[1]李瑞敏,丁艳艳,张永祥.噻托溴铵联合布地奈德治疗哮喘-慢性阻塞性肺疾病重叠综合征疗效观察[J].新乡医学院学报,2021,38(3):273-277.[doi:10.7683/xxyxyxb.2021.03.014]
　LI Ruimin,DING Yanyan,ZHANG Yongxiang.Effect of tiotropium bromide combined with budesonide in the treatment of asthma-chronic obstructive pulmonary disease overlap syndrome[J].Journal of Xinxiang Medical University,2021,38(3):273-277.[doi:10.7683/xxyxyxb.2021.03.014]
点击复制

噻托溴铵联合布地奈德治疗哮喘-慢性阻塞性肺疾病重叠综合征疗效观察
分享到：

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
38
期数:
2021年3
页码:
273-277
栏目:
临床研究
出版日期:
2021-03-05

文章信息/Info

Title:
Effect of tiotropium bromide combined with budesonide in the treatment of asthma-chronic obstructive pulmonary disease overlap syndrome
作者:
李瑞敏; 丁艳艳; 张永祥
（首都医科大学大兴教学医院呼吸与危重症医学科，北京　102600）
Author(s):
LI Ruimin; DING Yanyan; ZHANG Yongxiang
(Department of Respiratory and Critical Care Medicine,Daxing Teaching Hospital,Capital Medical University,Beijing 102600,China)
关键词:
哮喘-慢性阻塞性肺疾病重叠综合征; 布地奈德; 噻托溴铵; 呼出气一氧化氮; 内皮素-1; 心率变异性
Keywords:
asthma-chronic obstructive pulmonary disease overlap syndromebudesonidetiotropium bromidefractional exhaled nitric oxideendothelin-1heart rate variability
分类号:
R563
DOI:
10.7683/xxyxyxb.2021.03.014
文献标志码:
A
摘要:
目的　探讨噻托溴铵联合布地奈德治疗哮喘-慢性阻塞性肺疾病重叠综合征（ACOS）的临床效果。方法　选择2016年11月至2018年11月首都医科大学大兴教学医院收治的100例ACOS患者为研究对象，根据治疗方法将患者分为观察组（n=51）和对照组（n=49）。2组患者均给予止咳、抗感染等常规治疗，在常规治疗基础上，对照组患者给予噻托溴铵治疗，观察组患者给予噻托溴铵和布地奈德联合治疗。分别于治疗前及治疗后，应用呼出气一氧化氮（FeNO）测定系统检测FeNO水平；使用肺功能检测仪检查患者肺功能，包括用力肺活量（FVC）、第1秒用力呼气容积（FEV1）、FEV1/ FVC；应用慢性梗阻性肺疾病评估测试（CAT）评分和哮喘控制测试（ACT）评分评估患者病情；应用心率变异分析仪检查患者心率变异性（HRV），包括全部窦性心搏间期的标准差（SDNN）、全部相邻窦性心搏间期差值的均方根（RMSSD）、相邻窦性心搏间期的差值大于50 ms的心搏数占总心搏数的百分比（PNN50）；采用酶联免疫吸附法检测血清内皮素-1（ET-1）水平。治疗后评估2组患者临床疗效，并观察2组患者治疗期间不良反应发生情况。结果　治疗前2组患者FeNO、血清ET-1水平比较差异无统计学意义（P＞0.05），2组患者治疗后FeNO、血清ET-1水平显著低于治疗前（P＜0.05）；治疗后，观察组患者FeNO、血清ET-1水平显著低于对照组（P＜0.05）。治疗前2组患者FVC、FEV1、FEV1/ FVC比较差异无统计学意义（P＞0.05），2组患者治疗后FVC、FEV1、FEV1/ FVC显著大于治疗前（P＜0.05）；治疗后，观察组患者FVC、FEV1、FEV1/ FVC显著大于对照组（P＜0.05）。治疗前2组患者CAT评分、ACT评分比较差异无统计学意义（P＞0.05）；与治疗前比较，2组患者治疗后CAT评分显著降低，ACT评分显著升高（P＜0.05）；治疗后，观察组患者CAT评分显著低于对照组，ACT评分显著高于对照组（P＜0.05）。治疗前2组患者SDNN、RMSSD、PNN50比较差异无统计学意义（P＞0.05），2组患者治疗后SDNN、RMSSD、PNN50显著高于治疗前（P＜0.05）；治疗后，观察组患者SDNN、RMSSD、PNN50显著高于对照组（P＜0.05）。观察组和对照组患者治疗总有效率分别为92.16%（47/51）、77.55%（38/49），观察组患者治疗总有效率显著高于对照组（χ2=4.181，P＜0.05）。观察组和对照组患者不良反应发生率分别为13.73%（7/51）、16.33%（8/49），2组患者不良反应发生率比较差异无统计学意义（χ2=0.133，P>0.05）。结论　噻托溴铵联合布地奈德可以显著减轻ACOS患者的临床症状，改善肺功能。
Abstract:
Objective　To investigate the clinical effect of tiotropium bromide combined with budesonide in the treatment of asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS).Methods　　A total of 100 patients with ACOS admitted to Daxing Teaching Hospital of Capital Medical University from November 2016 to November 2018 were selected as the research subjects,and the patients were divided into observation group (n=51) and control group (n=49) according to the treatment methods.The patients in the two groups were given cough relieving,anti-infection and other conventional treatment.On the basis of conventional treatment,the patients in the control group were treated with tiotropium bromide,and the patients in the observation group were treated with tiotropium bromide combined with budesonide.Before and after treatment,the fractional exhaled nitric oxide (FeNO) level was detected by FeNO measuring system;the pulmonary function was measured by pulmonary function detector,including forced vital capacity (FVC),forced expiratory volume in one second (FEV1) and FEV1/FVC;the pathogenetic condition of patients was evaluated by chronic obstructive pulmonary disease assessment test (CAT) and asthma control test (ACT);the heart rate variability (HRV) was measured by heart rate variability analyzer,including the standard deviation of NN intervals (SDNN),the root mean square of successive differences in adjacent NN intervals (RMSSD) of all adjacent sinus intervals,and the percent of the number whose difference between adjacent NN interval more than 50 ms (PNN50);the level of serum endothelin-1(ET-1) was detected by enzyme-linked immunosorbent assay.The clinical efficacy of patients in the two groups was evaluated after treatment,and the adverse reactions of patients in the two groups were observed.Results　There was no significant difference in the levels of FeNO and serum ET-1 between the two groups before treatment (P＞0.05).The levels of FeNO and serum ET-1 after treatment were significantly lower than those before treatment in the two groups (P<0.05).The levels of FeNO and serum ET-1 in the observation group were significantly lower than those in the control group after treatment (P＜0.05).There was no significant difference in the FVC,FEV1 and FEV1/FVC between the two groups before treatment (P＞0.05).The FVC,FEV1 and FEV1/FVC of patients after treatment were significantly higher than those before treatment in the two groups (P＜0.05).The FVC,FEV1 and FEV1/FVC in the observation group were significantly higher than those in the control group after treatment (P＜0.05).There was no significant difference in the CAT score and ACT score between the two groups before treatment (P＞0.05).Compared with before treatment,the CAT score decreased significantly,and the ACT score increased significantly in the two groups after treatment (P＜0.05).After treatment,the CAT score in the observation group was significantly lower than that in the control group,and the ACT score in the observation group was significantly higher than that in the control group (P＜0.05).There was no significant difference in the SDNN,RMSSD and PNN50 between the two groups before treatment (P＞0.05).The SDNN,RMSSD and PNN50 of patients in the two groups after treatment were significantly higher than those before treatment (P＜0.05).The SDNN,RMSSD and pNN50 in the observation group were significantly higher than those in the control group after treatment (P＜0.05).The total effective rate in the observation group and the control group was 92.16% (47/51) and 77.55% (38/49),respectively.The total effective rate in the observation group was significantly higher than that in the control group (χ2=4.181,P＜0.05).The incidence of adverse reactions in the observation group and the control group was 13.73% (7/51) and 16.33% (8/49),respectively.There was no significant difference in the incidence of adverse reactions between the two groups (χ2=0.133,P＞0.05).Conclusion　Tiotropium bromide combined with budesonide can significantly reduce the clinical symptoms and improve lung function in patients with ACOS.

参考文献/References:

［1］　王晶，汪玉龙，郭锋.中老年人群中慢性阻塞性肺疾病、哮喘和哮喘-慢阻肺重叠综合征的临床特征分析［J］.临床和实验医学杂志，2020，19（24）：2626-2630.
［2］　陈锋，李群，吴迪，等.哮喘-慢性阻塞性肺疾病重叠综合征患者呼出气冷凝集液中TNF-α、IL-8、IL-10的检测水平及意义［J］.国际呼吸杂志，2020，40（8）：566-571.
［3］　BOULET L P,HANANIA N A.The many faces of asthma-chronic obstructive pulmonary disease overlap［J］.Curr Opini Pulm Med,2019,25(1):1-10.
［4］　徐高俊，潘选良，潘微微.孟鲁司特联合噻托溴铵用于治疗哮喘-慢性阻塞性肺疾病重叠综合征患者的临床观察［J］.中国药师，2019，22（4）：699-702.
［5］　李乃谦，杨传印.三子止咳胶囊联合布地奈德治疗慢性阻塞性肺疾病稳定期的临床研究［J］.现代药物与临床，2020，35（2）：291-294.
［6］　王贞，辛丽红.沙丁胺醇、布地奈德辅助雾化吸入治疗小儿哮喘合并呼吸道病毒感染的疗效［J］.中华生物医学工程杂志，2020，26（4）：360-364.
［7］　孙永昌.哮喘-慢阻肺重叠综合征指南解读［J］.中国呼吸与危重监护杂志，2014，13（4）：325-329.
［8］　王晓娟，方向阳.慢性阻塞性肺疾病全球倡议2019：慢性阻塞性肺疾病诊断、治疗与预防全球策略解读［J］.中国全科医学，2019（18）：2141-2149.
［9］　MORGAN B W,GRIGSBY M R,SIDDHARTHAN T,et al.Epidemiology and risk factors of asthma-chronic obstructive pulmonary disease overlap in low- and middle-income countries［J］.J Allergy Clin Immunol,2019,143(4):1598-1606.
［10］　张勇，韩兆勇.孟鲁司特钠片联合沙美特罗替卡松粉吸入剂治疗哮喘-慢性阻塞性肺疾病重叠综合征的临床研究［J］.中国临床药理学杂志，2020，36（7）：744-746.
［11］　王宁，栗娜，韩巧玲，等.布地奈德福莫特罗联合噻托溴铵治疗哮喘-慢性阻塞性肺疾病重叠的临床研究［J］.中国综合临床，2021，37（1）：39-45.
［12］　GUERRIERO M,CAMINATI M,VIEGI G,et al.Prevalence and features of asthma-chronic obstructive pulmonary disease overlap in Northern Italy general population［J］.J Asthma,2019,56(1):27-33.
［13］　石慧，云春梅，魏慧，等.噻托溴铵联合布地奈德福莫特罗治疗哮喘-慢阻肺重叠综合征临床观察［J］.中国药师，2020，23（5）：901-904.
［14］　李宇青，冯高华，成怡楠.FeNO和血清维生素D、白介素-22在哮喘-慢性阻塞性肺疾病重叠综合征患者中的表达及临床意义［J］.海南医学，2019，30（2）：150-154.
［15］　李莉，李军.FeNO与肺通气功能指标对哮喘-COPD重叠综合征患者的诊断价值研究［J］.广西医科大学学报，2019，36（1）：94-97.
［16］　BOONSAWAT W.Cost-effectiveness of budesonide/formoterol maintenance and rescue therapy in Thailand［J］.Asian Biomed,2018,4(4):571-578.
［17］　李树艳，张功亮，李霖钰.小儿哮喘治疗前后血清ET-1、NO、CEC水平变化及临床意义［J］.标记免疫分析与临床，2019，26（1）：89-92.
［18］　刘超，杨金凤，尚刚.吸入糖皮质激素联合化痰降气活血方对ACOS疗效及FeNO和ET-1水平的影响［J］.贵州医科大学学报，2018，43（2）：240-243.
［19］　AYUB I I,ARSHAD A M,SEKAR P,et al.Predictors of asthma-chronic obstructive pulmonary disease overlap syndrome in patients with chronic obstructive pulmonary disease from a tertiary care center in India［J］.Lung India,2018,35(2):137-142.
［20］　杨亚萍，邢江，冀美佳，等.慢性阻塞性肺疾病患者心率变异性与病情指标的相关性分析［J］.中国临床医生杂志，2019，47（9）：1048-1051.

相似文献/References:

[1]苏海生,忽新刚.布地奈德福莫特罗粉吸入剂吸入治疗对轻度支气管哮喘患者气道重塑和支气管肺泡灌洗液中炎症介质的影响 [J].新乡医学院学报,2011,28(03):339.
[2]刘　琳,陈秋芳,付　荣,等.早期应用布地奈德对极早产儿支气管肺发育不良的影响[J].新乡医学院学报,2021,38(5):468.[doi:10.7683/xxyxyxb.2021.05.015]
　LIU Lin,CHEN Qiufang,FU Rong,et al.Effect of early application of budesonide on bronchopulmonary dysplasia in very preterm infants[J].Journal of Xinxiang Medical University,2021,38(3):468.[doi:10.7683/xxyxyxb.2021.05.015]
[3]柴海强,刘　敏,李　妮,等.阿奇霉素联合山莨菪碱和布地奈德治疗社区获得性肺炎疗效观察[J].新乡医学院学报,2020,37(12):1177.[doi:10.7683/xxyxyxb.2020.12.017]
　CHAI Haiqiang,LIU Min,LI Ni,et al.Effect of azithromycin combined with anisodamine and budesonide in the treatment of community acquired pneumonia[J].Journal of Xinxiang Medical University,2020,37(3):1177.[doi:10.7683/xxyxyxb.2020.12.017]
[4]王　运.布地奈德联合福莫特罗雾化吸入治疗慢性阻塞性肺疾病的效果及其对患者肺功能和炎性递质的影响[J].新乡医学院学报,2017,34(10):932.[doi:10.7683/xxyxyxb.2017.10.017]
　WANG Yun.Curative effect of the budesonide and formoterol inhalation on chronic obstructive pulmonary disease and its effect on pulmonary function and inflammatory mediators[J].Journal of Xinxiang Medical University,2017,34(3):932.[doi:10.7683/xxyxyxb.2017.10.017]
[5]刘后存.特布他林联合布地奈德雾化吸入治疗儿童感染后闭塞性细支气管炎疗效观察[J].新乡医学院学报,2017,34(10):943.[doi:10.7683/xxyxyxb.2017.10.020]
　LIU Hou-cun.Effect of terbutaline combined with budesonide inhalation in the treatment of children with bronchiolitis obliterans after infection[J].Journal of Xinxiang Medical University,2017,34(3):943.[doi:10.7683/xxyxyxb.2017.10.020]
[6]姚丽霞.布地奈德雾化吸入治疗老年哮喘的疗效及其对血清白细胞介素-2、白细胞介素-5和γ-干扰素水平的影响[J].新乡医学院学报,2016,33(1):061.[doi:10.7683/xxyxyxb.2016.01.018]
　YAO Li-xia.Effect of budesonide inhalation in treating elderly patients with asthma and its effect on the levels of serum interleukin-2,interleukin-5 and interferon-γ[J].Journal of Xinxiang Medical University,2016,33(3):061.[doi:10.7683/xxyxyxb.2016.01.018]
[7]韩金芬,王文秀,王川云,等.布地奈德联合阿奇霉素治疗儿童肺炎支原体肺炎疗效观察[J].新乡医学院学报,2016,33(8):684.[doi:10.7683/xxyxyxb.2016.08.009]
　HAN Jin-fen,WANG Wen-xiu,WANG Chuan-yun,et al.Curative effect analysis of budesonide combined with azithromycin on mycoplasma pneumoniae pneumonia in children[J].Journal of Xinxiang Medical University,2016,33(3):684.[doi:10.7683/xxyxyxb.2016.08.009]

更新日期/Last Update: 2021-03-05