贾铁钢,乜庆荣
JIA Tiegang,NIE Qingrong

• 1:北京市房山区良乡医院呼吸科

摘要(Abstract)：

目的:探讨噻托溴铵治疗慢性阻塞性肺疾病(COPD)的临床疗效及对患者血清中白细胞介素-27(IL-27)水平的影响。方法:将136例COPD稳定期中重度患者随机分为观察组和对照组,对照组给予丙酸氟替卡松气雾剂治疗,观察组在此基础上给予噻托溴铵粉雾剂;评价两组患者治疗3个月后的临床疗效,比较两组患者治疗前后血清IL-27水平及用力肺活量(FVC)、第1秒用力呼气容积(FEV1)及第1秒用力呼吸容积占用力肺活量百分比(FEV1/FVC)肺功能指标的变化;并分析观察组患者血清IL-27水平与三项肺功能指标的相关性。结果:观察组临床治疗总有效率(98.53%)高于对照组(89.71%)差异有统计学意义(P<0.05);与治疗前相比,治疗3个月后,两组患者血清IL-27含量下降,观察组IL-27含量下降水平较对照组更为明显差异有统计学意义(P<0.05);与治疗前相比,两组治疗3个月后肺功能指标均有所改善,观察组3项肺功能指标均高于对照组,差异有统计学意义(P<0.05);观察组血清IL-27含量与FEV1、FEV1/FVC呈负相关(r=-0.611,r=-0.576,P<0.01),与FVC呈正相关(r=0.824,P<0.05)。结论:噻托溴铵治疗COPD可降低患者血清IL-27水平,对改善患者的气道炎症及肺功能具有重要促进作用。
Objective: To investigate the clinical efficacy of Tiotropium Bromide in the treatment of chronic obstructive pulmonary disease(COPD) and its effect on the levels of interleukin-27(IL-27)in serum of patients with chronic obstructive pulmonary disease(COPD). Methods: 136 cases of patients with moderate to severe stable COPD were randomly divided into observation group and control group. The control group was given Fluticasone Propionate Aerosol treatment while the observation group was given Tiotropium Bromide powder for inhalation besides fluticasone propionate aerosol treatment. Three months after treatment,the clinical efficacy of two groups was evaluated. Two groups were compared before and after treatment in terms of following of pulmonary function indexes,including the serum level of IL-27,forced vital capacity(FVC),1stsecond forced expiratory volume(FEV1) and the percentage of 1stsecond forced expiratory volume accounting for forced vital capacity(FEV1/FVC). The correlation between the level of serum IL-27 in observation group and three pulmonary function indexes was observed and analyzed. Results: The clinical treatment efficacy of observation group(98. 53%),significantly higher than that of the control group(89. 71%,P < 0. 05); Compared with before treatment,after 3 months treatment,the serum IL-27 levels of the patients in the two groups decreased,and the level of IL-27 in the observation group was significantly lower than that in the control group(P < 0. 05); Compared with before treatment,pulmonary function were improved after 3 months treatment,and FVC,FEV1 and FEV1/FVC levels in the observation group were significantly higher than those of the control group(P < 0. 05). The serum IL-27 level of the observation group was negatively correlated with FEV1 and FEV1/FVC(r =-0. 611,r =-0. 576,P < 0. 01),but was positively correlated with FVC(r = 0. 824,P < 0. 05). Conclusion: Tiotropium Bromide treatment of COPD can reduce the level of serum IL-27,and improve airway inflammation and pulmonary function.

关键词(KeyWords)： 肺疾病,阻塞性;药物疗法;噻托溴铵;血清素;用力呼气量
tiotropium bromide;COPD;IL-27;Th cell subsets in peripheral blood

Abstract:

Keywords:

基金项目(Foundation): 北京市科技计划项目(D151100002115002)

作者(Author): 贾铁钢,乜庆荣
JIA Tiegang,NIE Qingrong

参考文献(References)：

• [1]刘笑然,黄鑫炎,谭卫平,等.慢性阻塞性肺病患者外周血中CD34+细胞数量变化[J].海南医学院学报,2014(3):313-316.
• [2]毛卫未,江永青,欧阳良良,等.外周血白细胞CD64和CD11b指数在老年慢性阻塞性肺疾病急性期的早期诊断价值[J].细胞与分子免疫学杂志,2014(11):1201-1204.
• [3]戴沛军,冀雪娟,王恒辉,等.噻托溴铵联合沙美特罗/丙酸氟替卡松治疗稳定期重度慢性阻塞性肺疾病疗效观察[J].中华实用诊断与治疗杂志,2013(1):68-70.
• [4]朱秋蕾.噻托溴铵与沙美特罗/氟替卡松联合治疗慢性阻塞性肺疾病的临床疗效分析「J1.中国现代医生,2015(7):20-21.
• [5]Long X,Song WD,Liu YY,et al.The association of non-specific chronic inflammation with dendritic cells in a rat model of chronic obstructive pulmonary disease[J].Zhonghua Jie He Hu Xi Za Zhi,2011(8):609-613.
• [6]Nele SP,Ken RB,Tania M.The role of interleukin-6 in pulmonary and systemic manifestations in a murine model of chronic obstructive pulmonary disease[J].Experimental Lung Research,2010(3):469-483.
• [7]Kido M,Takeuchi S,Sugiyama N,et al.T cell-specific over expression of interleukin-27 receptor a subunit(WSX-1)prevents spontaneous skin inflammation in MRL/lpr mice[J].Br J Dermatol,2011(164):1214-1220.
• [8]崔丽英,任卉,郝璐,等.白细胞介素4、白细胞介素8、白细胞介素10在哮喘和慢性阻塞性肺疾病发病中的作用[J].中国临床医学,2012(1):22-24.
• [9]Cao J,Zhang L,Li D,et a1.IL-27 is elevated in patients with COPD and patients with pulmonary TB and induces human bronchial epithelial cells to produce CXCL 10[J].Chest,2012(1):121-130.
• [10]Sun C,Zhu M,Yang Z,et al.LL-37 secreted by epithelium promotes fibroblast collagen production:a potential mechanism ofsmall airway remodeling in chronic obstructive pulmonary disease[J].Lab Invest,2014(9):991-1002.
• [11]潘琪,林海燕.噻托溴铵与沙美特罗/丙酸氟替卡松联合吸入在重度慢性阻塞性肺疾病缓解期的临床应用[J].浙江医学,2015(8):698-700.
• [12]王彩芝,王雅红.吸入沙丁胺醇、异丙托溴铵气雾剂治疗稳定期慢性阻塞性肺疾病的临床观察[J].中国当代医药,2015(33):51-53.
• [13]赖善福,涂福文.支气管舒张药物联合用于慢性阻塞性肺疾病合并呼吸衰竭的疗效及安全性[J].中国医药,2014(12):1749-1751.
• [14]吕灼荣,房树娟,崔健,等.噻托溴铵联合沙美特罗/氟替卡松治疗稳定期C组慢性阻塞性肺疾病的疗效评价[J].国际医药卫生导报,2013(14):2135-2137.
• [15]陶丹萍,李志裸,傅强,等.白细胞介素-27在冠心病患者血浆中的变化及其临床意义[J].中国急救医学,2010(7):585-588.
• [16]韩志君,孙懿,严子禾,等.IL-27介导的炎症反应在原发性胆汁性肝硬化中的作用[J].中华微生物学和免疫学杂志,2010(8):755-759.
• [17]李兆国,吴晓梅.噻托溴铵吸入剂治疗稳定期D组慢性阻塞性肺疾病38例疗效评价[J].中国药业,2015(13):14-15.

文章评论(Comment)：