摘要
目的探讨噻托溴铵联合呼吸运动训练对早期稳定期慢性阻塞性肺疾病(COPD)患者机体免疫功能及生活质量的影响及临床意义。方法选择2015年1月—2016年6月浙江省衢州市人民医院收治的早期稳定期COPD患者90例,按照治疗情况分为未治疗组(30例,确诊为早期稳定期COPD但拒绝治疗)、噻托溴铵组(30例,接受单纯噻托溴铵治疗)和联合治疗组(30例,接受噻托溴铵联合呼吸运动训练治疗);选取同期健康体检者30例为健康对照组。3组患者入组后均随访12个月(于入组后第1、3、6、9、12个月随访),入组时(第0个月)及每次随访时需要完成外周血淋巴细胞亚群(CD_3^+、CD_4^+、CD_8^+、CD_4^+/CD_8^+)检测、血清免疫球蛋白(IgG、IgA)检测、肺功能[第1秒用力呼气末容积(FEV_1)]检测及慢性阻塞性肺疾病评估测试(CAT)评分,记录年急性加重次数。对随访期间相关指标的变化进行比较分析。结果组别与时间在CD_3^+、CD_4^+、CD_8^+、CD_4^+/CD_8^+、IgG、IgA、FEV_1、CAT评分及年急性加重次数上存在交互作用(P<0.05),组别在CD_3^+、CD_4^+、CD_8^+、CD_4^+/CD_8^+、IgG、IgA上主效应显著(P<0.05),时间在所有指标上主效应显著(P<0.05)。CD_3^+在6、9、12个月时,CD_4^+在1、3、6、9、12个月时,CD_4^+/CD_8^+在1、3、6、9、12个月时,IgG在6、9、12个月时,IgA在3、6、9、12个月时,联合治疗组高于未治疗组、噻托溴铵组,噻托溴铵组高于未治疗组(P<0.05)。CD_8^+在3、6、9、12个月时,联合治疗组低于未治疗组、噻托溴铵组,噻托溴铵组低于未治疗组(P<0.05)。3组患者CD_3^+、CD_4^+、CD_8^+、CD_4^+/CD_8^+、IgA、IgG与FEV_1均呈正相关,与CAT评分及年急性加重次数呈负相关(P<0.05)。结论早期稳定期COPD患者存在机体免疫功能的下降,且与肺功能及生活质量有相关性,同时此期机体免疫功能变化可反映病情。噻托溴铵联合呼吸运动训练治疗可提高早期稳定期COPD患者�
Objective To determine the effect and clinical significance of tiotropium bromide combined with respiratory training on immune function and quality of life in patients with chronic obstructive pulmonary disease(COPD)during the early stable phase.Methods Ninety patients with stable COPD who were treated at People's Hospital of Quzhou in Zhejiang from January 2015 to June 2016 were divided into the untreated group(n=30,diagnosed with early-stage stable COPD but refused medical treatment),tiotropium group(n=30,only treated by tiotropium)and combination therapy group(n=30,treated by tiotropium and respiratory training)according to the treatment plan.Thirty healthy individuals were selected as controls during the same period.All patients in the three groups were followed up for 12 months after admission(at the 1st,3rd,6th,9th and 12th month after enrollment).Peripheral blood lymphocyte subsets(CD3+,CD4+,CD8+,CD4+/CD8+),serum immunoglobulin(IgG,IgA),pulmonary function test,and COPD assessment test(CAT)were performed,and the number of exacerbations was recorded at admission and at each follow-up visit.The changes in related indicators collected during the follow-up period were analyzed and compared.Results An interaction between grouping and time was observed between CD3+,CD4+,CD8+,CD4+/CD8+,IgG,IgA,FEV1,CAT scores,and annual acute exacerbations(P<0.05).The main effects of grouping on CD3+,CD4+,CD8+,CD4+/CD8+,IgG,and IgA were significant(P<0.05),and the main effects of time on all indicators were significant(P<0.05).CD3+in the 6th,9th and 12th month,CD4+in the 1st,3rd,6th,9th and 12th month,CD4+/CD8+in the 1st,3rd,6th,9th and 12th month,IgG in the 6th,9th and 12th month,and IgA in the 3rd,6th,9th and 12th month,were higher in the combination therapy group than in the untreated group and tiotropium bromide group and were higher in the tiotropium bromide group than in the untreated group(P<0.05).CD8+in the 3rd,6th,9th and 12th month,were lower in the combination therapy group than in the untreated group and tiotropium bro
作者
刘贤兵
李芳
祝利芬
郑晓燕
LIU Xian-bing;LI Fang;ZHU Lifen;ZHENG Xiao-yan(Department of Respiration Medicine,People's Hospital of Quzhou,Quzhou 324000,China;Medical Laboratory,People's Hospital of Quzhou,Quzhou 324000,China)
出处
《中国全科医学》
CAS
北大核心
2018年第27期3323-3328,共6页
Chinese General Practice
基金
浙江省衢州市科技局2015年指导性科技项目(2015064
2015065)
关键词
肺疾病
慢性阻塞性
噻托溴铵
呼吸锻炼
机体免疫功能
生活质量
Pulmonary disease,chronic obstructive
Tiotropium
Breathing exercises
Immune function
Quality of life
