摘要
目的探讨糖皮质激素(激素)治疗中度至重度COPD急性加重期(AECOPD)患者的理想剂量。方法选取120例AECOPD患者,按稳定期肺功能分为中度AECOPD组(A组)和重度AECOPD组(B组),再根据是否使用激素和激素治疗剂量各分为3个亚组,a1组、b1组为低剂量激素组(入院3 d内给予等效泼尼松≤80 mg/d);a2组、b2组为高剂量激素组(入院3 d内给予等效泼尼松>80 mg/d);a3组、b3组为未使用激素组(入院后未使用全身性激素)。对比各组第1、3、7、10日的血清IL-6、IL-8水平变化和3 d有效率及治疗失败率。结果 A组血清IL-6、IL-8水平低于B组(P<0.05)。A组中,a1、a2组血清IL-6、IL-8在第3日即出现下降,低于a3组(P均<0.05),a1、a2组的3 d有效率均优于a3组(P均<0.017),a2组的IL-6、IL-8水平较a1组下降快,但在病程第10日2组比较差异均无统计学意义(P均>0.05),且2组的3 d有效率比较差异无统计学意义(P>0.017)。B组中,b2组第3、7、10日的血清IL-6、IL-8水平均低于第1日以及同期的b1组及b3组(P均<0.05),且其3 d有效率、治疗失败率均优于b3组(P均<0.017),但其3 d有效率与b1组相近(P>0.017)。b1组IL-8水平在第7、10日才低于第1日,而IL-6水平虽较b3组下降,但2组IL-6水平在第10日时比较差异无统计学意义(P>0.05),且b1组3 d有效率及治疗失败率与b3组相近。结论对于中度至重度COPD患者出现急性加重,积极使用全身性激素能有效改善全身炎症反应,但中度COPD患者出现急性加重,与低剂量的激素相比,使用高剂量的激素可能并未获益,而重度COPD患者出现急性加重,早期使用高剂量的激素可更有效改善症状及控制全身炎症反应。
Objective To investigate the optimal dose of glucocorticoid（hormone） in the treatment of acute exacerbation of chronic obstructive pulmonary disease（AECOPD）.Methods A total of 120 AECOPD patients were selected and divided into the moderate（group A） and severe AECOPD groups（group B） according to the stable stage of lung function.Based upon the use and therapeutic dose of corticosteroid,patients were assigned into three subgroups.In a1 and b1 subgroups,a low dose of prednisone（≤80 mg/d） was administered within 3 d after admission.In a2 and b2 subgroups,a high dose of prednisone（〉80 mg/d） was delivered within 3 d after admission.In a3 and b3 subgroups,no systemic hormone was administered.The serum levels of IL-6 and IL-8,3 d-effective rate and treatment failure rate were measured and compared at 1,3,7 and 10 d following corresponding treatment.Results The serum levels of IL-6 and IL-8 in group A were significantly lower than those in group B（both P〈0.05）.In group A,the serum levels of IL-6 and IL-8 in a1 and a2 subgroups tended to decline at 3 d,significantly lower compared with those in a3 subgroup（all P〈0.05）.The 3 d-effective rate in a1 and a2 subgroups was significantly higher than that in a3 subgroup（both P〈0.017）.The serum levels of IL-6 and IL-8 in a2 subgroup decreased faster than those in a1 subgroup,whereas no statistical significance was observed at 10 d between two subgroups（both P〉0.05）.No statistical significance was noted in terms of the 3 d-effective rate between two subgroups（P〉0.017）.In group B,the serum levels of IL-6 and IL-8 in b2 subgroup at 3,7 and 10 d were significantly lower compared with those at1 d,equally lower than those in b1 and b3 subgroups at the same time points（all P〈0.05）.The 3 d-effective rate and treatment failure rate in b2 subgroup were significantly superior to those in b3 subgroup（both P〈0.017）,whereas the 3 d-effective rate was almost similar to that in b1 subgroup（P〉0.017）.The IL-8 level at 7 and
出处
《新医学》
2017年第3期163-168,共6页
Journal of New Medicine
基金
广东省惠州市科技计划项目(2015Y268)
