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目的探讨胸腺肽对社区老年稳定期重度慢性阻塞性肺疾病(COPD)的疗效、免疫功能影响及安全性。方法选择确诊为老年稳定期重度COPD患者40例,将其随机分两组,对照组18例:常规口服药治疗和间歇低流量吸氧;治疗组22例:在常规口服药治疗和间歇低流量吸氧的基础上肌肉或皮下注射胸腺五肽20 mg/次,每周2次,疗程1年。观察治疗前后两组患者血清免疫球蛋白(IgG、IgA、IgM)水平、外周血T淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、1秒用力呼气容积(FEV1)、肺活量(FVC)、疗效和每年住院次数的变化。结果治疗后患者血清免疫球蛋白(IgG、IgA、IgM)水平、T淋巴细胞亚群(CD3+、CD4+、CD4+/CD8+比值)、PaO2均明显高于治疗前和对照组,PaCO2和每年住院次数却明显低于治疗前和对照组;CD8+变化不明显;两组患者FEV1、FVC均降低,治疗组比对照组下降较缓慢;治疗总有效率为90.9%,对照组为22.2%;依从性为86.4%,不良反应少,两组病死率差异无统计学意义。结论胸腺肽是提高社区老年稳定期重度COPD患者免疫功能、减少急性发作的一种有效而安全的方法,能明显延缓病情进展,改善生活质量,值得基层医院和社区推广。
Objective To investigate the therapeutic effect and safety of thymosin on elderly stable chronic obstructive pulmonary disease (COPD) in community. Methods Forty patients with severe chronic obstructive pulmonary disease (COPD) were enrolled in this study. They were randomly divided into two groups: control group (n = 18), conventional oral treatment and intermittent low-flow oxygen inhalation. Treatment group (n = 22) Oxygen based on the muscle or subcutaneous injection of thymopentin 20 mg / time, twice a week for 1 year. The levels of serum immunoglobulin (IgG, IgA and IgM), peripheral blood T lymphocyte subsets (CD3 +, CD4 +, CD8 +, CD4 + / CD8 +), PaO2 and arterial carbon dioxide Partial pressure (PaCO2), forced expiratory volume in 1 second (FEV1), vital capacity (FVC), efficacy and number of hospitalizations per year. Results After treatment, the levels of serum immunoglobulin (IgG, IgA and IgM), T lymphocyte subsets (CD3 +, CD4 +, CD4 + / CD8 + ratio) and PaO2 were significantly higher than those before treatment and control group Significantly lower than before treatment and control group; CD8 + did not change significantly; both groups of patients FEV1, FVC were decreased, the treatment group than the control group decreased more slowly; the total effective rate was 90.9%, control group was 22.2%; compliance was 86.4 %, Less adverse reactions, no significant difference between the two groups of mortality. Conclusion Thymosin is an effective and safe method to improve the immune function and reduce the acute episode of severe COPD patients in elderly stable stage. It can significantly delay the progress of disease and improve the quality of life. It is worth to promote the promotion of primary hospital and community.