重度COPD患者稳定期不同治疗方案的对照研究

发布时间：2018-03-11 18:47

本文选题：稳定期copd　切入点：噻托溴铵　出处：《广东药学院》2012年硕士论文　论文类型：学位论文

【摘要】：背景：慢性阻塞性肺疾病（COPD)是一种可以预防、可以治疗并伴有显著肺外效应的疾病，是一种具有气流受限特征的肺部疾病，气流受限不完全可逆，呈进行性发展。COPD的控制包括药物治疗和日常的功能锻炼。支气管舒张剂伴或者不伴吸入性糖皮质激素用于重度COPD患者稳定期的维持治疗被证明为有效的治疗方案。目的：评估噻托溴铵吸入、沙美特罗/氟替卡松吸入以及口服茶碱三种疗法对稳定期重度COPD患者的肺功能、生活质量、气道炎症因子的影响并观察药物的不良反应。方法：在4个星期的筛选期治疗后，符合条件的137个患者按1:1:1随机分配为三组,分别接受口服缓释茶碱片0.2BID、沙美特罗/氟替卡松50ug/250ug吸入BID或者噻托溴铵18ug QD吸入治疗。在试验的开始、第4、12、24周分别完成肺功能测定、6分钟步行实验、呼吸困难问卷、BODE指数、心电图以及痰细胞计数、痰VEGF和LTB4的测定。结果：在3组稳定期重度COPD患者中，茶碱组、沙美特罗/氟替卡松组以及噻托溴铵组分别有40、40、42个患者最终完成试验，三组患者的肺功能、6分钟步行实验、呼吸困难问卷、BODE指数都有所改善，，结果有统计学差异，吸入噻托溴铵组及沙美特罗/氟替卡松组的改善比茶碱组更显著，除了6分钟步行实验外，噻托溴铵组和沙美特罗/氟替卡松组两组之间其他检测无统计学差异。三组治疗方案都能减轻患者痰VEGF以及LTB4的含量，噻托溴铵对于痰VEGF的降低更显著。结论：噻托溴铵组、沙美特罗/氟替卡松组和茶碱组对于重度稳定期COPD患者均有较好的疗效，噻托溴铵组、沙美特罗/氟替卡松组相对于茶碱组疗效更显著，噻托溴铵组可能对于气道重塑有潜在的影响。
[Abstract]:Background: chronic obstructive pulmonary disease (COPD) is a preventable and can be treated with significant extrapulmonary effects of the disease, a lung disease characterized by airflow limitation, irreversible airflow limitation, a control for the development of.COPD include drug treatment and daily bronchodilator functional exercise. With or without inhaled corticosteroids as maintenance therapy for patients with severe COPD in stable phase were proved to be effective treatment. Objective: To evaluate the effect of tiotropium bromide inhalation, Shah Mette Lo / fluticasone inhalation and oral theophylline three therapy on severe stable lung function, quality of life in patients with COPD, adverse effect of airway inflammatory factors were observed.
Methods: during the screening period after 4 weeks of treatment, 137 eligible patients with 1:1:1 were randomly assigned into three groups, respectively received oral theophylline 0.2BID Shah Mette Lo / fluticasone inhalation of 50ug/250ug BID or 18ug QD tiotropium bromide inhalation therapy. At the start of the test, the 4,12,24 weeks were completed pulmonary function determination of 6 minute walk test, Dyspnea Questionnaire, BODE index, electrocardiogram and sputum cell counts, determination of sputum VEGF and LTB4.
Results: in 3 groups of patients with severe COPD in stable phase, theophylline group, Shah Mette Lo / fluticasone group and tiotropium group respectively 40,40,42 patients completed the final test, the pulmonary function of three groups of patients, 6 minutes walk test, Dyspnea Questionnaire, BODE index has improved, the results were statistically significant difference, inhalation the tiotropium group and Shah Mette Lo / fluticasone group better than theophylline group is more significant, in addition to the 6 minute walk test, the tiotropium group and Shah Mette Lo / fluticasone group between the two groups had no significant difference. Other treatment group three patients with phlegm can reduce VEGF and LTB4 content, Sai tiotropium bromide for reducing phlegm VEGF more significantly.
Conclusion: the tiotropium group, Shah Mette Lo / fluticasone group and theophylline group for severe COPD patients had good curative effect, the tiotropium group, Shah Mette Lo / fluticasone group compared with the more significant effect of theophylline group, the tiotropium group may have potential effects on airway remodeling.

【学位授予单位】：广东药学院
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R563.9

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