary disease

Objective To compare the effect of large volume lung lavage and small volume lung lavage on the improvement of serum inflammatory factors and lung function in patients with pneumoconiosis complicated with chronic obstructive pulmonary disease(COPD). Methods From August 2017 to July 2019,90 patients with pneumoconiosis and COPD admitted to Beijing Shijitan Hospital,Capital Medical University,were retrospectively selected,and they were divided into two groups according to different volume of lung lavage treatment plan,each 45 cases,the control group was treated with small-volume lung lavage,the observation group was treated with large-volume lung lavage. Serum inflammatory factorsinterleukin-6(IL-6),tumor necrosis factor α(TNF-α),transforming growth factor β1(TGF-β1) ],lung functionforced expiratory volume in the first second(FEV1),ratio of forced expiratory volume in the first second/force vital capacity(FEV1/FVC),peak expiratory flow(PEF) ] before treatment and 30 days after treatment,changes in exercise tolerance and quality of life at 6 months follow-up were compared between the two groups. The occurrence of adverse reactions in the 2 groups of patients was recorded. Results Before treatment,serum IL-6,TNF-α,TGF-β1 levels,FEV1,FEV1/FVC,PEF,6-min walking distance(6 MWD),and St. George’s Respiratory Questionnaire(SGRQ)scores were compared between the two groups,and there was no statistical difference significance(P > 0. 05). Thirty days after treatment,The levels of serum IL-6,TNF-α,TGF-1 in the observation group were(0. 35 ± 0. 08) μg/m L,(150. 35 ± 25. 63) ng/L,(41. 25 ± 5. 32) ng/L,respectively,which were significantly lower than those in the control group (0. 43 ± 0. 09) g/m L,(182. 76 ± 24. 17) ng/L,(50. 37 ± 5. 17)ng/L],the differences were statistically significant(P < 0. 05). Thirty days after treatment,FEV1,FEV1/FVC and PEF in the observation group were(1. 72 ± 0. 13) L,(69. 59 ± 5. 23) %,(371. 59 ± 10. 58) L/min,respectively,which were significantly higher than those in the control group(1. 46 ± 0. 12) L,(61. 03 ± 5. 17) %,(347. 02 ± 9. 27) L/min],the differences were statistically significant(P < 0. 05). After follow-up for 6 months,the SGRQ score in the observation group was(41. 39 ± 3. 02) points,which was significantly lower than that in the control group(49. 27 ± 3. 08) points],and the 6 MWD was(381. 75 ± 18. 31) m,which was significantly higher than that in the control group(307. 51 ± 17. 59) m],the differences were significant(P < 0. 05). The incidence of adverse reactions between the two groups was compared(35. 6% vs. 31. 1%),the difference was not statistically significant(P > 0. 05). Conclusion Compared with small-volume pulmonary lavage,high-volume pulmonary lavage in the treatment of pneumoconiosis with COPD can further inhibit the expression of serum inflammatory factors,contribute to the enhancement of pulmonary ventilation function,and improve exercise tolerance and quality of life,and its therapeutic safety is comparable to small-volume pulmonary lavage.