肖文香 李静 刘红梅

[摘要]目的 探討三种给药方式的糖皮质激素对慢性阻塞性肺疾病急性加重期（AECOPD）患者肺功能及炎性指标的影响。方法 选取2018年9月～2019年10月我院收治的60例AECOPD患者作为研究对象，按随机数字表法将患者分为A组（口服泼尼松）、B组（静脉输注甲泼尼龙）、C组（雾化吸入布地奈德），各20例。三组均同时接受平喘、化痰止咳、吸氧、营养支持及纠正电解质平衡等常规治疗。观察三组治疗前及治疗5 d后的肺功能[第1秒用力呼气量（FEV1）、用力肺活量（FVC）、FEV1/FVC]、血清炎症细胞因子[肿瘤坏死因子-α（TNF-α）、C反应蛋白水平（CRP）]水平，统计不良反应发生情况。结果 治疗前三组FEV1、FVC、FEV1/FVC水平比较，差异无统计学意义（P>0.05）。治疗5 d后，三组FEV1、FVC、FEV1/FVC水平均高于治疗前，差异有统计学意义（P<0.05）;B组FEV1、FVC、FEV1/FVC水平均高于C组，差异有统计学意义（P<0.05）;三组上述指标比较，差异均有统计学意义（P<0.05）。治疗前、后三组血清TNF-α、CRP水平差异均无统计学意义（P>0.05）;治疗5 d后，三组血清TNF-α、CRP水平均低于治疗前（P<0.05）。治疗5 d后，A组、 B组不良反应总发生率（40.00%，35.00%）高于C组（5.00%），差异均有统计学意义（P<0.05）;三组不良反应总发生率比较，差异有统计学意义（P<0.05）。结论 甲泼尼龙静脉滴注治疗与布地奈德雾化吸入治疗均能有效改善AECOPD 患者的肺功能，降低血清炎性因子水平，但布地奈德雾化吸入治疗的安全性较高。

[关键词]慢性阻塞性肺疾病急性加重;糖皮质激素;肺功能;炎性状况

[中图分类号] R56          [文献标识码] A          [文章编号] 1674-4721（2020）7（a）-0050-04

Effect of three types of glucocorticoid administration on lung function and inflammatory status of acute exacerbation of chronic obscructive pulmonary disease

XIAO Wen-xiang   LI Jing   LIU Hong-mei

Department of Pharmacy， CITIC Huizhou Hospital Co.， Ltd. CITIC Huizhou Hospital， Guangdong Province， Huizhou   516001， China

[Abstract] Objective To investigate the effects of three kinds of Glucocorticoids on pulmonary function and inflammatory status of acute exacerbation of chronic obscructive pulmonary disease （AECOPD）. Methods A total of 60 patients with AECOPD admitted to our hospital from September 2018 to October 2019 were selected as the research subjects， according to the random number table method， they were divided into group A （oral Prednisone）， group B （intravenous Methylprednisolone）， and group C （nebulized inhaled Budesonide）， each had 20 cases. All three groups of patients received conventional treatments such as asthma， phlegm and cough relief， oxygen inhalation，  nutritional support， and correction of electrolyte balance. Pulmonary function [forced expiratory volume in 1 second （FEV1）， forced vital capacity （FVC）， FEV1/FVC]， serum inflammatory cytokines [tumor necrosis factor-α （TNF-α）， C-reactive protein level （CRP） ] levels， the occurrence of adverse reactions were compared. Results There were no statistically significant differences in the levels of FEV1， FVC， and FEV1/FVC before treatment （P>0.05）. After 5 days of treatment， the levels of FEV1， FVC， and FEV1/FVC in the three groups were higher than those before treatment， and the difference were statistically significant （P<0.05）. The FEV1， FVC， FEV1/FVC levels in group B were higher than those in group C， the differences were statistically significant （P<0.05）. Ther was statistically significant difference in the above indicators of three groups （P<0.05）. The levels of serum TNF-α and CRP in the three groups before and after treatment were not statistically significant （P>0.05）; after 5 days of treatment， the levels of serum TNF-α and CRP in the three groups were lower than those before treatment （P<0.05）. After 5 days of treatment， the total incidence of adverse reactions in groups A and B （40.00%， 35.00%） were higher than that in group C （5.00%）， the differences were statistically significant （P<0.05）; adverse reactions in three groups， the difference in total incidence was statistically significant （P<0.05）. Conclusion Both intravenous drip therapy with Methylprednisolone and atomized inhalation therapy with Budesonide can effectively improve the lung function of AECOPD patients， reduce patients′ serum inflammatory factor levels， however， but the safety of Budesonide atomization inhalation therapy is higher.

[Keywords] Acute exacerbation of chronic obstructive pulmonary disease;Glucocorticoids; Lung function; Inflammation

慢性阻塞性肺疾病（COPD）是指具有气流阻塞特征的慢性肺气肿，是临床上常见的慢性疾病，致残率和病死率都很高。据有关调查显示[1]，我国COPD的发病率约为13.6%，多集中在40岁以上人群。COPD的确切发病机制尚未明确，已经发现的危险因素大致可分为内外因两类。临床表现为喘息和胸闷、气短或呼吸困难、慢性咳嗽、咳痰，更有甚者会出现呼吸衰竭，危及生命[2]。而COPD急性加重期（AECOPD）是指一种急性起病的过程，其特征是患者呼吸系统症状恶化，稳定期治疗不及时、不规范、环境理化因素改变均是引发此病的潜在因素[3]。研究发现[4]，给予AECOPD患者糖皮质激素的疗效显著。目前……