Objective To compare the effect of tiotropium bromide and ipratropium bromide on asthma chronic obstructive pulmonary disease overlap syndrome and their effects on serum TNF-α and IL-6.Methods Ninety cases of patients with asthma-chronic obstructive pulmonary disease overlap syndrome were selected, who were treated in hospital from March 2014 to March 2016, and they were divided into the A group (45 cases) and B group (45 cases).The patients of two groups were all treated with routine treatment, including reduction of exercise load, oxygenation, administration of budesonide aerosol inhalants (1 suction / time, 2 times / d).The patients of B group were treated with tiotropium inhalation powder (1 tablet / time, 1 time / d).The patients of A group were treated with ipratropium bromide aerosol (1 spray / time, 4 times / d).The patients of two groups were all treated for 8 weeks.The clinical efficacy, adverse reaction rate and changes of the levels of pulmonary function, TNF-α, IL-6 inflammatory cell levels, ACT, CAT and acute exacerbations of two groups were compared.Results After the appropriate treatment, the patients of the B group got a total effective rate of 91.1%, which was significantly better than the 73.3% of the A group (X2=4.865,P=0.027);The levels of PEF, FVC, FEV1%, IC/TLC, DLCO of the B group were significantly higher than those of the A group (t=10.173,t=4.250,t=7.409,t=2.162,t=1.743,P<0.05);The RV/TLC levels of the B group were significantly lower than those of the A group(t=3.931,P=0.000);The levels of ACT score of the B group were significantly higher than those of the A group(t=12.083,P=0.000);The TNF-α, IL-6 levels, CAT scores, acute exacerbation of the B group were significantly lower than those of the A group (t=7.754,t=2.831,t=7.701,t=9.000,P<0.01);There were dry mouth, headache, palpitations, nausea, hoarseness, dysuria,constipation and other adverse reactions occurred in both two groups, but there were no statistically significant between the two groups (P>0.05).Conclusion Compared with ipratropium bromide, tiotropium bromide for the treatment of asthma-chronic obstructive pulmonary disease overlap syndrome can get the exact effect, significantly reduce the levels of inflammatory cells, improve the lung function, and it is safe and reliable, which makes it worthy of clinical promotion.%目的 比较噻托溴铵与异丙托溴铵治疗哮喘-慢阻肺重叠综合征的效果及对血清TNF-α、IL-6的影响.方法 选择2014年3月-2016年3月唐山市协和医院呼吸内科收治哮喘-慢阻肺重叠综合征患者90例作为研究对象,按照随机数字表法分为2组,每组45例.2组患者均减少运动负荷,吸氧,给予布地奈德雾化粉吸入剂1吸/次,2次/d.A组在常规治疗基础上给予异丙托溴铵气雾剂1喷/次,4次/d;B组在常规治疗基础上给予噻托溴铵吸入粉雾剂1粒/次,1次/d.治疗8周后比较2组患者临床疗效,肺功能指标,TNF-α、IL-6水平,哮喘控制测试评分(ACT)、慢阻肺自我评估测试(CAT)及急性加重次数变化情况,并比较2组患者不良反应发生率.结果 治疗后B组总有效率为91.1%高于A组73.3%(X2=4.865,P=0.027);B组PEF、FVC、FEV1%、IC/TLC、DLCO高于A组、RV/TLC低于A组,差异均有统计学意义(t=10.173、4.250、7.409、2.162、1.743、3.931,P<0.05);B组ACT评分明显高于A组,TNF-α、IL-6水平、CAT评分、急性加重次数显著低于A组,差异均有统计学意义(t=12.083、7.754、2.831、7.701、9.000,P<0.01);2组患者治疗过程中均发生口干、头痛、心悸、恶心、声嘶、排尿困难、便秘等不良反应,但2组比较差异无统计学意义(P>0.05).结论 噻托溴铵治疗哮喘-慢阻肺重叠综合征疗效确切,能显著降低炎性细胞水平,提高肺功能,安全可靠,值得临床推广.
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