雾化吸入与全身应用糖皮质激素对老年AECOPD患者的临床疗效比较及对PCT和hs-CRP表达的影响
Efficacy comparison of aerosol inhaled and systemic glucocorticoid and its influence on the expressions of PCT and hs-CRP in elderly AECOPD
洪向春 1闻文波 1刘姗姗2
作者信息
- 1. 余姚市梨洲医院余姚市康复医院内科,浙江余姚315400
- 2. 宁波市妇女儿童医院内科,浙江宁波315016
- 折叠
摘要
目的 观察比较雾化吸入与全身应用糖皮质激素对老年慢性阻塞性肺疾病急性发作(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者的临床疗效及对炎症介质降钙素原(procalcitonin,PCT)和超敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)表达的影响.方法 前瞻性纳入146例老年AECOPD患者为研究对象.随机分为3组,雾化吸入激素组(布地奈德2 mg/次,3次/天×5天,雾化组)48例;静脉应用激素组(甲基强的松龙40 mg/次,1次/天×5天,静脉组)50例和未应用激素组(对照组)48例.3组患者均常规予以氧疗、抗感染、祛痰剂及支气管扩张剂(β2受体激动剂、多索茶碱)等治疗.检测患者治疗前及治疗5天后血清PCT和hs-CRP的表达,同步记录治疗期间患者症状、血气分析、肺功能、住院天数、空腹血糖及不良反应等临床参数.结果 雾化组与静脉组临床总有效率、肺功能指标[第1秒用力呼气容积占预计值百分比(FEV1%pred)、第1秒用力呼气容积占用力肺活量的比值(FEV1/FVC)]和血气分析(pH值、PaO2、PaCO2)改善率均高于对照组,住院天数明显短于对照组(P<0.05),但在2组间比较无统计学意义.与治疗前比较,治疗后3组患者血清PCT和hs-CRP水平均有所下降(P<0.05);与对照组相比,雾化组与静脉组PCT和hs-CRP水平下降更为明显,但在2组间比较差异无统计学意义.与对照组、雾化组比较,静脉组患者空腹血糖升高更为明显(P<0.05);与对照组相比,雾化组和静脉组不良反应发生率明显升高,以静脉组升高更为显著(P<0.05).结论应用糖皮质激素有助于改善老年AECOPD患者的临床症状、肺功能,纠正低氧血症,缩短住院天数;雾化吸入与全身应用糖皮质激素在抗气道炎症方面疗效相当;雾化吸入糖皮质激素不良反应少,可推荐用于治疗老年AECOPD患者.
Abstract
Objective To observe and compare the clinical effect of aerosol inhaled and systemic glucocorticoid treatment and its influence on the expression of procalcitonin ( PCT) and hyper-sensitive C reactive protein ( hs-CRP) in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods 146 elderly patients with AECOPD were enrolled prospectively.The patients were divided in three groups randomly, including inhalation group (48 cases referred as 2 mg of budesonide nebulization every 8 hours with therapeutic course of 5 days), intravenous group (50 cases referred as 40 mg methylprednisolone intravenous injection once daily with therapeutic course of 5 days), and control group (48 cases with no glucocorticoid ) .All the patients were treated with routine oxygen therapy, anti-inflammation, bronchodilators (β2 receptor agonist and doxofylline) and mucolytics, and so on.The levels of serum PCT and hs-CRP were detected before and after five days treatment, and also the clinical parameters such as symptoms, blood gas analysis, lung function, hospital days, fasting blood glucose and adverse reaction were simultaneously recorded. Results The general clinical data demonstrated no significant difference among the groups.Compared with the control group, the total effective rate, improvement rate of lung function (FEV1%pred and FEV1/FVC) and of blood gas parameters (pH value, PaO2 and PaCO2) in the inhalation group and intravenous group were higher, with shorter hospital days(P<0.05), while with no obvious difference between the two group.The levels of the serum PCT and hs-CRP were decreased in the patients enrolled after treatment, compared with the prior treatment (P<0.05).Compared with the control group, the levels of serum PCT and hs-CRP in the inhalation group and intravenous group decreased significantly, while with no obvious difference between the two groups.The levels of fasting blood glucose in the intravenous group were the highest;compared with the control group, the adverse effect incidence of the inhalation and intravenous groups were higher obviously, with the most obvious in the intravenous group ( P<0.05 ). Conclusion Application of glucocorticoid is benefit to improving the clinical symptom and lung function, and to rectifying hypoxemia and to shortening hospital days.The aerosol inhaled and systemic glucocorticoid application shows equivalent clinical efficiency on anti-airway inflammation.The glucocorticoid inhalation has fewer adverse effects and is recommended to treat the elderly patients with AECOPD .
关键词
慢性阻塞性肺疾病急性发作/老年/糖皮质激素/雾化吸入/降钙素原/超敏C反应蛋白Key words
acute exacerbation of chronic obstructive pulmonary disease/elderly/glucocorticoid/aerosol inhaled/procalcitonin/hyper-sensitive C reactive protein引用本文复制引用
出版年
2017
NETL
NSTL
维普
万方数据