摘要
目的观察3种不同方式使用糖皮质激素治疗慢性阻塞性肺疾病急性加重期(AE-COPD)患者全身炎症反应的疗效。方法将120例AE-COPD患者按随机数字表法分为4组,每组30例。4组患者均给予吸氧、使用抗生素和支气管扩张剂等治疗。口服激素组:泼尼松30 mg.d-1,口服,连续7d;雾化吸入激素组:布地奈德4mg.d-1雾化吸入,2次·d-1,连续7d;静脉滴注激素组:甲基强的松龙80mg.d-1,静脉滴注,2次·d-1,连续7d;对照组:不使用任何激素。观察各组治疗前后肺功能、血气分析、C-反应蛋白、体质量指数、下肢肌肉周径的变化及临床症状得分情况。结果 3组糖皮质激素组治疗后与对照组比较:一秒用力呼气容积(FEV1)、动脉血氧分压(PaO2)明显升高,全身症状明显改善,C-反应蛋白明显降低(P<0.05或P<0.01)。静脉滴注激素组治疗后的FEV1及PaO2较其他2组激素组明显升高(P<0.05),口服激素组与雾化吸入激素组比较差异无统计学意义(P>0.05)。静脉滴注激素组的体质量指数明显高于其他3组(P<0.05)。各组下肢肌肉周径变化的比较差异均无统计学意义(均P>0.05)。结论 3种不同方式使用糖皮质激素均可减轻AE-COPD患者的全身炎症反应,改善临床症状及肺功能,但以静脉滴注甲基强的松龙为最有效。
Objective To observe the clinical effects of three types of corticosteroids on systemic inflammation in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）.Methods One hundred and twenty hospitalized patients with AECOPD were randomly divided into four groups,with 30 patients in each group.All patients were conventionally treated with oxygen,antibiotics and bronchodilators.On this basis,oral corticosteroids group received 30 mg·d-1 of prednisone for 7 days;nebulized corticosteroids group received 4 mg·d-1 of nebulized budesonide twice daily for 7 days;intravenous corticosteroids group received intravenous infusion of 80 mg·d-1 of methylprednisolone twice daily for 7 days;control group only received conventional treatment.The lung functions,arterial blood gas values,C-reactive protein（CRP）,body mass index,mid-thigh circumference and symptom scores were measured before and after treatment.Results Compared with control group,corticosteroids treatment increased FEV1 and PaO2,decreased CRP levels,and improved systemic symptoms（P0.05 or P0.01）.Compared with intravenous corticosteroids group,FEV1 and PaO2 decreased in oral corticosteroids group and nebulized corticosteroids group（P0.05）,but no significant differences were observed between the two groups（P0.05）.In addition,body mass index in intravenous corticosteroids group was higher than that in the other three groups（P0.05）.There were no significant differences in mid-thigh circumference among the four groups（P0.05）.Conclusion The three types of corticosteroids treatment,especially intravenous infusion of methylprednisolone,can effectively reduce systemic inflammation and improve lung functions and clinical symptoms in patients with AECOPD.
出处
《实用临床医学（江西）》
CAS
2011年第11期8-11,共4页
Practical Clinical Medicine
基金
江西省景德镇市科技局资助(sf20104303)
关键词
肺疾病
慢性阻塞性肺疾病
糖皮质激素
急性发作
pulmonary disease
chronic obstructive pulmonary disease
corticosteroids
acute exacerbation
