摘要
目的探讨免疫调节剂联合布地格福对慢性阻塞性肺疾病(COPD)的治疗效果及其对气道黏液高分泌、预后的影响。方法选取2019年9月—2021年9月国药同煤总医院呼吸与危重症医学科诊治COPD患者80例,随机数字表法分为对照组、研究组,各40例。对照组采取布地格福治疗,研究组采取布地格福+免疫调节剂治疗。治疗4周后,比较2组临床疗效,治疗前后肺功能指标[第1秒用力呼气容积/用力肺活量(FEV_(1)/FVC)、FEV_(1)占预计值百分比(FEV_(1)%)、残气容积/肺总量(RV/TLC)]、Treg/Th17细胞因子[白介素-17(IL-17)、转化生长因子-β_(1)(TGF-β_(1))、IL-10]、气道黏液高分泌相关指标[Toll样受体4(TLR4)、黏蛋白5AC(MUC5ac)、痰液干/湿比重],以及不良反应、预后情况。结果研究组治疗总有效率高于对照组(95.00%vs.65.00%,χ^(2)=11.250,P=0.001);研究组FEV_(1)/FVC、FEV_(1)%高于对照组(t/P=2.498/0.015、3.177/0.002),RV/TLC低于对照组(t=4.557,P<0.001);研究组痰液IL-10、TGF-β_(1)、TLR4高于对照组(t=4.514、9.407、3.575,P均<0.001),IL-17、MUC5ac、痰液干/湿比重低于对照组(t=6.232、4.046、8.771,P均<0.001);2组不良反应发生率比较,差异无统计学意义(P>0.05)。治疗12周后进行随访,研究组急性加重次数少于对照组(t=10.849,P<0.001),再住院率低于对照组(χ^(2)=4.451,P=0.034)。结论免疫调节剂联合布地格福治疗COPD效果显著,可缓解气道黏液高分泌状态、减轻临床症状、提升免疫功能,从而进一步改善预后。
Objective To investigate the therapeutic effect of immunomodulator combined with budesonide on chronic obstructive pulmonary disease(COPD)and its influence on airway mucus hypersecretion and prognosis.Methods From September 2019 to September 2021,80 patients with COPD were selected from the Department of Respiratory and Critical Care Medicine of Sinopharm Tongmei General Hospital.They were randomly divided into control group and research group,with 40 patients in each group.The control group was treated with budesonide,while the study group was treated with budesonide plus immunomodulator.To compare the clinical efficacy of the two groups,pulmonary function indexes[forced expiratory volume in the first second/forced vital capacity(FEV_(1)/FVC),FEV_(1)%of the estimated value(FEV_(1)%),residual volume/total lung volume(RV/TLC)],Treg/Th17 cytokines[interleukin-17(IL-17),transforming growth factor)before and after treatment-β_(1)(TGF-β_(1)),IL-10],airway mucus hypersecretion related indicators[Toll like receptor 4(TLR4),mucin 5AC(MUC5ac),dry/wet proportion of sputum],adverse reactions and prognosis.Results After 4 weeks of treatment,the total effective rate of the study group was higher than that of the control group(95.00%vs.65.00%,χ^(2)=11.250,P=0.001)。FEV_(1)/FVC,FEV_(1)%in the study group were higher than those in the control group(t/P=2.498/0.015,3.177/0.002),and RV/TLC were lower than those in the control group(t=4.557,P<0.001).Study group sputum IL-10,TGF-β_(1).TLR4 was higher than that in the control group(t=4.514,9.407,3.575,P<0.001).The dry/wet specific gravity of IL-17,MUC5ac and sputum in the control group was lower than that in the control group(t=6.232,4.046,8.771,P<0.001).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Follow up after 12 weeks of treatment showed that the number of acute exacerbations in the study group was less than that in the control group(t=10.849,P<0.001),and the readmission rate was lower than that in the control group(χ^(2)=4.451,P=0.034).Conclusion The combination of immunomodulator and budesonide in the treatment of COPD has a significant effect,which can alleviate the airway mucus hypersecretion,alleviate clinical symptoms,improve immune function,and further improve the prognosis.
作者
王晋红
赵海
冯涛
郭穆芳
白海霞
Wang Jinhong;Zhao Hai;Feng Tao;Guo Mufang;Bai Haixia(Department of Respiratory and Critical Care Medicine,Sinopharm Tongmei General Hospital,Shanxi Province,Datong 037036,China)
出处
《疑难病杂志》
CAS
2023年第2期119-123,131,共6页
Chinese Journal of Difficult and Complicated Cases
基金
山西中医药大学科技创新能力培育计划项目(2019PY-126)。
关键词
慢性阻塞性肺疾病
免疫调节剂
布地格福
气道黏液高分泌
Chronic obstructive pulmonary disease
Immunomodulators
Budegefo
Airway mucus hypersecretion
