Objective To explore the therapeutic effect of the combination of Tiotropium bromide power for inhalation and Ambroxol in patients with mild-to-moderate stable chronic obstructive pulmonary disease (COPD). Method 110 patients with mild-to-moderate stable COPD from January 2014 to June 2016 in our hospital were selected as the subjects, all patients were randomly divided into observation group and control group by the random number table method. Control group patients were accepted regular treatment included oxygen therapy, cough and asthma relieving medicine. Observation group patients were treated with tiotropium bromide and ambroxol on the bosis of observation group. Before treatment and 6 months after treatment, the pulmonary function, the severity of symptoms estimated by the COPD assessment test (CAT), airway inflammatory index and airway remodeling index and hospitalization frequency during the follow-up period were compared between the two groups. Result After treatment, the forced expiratory volume in one second (FEV1), FEV1% predicted value, FEV1/forced vital capacity (FVC), peak expiratory flow (PEF), PEF% predicted value, maximal expiratory flow in 25% vital capacity (MEF25%), MEF25% ~ 75%, MEF75% in the two groups were significantly higher than before treatment (P < 0.05). Compared with control group, the FEV1, FEV1% predicted value, FEV1/FVC, PEF, PEF% predicted value, MEF25%, MEF25% ~ 75% of observation group were significantly higher than that of control group (P < 0.05), MEF75% improved, but there was no significant difference between the two groups (P > 0.05). After treatment, the CAT scores of the two groups were significantly lower than those before treatment (P < 0.05). The score of CAT in observation group was significantly lower than control group (P<0.05). The frequency of acute exacerbation of observation group (5 cases) requiring hospitalization was significantly lower than that of control group (13 cases) during the whole follow-up period (χ2 = 4.420,P = 0.036). After treatment, two groups of patients with interleukin (IL)-6 and IL-18 levels were significantly lower than before treatment (P < 0.05), Clara cell cell protein protein (CC16) level was significantly higher than before treatment (P < 0.05); IL-6 and IL-18 levels in observation group after treatment were significantly lower than control group (P < 0.05), the level of CC16 was significantly higher than control group (P < 0.05). Matrix metalloproteinase-9, transforming growth factor-β1, TIMP-1, basic fibroblast growth factor in the seum were significantly decreased in both groups after treatment (P<0.05), and the above indexes in observation group were significantly lower than that of control group (P < 0.05). Conclusion Tiotropium bromide power for inhalation combined with Ambroxol can improve the pulmonary function of mild-to-moderate stable COPD, abbreviate airway inflammation and delay airway remodeling.%目的 分析噻托溴铵粉吸入剂联合盐酸氨溴索对轻/中度稳定期慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者血清细胞因子水平及气道重塑的影响.方法 选取2014年1月至2016年6月于本院就诊的110例轻/中度稳定期COPD患者为研究对象.按照随机数表法将患者分为观察组和对照组,每组各50例.对照组患者接受吸氧、止咳、平喘等常规治疗,观察组患者在对照组治疗基础上加用噻托溴铵粉吸入剂联合盐酸氨溴索.比较两组患者治疗前和治疗后6个月肺功能变化、COPD评估测试(the COPD assessment test,CAT)评分、气道炎性指标、气道重塑指标及观察期内因急性发作而住院的患者例数.结果 治疗后两组患者第一秒用力呼气量(forced expiratory volume in one second,FEV1)、FEV1占预计值百分比(FEV1%预计值)、FEV1/用力肺活量(forced vital capacity,FVC)、呼气流量峰值(peak expiratory flow,PEF)、PEF占预计值百分比(PEF%预计值)、25%肺活量最大呼气流量(maximal expiratory flow in 25%vital capacity,MEF25%)、25%~75%肺活量最大呼气流量(MEF25%~75%)、75%肺活量最大呼气流量(MEF75%)均显著高于治疗前(P<0.05).与对照组相比,观察组患者FEV1、FEV1%预计值、FEV1/FVC、PEF、PEF%预计值、MEF25%、MEF25%~75%改善更显著(P<0.05),MEF75%有所提高,但两组间比较均无显著差异(P>0.05).治疗后两组患者CAT评分较治疗前均显著降低(P<0.05),观察组患者治疗后CAT评分显著低于对照组(P<0.05).观察期内,观察组5例和对照组13例患者因急性加重而住院治疗,两组比较差异具有显著性(χ2=4.420,P=0.036).治疗后两组患者白介素(interleukin,IL)-6和IL-18水平较治疗前均显著降低(P<0.05),克拉拉细胞蛋白(Clara cell protein,CC16)水平较治疗前显著升高(P<0.05);观察组患者治疗后IL-6和IL-18水平显著低于对照组(P<0.05),CC16水平显著高于对照组(P<0.05).治疗后两组患者血清中基质金属蛋白酶-9、转化生长因子-β1、基质金属蛋白酶组织抑制因子-1及碱性成纤维细胞生长因子水平较治疗前均显著降低(P<0.05),观察组患者血清中上述指标水平均显著低于对照组(P<0.05).结论 噻托溴铵粉吸入剂联合盐酸氨溴索治疗轻/中度稳定期COPD,能够明显改善患者肺功能,降低气道炎性因子表达水平,进一步延缓气道重塑.
展开▼
