黄穗华 董敬军 邓杰方

[摘要]目的 探讨噻托溴铵与孟鲁司特联合治疗对慢性阻塞性肺疾病（COPD）患者的肺功能、痰液炎性细胞及炎性因子表达的影响。方法 选取2017年4月～2018年3月我院收治的86例COPD患者，采用随机数字表法将其分为对照组、观察组，每组43例。对照组予以茶碱缓释片口服治疗，研究组予以噻托溴铵联合孟鲁司特治疗。比较两组患者干预前后第一秒用力呼气量（FEV ）、肺活量（FVC）、第一秒用力呼气量占肺活量比例（FEV1/FVC）水平、痰液髓过氧化物酶（MPO）、白细胞介素（IL）-8、白三烯 B4（LTB4）水平、中性粒细胞以及嗜酸粒细胞水平。结果 干预前，两组患者肺功能相关指标的比较，差异均无统计学意义（P>0.05）；干预后，两组患者的肺功能相关指标均高于干预前，差异均有统计学意义（P<0.05）。研究组患者的肺功能相关指标均高于对照组，差异均有统计学意义（P<0.05）。干预前，两组患者的痰液炎性因子比较，差异均无统计学意义（P>0.05）；干预后，两组患者的痰液炎性因子均低于干预前，差异均有统计学意义（P<0.05），研究组患者的痰液炎性因子均低于对照组，差异均有统计学意义（P<0.05）。干预前，两组患者的诱导痰液炎性细胞比较，差异均无统计学意义（P>0.05）；干预后，两组患者的诱导痰液炎性细胞均低于干预前，差异均有统计学意义（P<0.05）；研究组患者的诱导痰液炎性细胞均低于对照组，差异均有统计学意义（P<0.05）。結论 噻托溴铵联合孟鲁司特治疗COPD可显著改善患者肺功能，降低痰液炎性因子水平，减少痰液炎性细胞。

[关键词]噻托溴铵；孟鲁司特；慢性阻塞性肺疾病；炎性细胞；炎性因子

[中图分类号] R563 [文献标识码] A [文章编号] 1674-4721（2018）8（b）-0085-04

Effect of Tiotropium Bromide combined with Montelukast on pulmonary function， inflammatory cells in sputum and expression of inflammatory factors in patients with chronic obstructive pulmonary disease

HUANG Sui-hua DONG Jing-jun DENG Jie-fang

Department of Respiratory Medicine， Bao′an District Central Hospital of Shenzhen City， Guangdong Province， Shenzhen 518101， China.

[Abstract] Objective To investigate the effect of Tiotropium Bromide combined with Montelukast on lung function， inflammatory cells in sputum and expression of inflammatory factors in patients with chronic obstructive pulmonary disease （COPD）. Methods A total of 86 COPD patients admitted to our hospital from April 2017 to March 2018 were selected and divided into control group and observation group with 43 cases in each group by random number table method. The control group was treated with Theophylline Sustained-release Tablets orally， while the study group was treated with Tiotropium Bromide combined with Montelukast. The levels of forced expiratory volume （FEV1）， vital capacity （FVC）， ratio of forced expiratory volume to vital capacity （FEV1/FVC）， sputum myeloperoxidase （MPO）， interleukin （IL）-8， leukotriene B4 （LTB4）， neutrophils and eosinophils were compared before and after the intervention. Results Before the intervention， there was no statistical difference between the two groups （P>0.05）. After the intervention， the lung function related indexes of the two groups were higher than those before the intervention， and the differences were statistically significant（P<0.05）. The lung function related indexes of the patients in the study group were higher than those of the control group， and the differences were statistically significant （P<0.05）. Before the intervention， there was no statistically significant difference in sputum inflammatory factors between the two groups （P>0.05）. After the intervention， the sputum inflammatory factors of the two groups of patients were lower than those before the intervention， the differences were statistically significant（P<0.05）， and the sputum inflammatory factors of the patients in the study group were lower than those of the control group， the differences were statistically significant （P<0.05）. Before the intervention， there was no statistically significant difference between the two groups in inducing sputum inflammatory cells（P>0.05）. After the intervention， the induced sputum inflammatory cells in the two groups were lower than those before the intervention， and the difference was statistically significant （P<0.05）. The induced sputum inflammatory cells in the study group were lower than those in the control group， the differences were statistically significant（P<0.05）. Conclusion Tiotropium Bromide combined with Montelukast can significantly improve the pulmonary function of COPD patients， reduce the level of inflammatory factors in sputum and reduce inflammatory cells in sputum.

[Key words] Tiotropium bromide； Montelukast； Chronic obstructive pulmonary disease； Inflammatory cells； Inflammatory factors

慢性阻塞性肺疾病（COPD）是临床中常见的一种呼吸系统疾病，具有较高的发病率，患者主要临床表现为进行性呼吸困难加重[1]，对患者生活工作造成严重影响。目前临床认为发病的诱发因素主要是肺血管、肺实质、气道的慢性炎症[2]。临床治疗以改善患者呼吸困难症状为首选，因此在治疗中单独使用支气管扩张药物治疗的效果并不理想。需要加以抗炎药物提高疗效。噻……