叶 斌,叶 波.不同β受体激动剂联合阿托伐他汀治疗COPD合并冠状动脉粥样硬化心脏病患者临床疗效的对比研究[J].转化医学杂志,2022,11(5):300-305
不同β受体激动剂联合阿托伐他汀治疗COPD合并冠状动脉粥样硬化心脏病患者临床疗效的对比研究
Combination of different Beta receptor agonists and atorvastatin in treatment of patients with COPD and coronary atherosclerotic heart disease
  
DOI:
中文关键词:  β2受体激动剂  阿托伐他汀  慢性阻塞性肺病  肺功能  心血管事件
英文关键词:β2 receptor agonists  atorvastatin  Chronic obstructive pulmonary disease  pulmonary function  cardiovascular events
基金项目:
作者单位
叶 斌 成都市第一人民医院呼吸科 
叶 波 四川省肿瘤医院检验科 
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中文摘要:
      目的 探讨布地格福与硫酸特布他林联合应用阿托伐他汀治疗慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)合并冠状动脉粥样硬化心脏病患者的疗效、肺功能和氧化应激水平的差异研究。方法 本研究前瞻性选择2019年1月-2021年12月成都市第一人民医院收治的慢性阻塞性肺疾病COPD合并冠状动脉粥样硬化心脏病患者104例,依据随机数表法将所有纳入患者分为治疗A组、治疗B组,每组各52例。治疗A组予以阿托伐他汀+硫酸特布他林雾化液,治疗B组用阿托伐他汀+布地格福吸入雾化剂干预,观察比较干预前后各组纳入患者的临床疗效、临床症状缓解时间、血清炎性水平、血浆内皮素-1(endothelin-1,ET-1)与脑钠肽(brain natriuretic peptide,BNP)水平、肺功能、氧化应激水平以及药物安全性, 并且随访6个月记录心血管事件(急性心肌梗死、心力衰竭、新发心绞痛)的发生率。结果 治疗B组接受联合干预方案后的临床治疗有效率为92.3%,高于治疗A组69.2%(χ2=8.914,P<0.05)。治疗B组接受联合干预方案后的咳嗽缓解时长、喘息缓解时长及肺啰音消失时长等指标均短于治疗A组(P<0.05)。干预后两组患者肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、白细胞介素-8(Interleukin-8,IL-8)与白细胞介素-6(Interleukin-6,IL-6)水平较干预前均下降(P<0.05),且干预后治疗B组患者的TNF-α、IL-8与IL-6水平均低于治疗A组(P<0.05)。干预后两组患者血浆ET-1和BNP水平较干预前均改善(P<0.05),且干预后治疗B组患者的血浆ET-1和BNP水平低于治疗A组(P<0.05)。干预后两组患者的肺功能较干预前有了明显改善(P<0.05),且干预后治疗B组患者的第一秒用力呼气容积(Forced expiratory volume in one second,FEV1)、第一秒用力呼气容积占预计值的百分比(Forced expiratory volume in one second percentage,FEV1%)、FEV1/用力肺活量(Forced vital capacity,FVC)水平则高于治疗A组(P<0.05)。干预后两组患者的活性氧(Reactive oxygen species,ROS)、丙二醛(malondialdehyde,MDA)、谷胱甘肽过氧化物酶(glutathione peroxidase,GPX)、超氧化物歧化酶(superoxide dismutase,SOD)水平较干预前有了明显改善(P<0.05),且干预后治疗B组患者的ROS、MDA水平低于治疗A组,而GPX、SOD水平则高于治疗A组(P<0.05)。两组COPD患者在干预过程中均未出现严重不良反应,药物干预方案安全性良好。治疗A组出现转氨酶上升4例,皮肤过敏2例,腹部疼痛2例,排便困难3例,不良症状出现率为21.2%(11/52)。治疗B组出现转氨酶上升1例,皮肤过敏1例,腹部疼痛0例,排便困难1例,不良症状出现率为5.8%(3/52),暂停用药后两组患者不良症状均得到有效缓解,且治疗B组患者的不良症状出现率低于治疗A组(P<0.05)。随访6个月期间,治疗A组主要心血管不良事件(major adverse cardiovascular events,MACE)12例(23.1%),其中新发心绞痛6例(11.5%),急性心肌梗死2例(3.9%),心力衰竭 4 例(7.7%)。治疗B组MACE 7例(13.5%),其中新发心绞痛3例(5.8%),急性心肌梗死1例(1.9%),心力衰3例(5.8%),两组MACE相比较,有治疗B组比A组低(P<0.05)。结论 将β2受体激动剂布地格福吸入雾化剂与阿托伐他汀联合应用于COPD治疗中,其临床疗效显著,可加快临床症状缓解时间,有效改善患者肺功能、血浆ET-1与BNP水平,减轻血清炎性水平,控制氧化应激水平,降低COPD合并冠状动脉粥样硬化心脏病患者MACE发生率, 药物安全性良好。
英文摘要:
      Objectives To investigate the efficacy of different Beta receptor agonists combined with atorvastatin in treatment of Chronic obstructive pulmonary disease(COPD) patients with coronary atherosclerotic heart disease. Methods This study prospectively selected 104 patients with COPD combined with coronary atherosclerotic heart disease who were treated in our hospital from January 2019 to December 2021. All the included patients were divided into treatment group A and treatment group B by random number table method with 52 cases in each group. Treatment group A was given atorvastatin and terbutaline sulfate nebulized liquid, and treatment group B was given atorvastatin and Budesonide inhalation aerosol for intervention. The clinical efficacy and clinical symptoms of the included patients in each group before and after the intervention were observed and compared. The serum inflammatory level, plasma endothelin-1(ET-1)and brain natriuretic peptide(BNP) levels, lung function, oxidative stress level, and drug safety, and the cardiovascular events (acute myocardial infarction, heart failure, new-onset angina) were recorded during 6-month follow-up. Results The effective rate of clinical treatment in the group B after receiving the combined intervention program was 92.3%, which was higher than that in the group A 69.2% (χ2=8.914, P<0.05). The duration of wheezing relief and the duration of pulmonary rales disappearing in the group B were shorter than these in the group A ( P<0.05). The levels of tumor necrosis factor-α(TNF-α), interleukin-8(IL-8), and interleukin-6(IL-6) in the two groups after intervention were lower than these before intervention (P<0.05). And the levels of TNF-α, IL-8, and IL-6 in the group B were lower than these in the group A after intervention (P<0.05); After intervention, the plasma ET-1 and BNP levels of the patients in the group B were lower than these in the treatment group A (P<0.05). The lung function of patients in the two groups was significantly improved (P<0.05) after intervention, and the levels of forced expiratory volume in one second(FEV1), forced expiratory volume in one second percentage(FEV1%) and FEV1/forced vital capacity(FVC) in the group B after were higher than these in the group A (P<0.05). The levels of reactive oxygen species (ROS), malondialdehyde (MDA), glutathione peroxidase (GPX), and superoxide dismutase (SOD) of patients in the two groups after intervention were improved compared with these before intervention(P<0.05). After intervention, the ROS and MDA levels of the patients in the group B were lower than these in the group A, while the GPX and SOD levels were higher than these in the group A (P<0.05). There were no serious adverse reactions in patients of the two groups during the intervention process, and the drug intervention program was safe. In the group A, there were 5 cases of transaminase increasing, 2 cases of skin allergy, 2 cases of abdominal pain, 3 cases of defecation difficulty, and the incidence of adverse symptoms was 21.2% (11/52). In the group B, there was 1 case of transaminase, 1 case of skin allergy, and 1 case of defecation difficulty, and the incidence of adverse symptoms was 5.8% (3/52). During the 6-month follow-up period, there were 12 cases (23.1%) of major adverse cardiovascular events (MACE) in the group A, including 6 cases (11.5%) of new angina pectoris, 2 cases of acute myocardial infarction ( 3.9%), 4 cases (7.7%) of heart failure. There were 7 cases (13.5%) of MACE in the group B, including 3 cases (5.8%) of new angina pectoris, 1 case (1.9%) of acute myocardial infarction, and 3 cases of heart failure (5.8%). The MACE in the group B was lower than that in the group A (P<0.05). Conclusion The combination of β2 receptor agonist Budesonide inhalation aerosol and atorvastatin in the treatment of COPD had a good clinical effect, which can speed up the clinical symptom remission time, and effectively improve the pulmonary function and reduce serum inflammatory level, controlling oxidative stress level, and MACE in patients with COPD and coronary atherosclerotic heart disease. The treatment is safety and worthy of promotion.
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