噻托溴铵联合布地奈德福莫特罗对哮喘-慢性阻塞性肺疾病重叠综合征患者气道重塑及免疫炎症反应的影响

王琴 朱齐琦 黄小红

[關键词] 哮喘-慢性阻塞性肺疾病重叠综合征;噻托溴铵;布地奈德福莫特罗;气道重塑;免疫;炎症反应

[中图分类号] R974.2          [文献标识码] B          [文章编号] 1673-9701（2021）29-0068-04

Effects of tiotropium bromide combined with budesonide and formoterol fumarate on airway remodeling and immune inflammatory response in patients with asthma-chronic obstructive pulmonary disease overlap syndrome

WANG Qin1   ZHU Qiqi2   HUANG Xiaohong1

1.Department of Geriatrics， Jiujiang No.1 People′s Hospital in Jiangxi Province， Jiujiang   332000， China; 2.Department of Respiration， Jiujiang No.1 People′s Hospital in Jiangxi Province， Jiujiang   332000， China

[Abstract] Objective To investigate the effects of tiotropium bromide combined with budesonide and formoterol fumarate on airway remodeling and immune inflammatory response in patients with asthma-chronic obstructive pulmonary disease （COPD） overlap syndrome （ACOS）. Methods A total of 100 patients with ACOS admitted to our hospital from January 2018 to January 2020 were retrospectively selected and divided into two groups based on the treatment method. They were the treatment group of tiotropium bromide combined with budesonide and formoterol fumarate （the combined treatment group， n=50） and the treatment group of budesonide and formoterol fumarate individually （the individual treatment group， n=50）. The symptom scores， lung function， airway remodeling index， immunity， inflammatory response， clinical efficacy， and occurrence of adverse reactions （ARs） in the two groups were statistically analyzed. Results The increase in the score of Activated Clotting Time of whole blood （ACT）， decrease in the score of COPD Assessment Test （CAT） and the score of Modified Medical Research Council Dyspnea Scale （mMRC）， decrease in residual volume （RV）/VTC， increase in inspiratory capacity （IC）/Total Lung Capacity （TLC） and forced expiratory volume in one second （FEV1）， decrease in WT， TDR and WA， increase in Th1， Th2 and Th1/Th2， decrease in the levels of serum hypersensitive C-reactive protein （hs-CRP） and eosinophil count （EOS） in the combined treatment group were significantly higher than those in the individual treatment group，the difference was statistically significant （P<0.05）. The total effective rate of the combined treatment group was significantly higher than that in the individual treatment group，the difference was statistically significant （P<0.05）. The incidence of ARs in the combined treatment group was significantly lower than that in the individual treatment group，the difference was statistically significant （P<0.05）. Conclusion In the treatment of ACOS， tiotropium bromide combined with budesonide and formoterol fumarate is more effective than budesonide and formoterol fumarate individually in reducing airway remodeling and immune inflammatory response in patients.

[Key words] Asthma-chronic obstructive pulmonary disease overlap syndrome; Tiotropium bromide; Budesonide and formoterol fumarate; Airway remodeling; Immunity; Inflammatory response

支气管哮喘、慢性阻塞性肺疾病（以下简称慢阻肺）在呼吸科均较为常见，在一定条件下会转化，哮喘-慢阻肺重叠综合征是其主要表现形式，老年人是高发人群，主要危险因素为吸烟[1]。相关医学研究显示[2]，气道炎症及变态反应是哮喘-慢阻肺重叠综合征的主要诱发因素，其会降低患者的免疫功能，因此极易反复发作，很难治愈，对患者的肺功能造成不良影响，严重的情况下还会引发肺衰竭，严重威胁患者生命安全。现阶段，吸入糖皮质激素治疗是临床通常采用的治疗方法，其能够对患者肺功能进行改善，但是缺乏理想的疗效[3]。本研究统计分析了2018年1月至2020年1月本院哮喘-慢阻肺重叠综合征患者100例的临床资料，探讨噻托溴铵联合布地奈德福莫特罗对哮喘-慢阻肺重叠综合征患者气道重塑及免疫炎症反应的影响，现报道如下。

1资料与方法

1.1 一般资料

回顾性选取2018年1月至2020年1月本院哮喘-慢阻肺重叠综合征患者100例，纳入标准：①均有持续性气流受限等临床表现;②均有哮喘史;③均符合哮喘-慢阻肺重叠综合征的诊断标准[4]。排除标准：①其他原因引发的呼吸困难、气喘者;②有严重胸部病变者;③近6周内应用过糖皮质激素者。依据治疗方法分为噻托溴铵联合布地奈德福莫特罗治疗组（联合治疗组，n=50）、单独布地奈德福莫特罗治疗组（单独治疗组，n=50）两组。……