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目的:探讨吸入激素治疗哮喘-慢阻肺重叠综合征(ACOS)患者的临床疗效及对内皮细胞功能的影响。方法:收集2013年3月至2016年3月在我院接受治疗的95例ACOS患者,随机分为对照组48例和观察组47例。对照组患者给予西医综合治疗,观察组患者在对照组基础上给予丙酸氟替卡松雾化吸入剂治疗。观察治疗前后两组的肺功能指标(包括最大肺活量(FVC)、1 s用力呼吸容积(FEV1)、吸气分数(IC/TLC)、残总比(RV/TLC)以及一氧化碳弥散量(DLCO))、内皮细胞功能指标(包括可溶性细胞间黏附因子(SICAM-1)、血清NO及内皮素1(ET-1))、症状评分(包括哮喘症状评分(ACT)及慢阻肺症状评分(CAT))的变化以及临床疗效。结果:观察组的临床总有效率为89.4%,显著高于对照组的77.1%(P<0.05)。治疗后,两组的FEV1、FEV1/FVC、IC/TLC及RV/TLC均较治疗前明显改善(P<0.05),且观察组的FEV1、FEV1/FVC、IC/TLC、RV/TLC及DLCO改善幅度大于对照组(P<0.05)。治疗后,两组的血清SICAM和ET-1水平均较治疗前明显降低,血清NO水平显著升高(P<0.05),且观察组的血清SICAM和ET-1水平显著低于对照组,血清NO水平明显高于对照组(P<0.05)。治疗后,两组的ACT评分和CAT评分均较治疗前明显改善(P<0.05),且观察组的ACT评分显著高于对照组,CAT评分低于对照组(P<0.05)。结论:吸入糖皮质激素治疗ACOS的临床疗效显著,可有效改善患者的临床症状、肺功能和内皮细胞功能。
Objective: To investigate the clinical efficacy of inhaled corticosteroids in the treatment of patients with asthma - COPD and its effect on the function of endothelial cells. Methods: A total of 95 patients with ACOS treated in our hospital from March 2013 to March 2016 were randomly divided into control group (n = 48) and observation group (n = 47). Patients in the control group were treated with western medicine, while those in the observation group were treated with fluticasone propionate nebulized inhalation on the basis of the control group. Before and after treatment, the pulmonary function indexes including FVC, FEV1, IC / TLC, RV / TLC and DLCO were observed. (Including SICAM-1, serum NO and endothelin-1 (ET-1)), symptom scores (including asthma symptom score (ACT) and COPD symptom score )) Changes and clinical efficacy. Results: The total effective rate in the observation group was 89.4%, significantly higher than that in the control group (77.1%, P <0.05). After treatment, FEV1, FEV1 / FVC, IC / TLC and RV / TLC in both groups were significantly improved (P <0.05), and FEV1, FEV1 / FVC, IC / TLC, RV / TLC and DLCO The improvement was greater than that of the control group (P <0.05). After treatment, the levels of serum SICAM and ET-1 in both groups were significantly lower than those before treatment, and the levels of serum NO were significantly increased (P <0.05), and the levels of SICAM and ET-1 in the observation group were significantly lower than those in the control group NO level was significantly higher than the control group (P <0.05). After treatment, the ACT score and CAT score in both groups were significantly improved (P <0.05), and the ACT score in the observation group was significantly higher than that in the control group, CAT score was lower than the control group (P <0.05). Conclusion: The clinical efficacy of inhaled corticosteroids in the treatment of ACOS is significant, which can effectively improve the clinical symptoms, lung function and endothelial cell function in patients.