沙美特罗-丙酸氟替卡松吸入治疗中重度COPD 的临床观察.doc

　　沙美特罗/丙酸氟替卡松吸入治疗中重度COPD 的临床观察 【摘要】 目的 探讨吸入型肾上腺糖皮质激素(ICS)与长效β2受体激动剂（LABA）的预混制剂沙美特罗/丙酸氟替卡松(SAL/FP)对中重度慢性阻塞性肺疾病(COPD)的 治疗 作用。方法 COPD病人70例（全部病例入组前未使用过任何剂型的激素、受体激动剂、抗胆碱药，无氧疗史），随机分成两组，A组35例，吸入沙美特罗/丙酸氟替卡松（SAL/FP ）干粉剂，1吸/次，2次/天;B组35例，不吸入上述药物;两组病人均服用沐舒坦30mg/ tid。观察治疗3月、6月、12月三个时间点病人临床症状、乔治生活质量评分、肺功能、血中IL8和TNFα的水平、急性发作次数、住院次数、住院费用。结果 观察期各不同时间点A、B两组肺功能、圣·乔治生活质量评分(SGRQ)、急性加重发生次数及、健康状态和住院次数、等各项观察指标差异有显著性（Plt;0.05）；A组明显优于 B组，治疗前后诱导痰IL8和TNFα明显减低（Plt;0. 05）；但住院费用A 、B两组无明显差别（Pgt;0.０5）。结论 ICS与LABA治疗中重度COPD具有良好协同作用，其预混制剂(SAL/FP 50/ 250μg)干粉剂使用方便，近期疗效好，有临床应用价值，可短期改善COPD的FEV1的水平，对全身炎症反应无明显抑制作用，医疗费用没有明显增加。 【关键词】 慢性阻塞性肺疾病; 糖皮质激素; β2激动剂; 联合用药 　　ABSTRACT Objective To discuss the curative effect of inhaled glucocorticoid (ICS) in bination oderate and severe chronic obstructive pulmonary disease (COPD). Methods 70 patients ly divided into 2 groups: Group A and Group B, 35 in each group; all the patients, before this treatment, had no application history of any type of hormones, receptor agonists and anticholinergic drugs and they never had oxygen therapy; ambroxol g once and 3 times a day, and for patients in Group A, inhalation of Seretide Dry Poeterol/fluticasone, SM/FP, 50μg of salmeterol/259μg of fluticasone) ade at 3 time points (3 months, 6 months and 12 months after treatment) to the folloptoms, the score of St. George’s respiratory questionnaire (SGRQ), pulmonary function, the level of blood interleukin-8 (ＩＬ8) and ＴＮＦα , the acute exacerbations, times and expenses of hospitalization. Results The difference betonary function, the score of SGRQ, the acute exacerbation, the health status and the times of hospitalization and ＴＮＦα in Group A decreased significantly (Ｐ＜0.05); the parison of hospitalization expenses betoderate and severe COPD, the administration of SM/FP (50/ 250μg) is simple and the short-term curative effect is good, it can soon improve FEV1 but has no obvious inhibition on systemic inflammatory response; there exists no obvious increase of the hospitaliza