吸入性皮质类固醇/长效抗胆碱能药物/长效β<sub>2</sub>受体激动剂联用治疗慢性阻塞性肺疾病哮喘重叠综合征的临床研究

doi:10.3877/cma.j.issn.1674-6902.2025.06.018

中华肺部疾病杂志(电子版) ›› 2025, Vol. 18 ›› Issue (06) : 961 -965. doi: 10.3877/cma.j.issn.1674-6902.2025.06.018

论著

吸入性皮质类固醇/长效抗胆碱能药物/长效β₂受体激动剂联用治疗慢性阻塞性肺疾病哮喘重叠综合征的临床研究

付建力¹, 李鹏飞²^,^†(

), 尹珊珊¹, 张艳彬³, 胥杰², 刘涌²

¹100176　北京，首都医科大学附属北京同仁医院/药学部
²102300　北京，首都医科大学附属北京同仁医院呼吸与危重症医学科
³100176　北京，首都医科大学附属北京同仁医院/放射科

收稿日期:2025-04-30 出版日期:2025-12-25
通信作者: 李鹏飞
基金资助:
北京市医院管理中心临床技术创新项目(XMLX202104)

Study on the effect of triple therapy with inhaled corticosteroids, long-acting muscarinic antagonists and long-acting β₂ agonists in patients with chronic obstructive pulmonary disease-asthma overlap syndrome

Jianli Fu¹, Pengfei Li²^,^†(), Shanshan Yin¹, Yanbin Zhang³, Jie Xu², Yong Liu²

¹Department of Pharmacy of Beijing Tongren Hospital of Capital Medical University, Beijing 100176, China
²Department of Respiratory and Critical Care Medicine of Beijing Tongren Hospital of Capital Medical University, Beijing 102300, China
³Department of Radiology of Beijing Tongren Hospital of Capital Medical University, Beijing 100176, China

Received:2025-04-30 Published:2025-12-25
Corresponding author: Pengfei Li

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引用本文：

付建力, 李鹏飞, 尹珊珊, 张艳彬, 胥杰, 刘涌. 吸入性皮质类固醇/长效抗胆碱能药物/长效β₂受体激动剂联用治疗慢性阻塞性肺疾病哮喘重叠综合征的临床研究[J/OL]. 中华肺部疾病杂志(电子版), 2025, 18(06): 961-965.

Jianli Fu, Pengfei Li, Shanshan Yin, Yanbin Zhang, Jie Xu, Yong Liu. Study on the effect of triple therapy with inhaled corticosteroids, long-acting muscarinic antagonists and long-acting β₂ agonists in patients with chronic obstructive pulmonary disease-asthma overlap syndrome[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2025, 18(06): 961-965.

目的

分析吸入性皮质类固醇(inhaled corticosteroids, ICS)、长效抗胆碱能药物(long-acting muscarinic antagonists, LAMA)，长效β₂受体激动剂(long-acting β₂ agonists, LABA)联用治疗慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)哮喘重叠综合征(asthma overlap syndrome, ACOS)的临床疗效。

方法

选取2021年12月至2024年6月我院收治的ACOS患者67例为对象，根据用药方式分为对照组32例，观察组35例。对照组予以ICS、LABA，观察组予以ICS、LAMA、LABA。对比两组肺部CT征象变化、临床疗效、肺功能、内皮功能、免疫功能、氧化应激反应及不良反应。

结果

观察组胸部CT征象肺气肿、支气管壁增厚低于对照组(P<0.05)；观察组治疗有效31例(88.57%)高于对照组有效22例(68.75%)(P<0.05)；观察组治疗后用力肺活量(forced vital capacity, FVC)(2.45±0.37)L、第一秒用力呼气容积(forced expiratory volume in the first second, FEV₁)(1.43±0.24)L、FEV₁/FVC(60.67±3.89)、峰值呼气流速(peak expiratory flow rate, PEF)(4.15±0.74)L/s高于对照组FVC(2.23±0.28)L、FEV₁(1.25±0.31)L、FEV₁/FVC(55.99±2.49)、PEF(3.70±0.15)L/s(P<0.05)；内皮素-1(endothelin-1, ET-1)(2.75±0.21)ng/L、可溶性细胞间黏附分子1(soluble intercellular adhesion molecule-1, sICAM-1)mg/ml(570.23±34.46)低于对照组ET-1(3.05±0.55)ng/L、sICAM-1(597.82±44.83)mg/ml(P<0.05)；辅助性T细胞1型(T helper 1 cell, Th1)(29.71±3.66)、Th1/Th2(8.54±1.63)高于对照组Th1(20.16±0.94)、Th1/Th2(7.38±0.96)(P<0.05)；丙二醛(malondialdehyde, MDA)nmol/L(6.13±0.99)低于对照组MDA(6.91±0.54)nmol/L，超氧化物歧化酶(superoxide dismutase, SOD)(51.05±4.73)U/ml高于对照组(43.35±4.68) U/ml(P<0.05)；观察组发生不良反应2例(5.71%)，对照组发生不良反应6例(18.75%)。

结论

ACOS患者采用ICS、LAMA、LABA三联用药提高治疗效果，改善肺功能、免疫功能、内皮功能、降低氧化应激反应具有意义。

关键词: 肺疾病，慢性阻塞性, 哮喘重叠综合症, 肺功能, 免疫功能, 内皮功能, 吸入性皮质类固醇

Objective

To analyze the clinical efficacy of combined therapy with inhaled corticosteroids (ICS), long-acting muscarinic antagonists (LAMA), and long-acting β₂ agonists (LABA) in treating chronic obstructive pulmonary disease(COPD) -asthma overlap syndrome (ACOS).

Methods

A total of 67 ACOS patients admitted to our hospital from December 2021 to June 2024 were selected as subjects and divided into a control group (32 cases) and an observation group (35 cases) based on treatment regimens. The control group received ICS and LABA, while the observation group received ICS, LAMA, and LABA. Changes of CT signs of lung, Clinical efficacy, lung function, endothelial function, immune function, oxidative stress response, and adverse reactions were compared between the two groups.

Results

The chest CT signs of the observation group were lower than those of the control group (P<0.05). The treatment effectiveness rate in the observation group was 31 cases (88.57%), higher than 22 cases (68.85%) in the control group (P<0.05). After treatment, the observation group showed higher forced vital capacity (FVC) (2.45±0.37) L, forced expiratory volume in the first second (FEV₁) (1.43±0.24) L, FEV₁/FVC ratio(60.67±3.89) %, and peak expiratory flow rate (PEF)(4.15±0.74) L/s compared to the control group FVC (2.23±0.28)L, FEV₁(1.25±0.31)L, FEV₁/FVC (55.99±2.49)%, PEF(3.70±0.15)L/s (P<0.05). Post-treatment levels of endothelin-1 (ET-1)(2.75±0.21)ng/L and soluble intercellular adhesion molecule-1(sICAM-1) (570.23±34.46) mg/ml were lower in the observation group than in the control group ET-1(3.05±0.55)ng/L, sICAM-1(597.82±44.83) mg/ml(P<0.05). Post-treatment levels of T helper 1 cell (Th1) (29.71±3.66)% and Th1/Th2 ratio (8.54±1.63) were higher in the observation group than in the control group Th1 (20.16±0.94) %, Th1/Th2 (7.38±0.96) (P<0.05). Post-treatment malondialdehyde (MDA) levels (6.13±0.99)nmol/L were lower in the observation group than in the control group (6.91±0.54)nmol/L, while superoxide dismutase (SOD) levels (51.05±4.73)U/ml were higher than in the control group (43.35±4.68)U/ml (P<0.05). The incidence of adverse reactions was 2 cases (5.71%) in the observation group, lower than 6 cases (18.75%) in the control group.

Conclusion

Triple therapy with ICS, LAMA, and LABA in ACOS patients improves treatment efficacy, enhances lung function, immune function, endothelial function, reduces oxidative stress response, and demonstrates high safety.

Key words: Chronic obstructive pulmonary disease, Asthma overlap syndrome, Lung function, Immune function, Endothelial function, Inhaled corticosteroids

表1 两组ACOS患者肺功能对比(

±s)

组　别	例数	FVC(L)		FEV₁(L)		FEV₁/FVC		PEF(L/s)
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	35	2.06±0.14	2.45±0.37	1.20±0.22	1.43±0.24	51.31±9.09	60.67±3.89	3.43±0.29	4.15±0.74
对照组	32	2.01±0.09	2.23±0.28	1.18±0.21	1.25±0.31	54.25±6.25	55.99±2.49	3.43±0.30	3.70±0.15
t值		1.869	2.871	0.261	2.555	1.532	5.812	0.026	3.382
P值		0.066	0.006	0.795	0.013	0.130	0.001	0.979	0.001

表1 两组ACOS患者肺功能对比(

±s)

组　别	例数	FVC(L)		FEV₁(L)		FEV₁/FVC		PEF(L/s)
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	35	2.06±0.14	2.45±0.37	1.20±0.22	1.43±0.24	51.31±9.09	60.67±3.89	3.43±0.29	4.15±0.74
对照组	32	2.01±0.09	2.23±0.28	1.18±0.21	1.25±0.31	54.25±6.25	55.99±2.49	3.43±0.30	3.70±0.15
t值		1.869	2.871	0.261	2.555	1.532	5.812	0.026	3.382
P值		0.066	0.006	0.795	0.013	0.130	0.001	0.979	0.001

表2 两组ACOS患者内皮功能对比(

±s)

组　别	例数	ET-1(ng/L)		sICAM-1(mg/ml)
组　别	例数	治疗前	治疗后	治疗前	治疗后
观察组	35	3.21±0.20	2.75±0.21	631.34±58.79	570.23±34.46
对照组	32	3.24±0.22	3.05±0.55	644.79±65.48	597.82±44.83
t值		0.562	2.973	0.886	2.838
P值		0.576	0.004	0.379	0.006

表2 两组ACOS患者内皮功能对比(

±s)

组　别	例数	ET-1(ng/L)		sICAM-1(mg/ml)
组　别	例数	治疗前	治疗后	治疗前	治疗后
观察组	35	3.21±0.20	2.75±0.21	631.34±58.79	570.23±34.46
对照组	32	3.24±0.22	3.05±0.55	644.79±65.48	597.82±44.83
t值		0.562	2.973	0.886	2.838
P值		0.576	0.004	0.379	0.006

表3 两组ACOS患者免疫功能及氧化应激反应(

±s)

组　别	例数	MDA(nmol/L)		SOD(U/ml)		Th1		Th1/Th2
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	35	7.18±0.58	6.13±0.99	42.18±3.78	51.05±4.73	12.34±1.97	29.71±3.66	5.25±0.95	8.54±1.63
对照组	32	7.25±0.61	6.91±0.54	43.53±4.19	43.35±4.68	11.69±2.23	20.16±0.94	4.98±1.36	7.38±0.96
t值		0.484	4.004	1.387	6.696	1.262	14.334	0.966	3.493
P值		0.630	0.000	0.170	0.000	0.211	0.000	0.337	0.001

表3 两组ACOS患者免疫功能及氧化应激反应(

±s)

组　别	例数	MDA(nmol/L)		SOD(U/ml)		Th1		Th1/Th2
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	35	7.18±0.58	6.13±0.99	42.18±3.78	51.05±4.73	12.34±1.97	29.71±3.66	5.25±0.95	8.54±1.63
对照组	32	7.25±0.61	6.91±0.54	43.53±4.19	43.35±4.68	11.69±2.23	20.16±0.94	4.98±1.36	7.38±0.96
t值		0.484	4.004	1.387	6.696	1.262	14.334	0.966	3.493
P值		0.630	0.000	0.170	0.000	0.211	0.000	0.337	0.001

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Study on the effect of triple therapy with inhaled corticosteroids, long-acting muscarinic antagonists and long-acting β₂ agonists in patients with chronic obstructive pulmonary disease-asthma overlap syndrome

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Study on the effect of triple therapy with inhaled corticosteroids, long-acting muscarinic antagonists and long-acting β2 agonists in patients with chronic obstructive pulmonary disease-asthma overlap syndrome

Study on the effect of triple therapy with inhaled corticosteroids, long-acting muscarinic antagonists and long-acting β₂ agonists in patients with chronic obstructive pulmonary disease-asthma overlap syndrome