糠酸氟替卡松/维兰特罗对慢性阻塞性肺疾病急性发作期的影响

doi:10.3877/cma.j.issn.1674-6902.2020.05.005

目的

观察糠酸氟替卡松/维兰特罗(FF/VI)对慢性阻塞性肺病(COPD)急性发作期患者肺功能、外周血Th1/Th2漂移、谷胱甘肽过氧化物酶(GSH-PX)、丙二醛(MDA)和8-羟基脱氧鸟苷(8-OHdG)水平的影响。

方法

选取本院100例COPD急性发作期患者，以数字表法随机分为2组，对照组予以常规治疗，研究组于其基础上使用FF/VI，比较2组治疗前后肺功能指标[残气量与肺总量百分比(RV/TLC%)、1 s末用力呼气容积占预计值百分比(FEV₁%)]、GSH-PX、MDA、8-OhdG水平及不良反应情况；并取同期50例体检健康者纳入健康组，分析研究组与对照组外周血Th1/Th2漂移[干扰素γ(INF-γ)、白介素4(IL-4)及IL-4/INF-γ]情况。

结果

研究组治疗后FEV₁%明显高于对照组(P<0.05)，且RV/TLC%明显低于对照组(P<0.05)；2组治疗前INF-γ、IL-4均显著高于健康组(P<0.05)，INF-γ/IL-4显著低于健康组(P<0.05)，2组治疗后INF-γ、IL-4显著降低(P<0.05)，且INF-γ/IL-4显著升高(P<0.05)，研究组INF-γ、IL-4明显低于对照组(P<0.05)，INF-γ/IL-4明显高于对照组(P<0.05)；研究组治疗后GSH-PX水平明显高于对照组(P<0.05)，MDA、8-OhdG水平明显低于对照组(P<0.05)；2组不良反应总发生率比较无显著差异(P>0.05)。

结论

FF/VI可有效调节COPD急性发作期患者外周血Th1/Th2漂移，改善GSH-PX、MDA、8-OhdG表达水平，增强机体免疫能力与抗氧化功能，促进肺功能恢复。

关键词: 糠酸氟替卡松/维兰特罗, 肺疾病, 慢性阻塞性, 急性发作期, 肺功能, Th1/Th2

Objective

To observe the effects of fluticasone furoate/vilantrol (FF/VI) on lung function, peripheral blood Th1/Th2 drift, glutathione peroxidase (GSH-PX), malondialdehyde (MDA) and 8-hydroxy-2′-deoxyguanosine (8-OHdG) levels in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD).

Methods

A total of 100 patients with acute exacerbation of COPD were selected from the hospital and randomly divided into two groups by number table method. The control group were given conventional treatment. On the basis, the experimental group were additionally treated with FF/VI. Lung function indexes [the ratio of residual volume to total lung capacity (RV/TLC%), the percentage of forced expiratory volume in one second in the predicted value (FEV₁%)], levels of GSH-PX, MDA and 8-OhdG and adverse reactions were compared between the two groups before and after treatment. 50 healthy people were selected and included in the health group at the same time. The situation of peripheral blood Th1/Th2 drift [interferon γ (INF-γ), interleukin 4 (IL-4) and IL-4/INF-γ] in the experimental group and the control group was analyzed.

Results

After treatment, the FEV₁% in the experimental group was significantly higher than that in the control group (P<0.05), and the RV/TLC% was significantly lower than that in the control group (P<0.05). Before treatment, INF-γ and IL-4 were significantly higher in the experimental group and the control group than in the healthy group (P<0.05), while INF-γ/IL-4 was significantly lower than the healthy group (P<0.05). After treatment, INF-γ and IL-4 in the experimental group and the control group decreased significantly (P<0.05), and INF-γ/IL-4 increased significantly (P<0.05). INF-γ and IL-4 in the experimental group were significantly lower than those in the control group (P<0.05), and INF-γ/IL-4 was significantly higher than the control group (P<0.05). After treatment, the GSH-PX level in the experimental group was significantly higher than that in the control group (P<0.05), and the levels of MDA and 8-OhdG were significantly lower than the control group (P<0.05). There was no significant difference in the overall incidence of adverse reactions between the two groups (P>0.05).

Conclusion

FF/VI can effectively regulate the peripheral blood Th1/Th2 drift in patients with acute exacerbation of COPD, improve the expression levels of GSH-PX, MDA and 8-OhdG, and enhance the immune capacity, with antioxidant effect. It also can promote the recovery of lung function.

Key words: Fluticasone furoate/vilantrol, Chronic obstructive pulmonary disease, Acute exacerbation, Lung function, Th1/Th2

表1 2组治疗前后肺功能比较(±s)

组　别	例数	时间	FEV₁%	RV/TLC%
研究组	55	治疗前	51.04±9.82	57.36±10.65
		治疗后	68.62±11.47^ab	41.86±7.12^ab
对照组	45	治疗前	50.36±9.71	56.90±10.43
		治疗后	61.38±10.25^a	48.12±8.34^a

表1 2组治疗前后肺功能比较(±s)

组　别	例数	时间	FEV₁%	RV/TLC%
研究组	55	治疗前	51.04±9.82	57.36±10.65
		治疗后	68.62±11.47^ab	41.86±7.12^ab
对照组	45	治疗前	50.36±9.71	56.90±10.43
		治疗后	61.38±10.25^a	48.12±8.34^a

表2 研究组、对照组治疗前后与健康组外周血Th1/Th2比较(±s)

组　别	例数	时间	INF-γ(ng/L)	IL-4(ng/L)	INF-γ/IL-4
研究组	55	治疗前	241.76±40.98^c	141.58±7.23^c	1.72±0.31^c
		治疗后	123.68±20.47^abc	64.39±10.42^abc	1.97±0.35^c
对照组	45	治疗前	240.63±38.72^c	140.65±7.12^c	1.70±0.32^c
		治疗后	145.72±23.65^ac	73.60±11.57^ac	1.83±0.30^c
健康组	50		101.35±18.74	46.83±7.25	2.25±0.40

表2 研究组、对照组治疗前后与健康组外周血Th1/Th2比较(±s)

组　别	例数	时间	INF-γ(ng/L)	IL-4(ng/L)	INF-γ/IL-4
研究组	55	治疗前	241.76±40.98^c	141.58±7.23^c	1.72±0.31^c
		治疗后	123.68±20.47^abc	64.39±10.42^abc	1.97±0.35^c
对照组	45	治疗前	240.63±38.72^c	140.65±7.12^c	1.70±0.32^c
		治疗后	145.72±23.65^ac	73.60±11.57^ac	1.83±0.30^c
健康组	50		101.35±18.74	46.83±7.25	2.25±0.40

表3 研究组与对照组治疗前后GSH-PX、MDA、8-OhdG水平比较(±s)

组　别	例数	时间	GSH-PX(U/ml)	MDA(nmol/ml)	8-OhdG(ng/ml)
研究组	55	治疗前	136.57±21.45	8.05±1.24	7.23±1.25
		治疗后	170.28±32.74^ab	5.13±0.98^ab	1.30±0.21^ab
对照组	45	治疗前	137.24±21.36	8.11±1.26	7.18±1.23
		治疗后	151.83±27.61^a	6.72±0.83^a	2.36±0.42^a

表3 研究组与对照组治疗前后GSH-PX、MDA、8-OhdG水平比较(±s)

组　别	例数	时间	GSH-PX(U/ml)	MDA(nmol/ml)	8-OhdG(ng/ml)
研究组	55	治疗前	136.57±21.45	8.05±1.24	7.23±1.25
		治疗后	170.28±32.74^ab	5.13±0.98^ab	1.30±0.21^ab
对照组	45	治疗前	137.24±21.36	8.11±1.26	7.18±1.23
		治疗后	151.83±27.61^a	6.72±0.83^a	2.36±0.42^a

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Effects of fluticasone furoate/vilantrol on on lung function, peripheral blood Th1/Th2 drift, GSH-PX, MDA and 8-OHdG levels in patients with acute exacerbation of COPD

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Effects of fluticasone furoate/vilantrol on on lung function, peripheral blood Th1/Th2 drift, GSH-PX, MDA and 8-OHdG levels in patients with acute exacerbation of COPD