全身性和吸入性糖皮质激素治疗对AECOPD系统性炎症反应水平的影响

摘要

Objective To investigate the effect of different administration ways of glucocorticoid in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods One hundred and fifty patients with AECOPD (grade B and C) were randomly divided into intravenous administration group,oral administration group and aerosol inhalation group.Arterial blood gas (ABG) indexes (PO2 and PCO2),lung functions (FVC,FEV1 and FEV1/FVC),the serum levels of inflammatory mediators (CRP,TNF-α,IL-5,IL-6 and IL-10) and the adverse reactions were recorded,before and after 7 days treatment.Results After 7 days treatment,ABG indexes,lung functions and the serum levels of inflammatory mediators were all improved in 3 groups (P ＜ 0.05 in all),compared with before treatment.Then,after 7 days treatment,the differences in the serum levels of CRP,TNF-α,IL-5,IL-6 and IL-10,and,FVC,PaO2 and PaCO2 were not found among 3 groups (P ＞ 0.05 in all).However,the improvement of FEV1％ and FEV1/FVC was more significant in intravenous administration group (P ＜ 0.05 in all).And no differences in FEV1％ and FEV1/FVC was observed between oral administration group and aerosol inhalation group (P ＞ 0.05 in all),after 7 days treatment.Meanwhile,we also noticed that therates of adverse reactions was lower in aerosol inhalation group (P ＜ 0.05).And there was no difference in the rates of adverse reactions between intravenous administration group and oral administration group (P ＞ 0.05).Conclusion Our results indicated that both systemic and inhaled corticosteroids could improve ABG indexes,lung functions and the serum levels of inflammatory mediators in patients with AECOPD.Meanwhile,the effects of intravenous administration of corticosteroid are better than that of oral administration and inhalation.However,inhalation was safer.Therefore,individual treatment should be considered in patient with AECOPD.%目的 探讨糖皮质激素的不同给药方式对慢性阻塞性肺疾病急性加重期(AECOPD)患者血气指标、肺功能和炎症因子的影响.方法 按入选标准采用随机数字表法将收治的150例AECOPD患者(B和C级)分为静脉组、口服组及吸入组,每组各50例.三组患者均给予抗感染、化痰以及维持酸碱平衡等的常规治疗.分别记录1d和7d时患者动脉血气指标(PO2和PCO2)、肺功能指标(FVC、FEV1和FEV1/FVC)、血炎症介质(CRP、TNF-α、IL-5、IL-6和IL-10)水平.结果 三组患者治疗7d后动脉血气指标、肺功能指标和血炎症介质水平均较治疗前改善,差异有统计学意义(P＜0.05).治疗7d后三组之间CRP、TNF-α、IL-5、IL-6和IL-10以及FVC、PaO2、PaCO2水平均无统计学差异(P＞0.05);但静脉组治疗7d后FEV1％、FEV1/FVC水平改善较其他组更明显,差异有统计学意义(P＜0.05),但口服组及雾化吸入组之间比较差异无统计学意义(P＞0.05).治疗期间雾化吸入组不良反应发生率较口服组和静脉组更低,差异有统计学意义(P＜0.05),但静脉组与口服组之间比较未见明显统计学差异(P均＞0.05).结论 全身与吸入糖皮质激素治疗AECOPD均能有效改善患者的血气指标、肺功能及炎症水平,且静脉甲泼尼龙效果稍优于口服泼尼松和吸入布地奈德,但吸入激素的不良反应更少更安全.临床可对不同患者应采用不同的治疗药物及方法.