CAJ | 학술논문

目的探讨不同剂量糖皮质激素对慢性阻塞性肺疾病急性加重期(AECOPD)患者炎性因子水平的影响和临床疗效. 方法选取2007年3月至2011年3月我院呼吸科AECOPD(肺功能Ⅱ级和Ⅲ级)的患者45例,将患者随机分成3组:甲泼尼龙40 mg组:甲泼尼龙40 mg静脉注射1次/d;甲泼尼龙80 mg组:甲泼尼龙40 mg静脉注射2次/d;空白对照组:不使用任何糖皮质激素.观察3组患者治疗前及治疗后第7天呼吸困难评分、动脉血气分析、临床症状评分和血清白介素(IL)-6、IL-8、肿瘤坏死因子(TNF)-α和C-反应蛋白(CRP)的变化,并记录相关的药物不良反应.结果治疗后第7天3组患者中甲泼尼龙40 mg组和甲泼尼龙80 mg组的临床症状评分、Borg评分、动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)改善均优于空白对照组(F=3.67、7.16、42.88、49.83,均P＜0.05),而甲泼尼龙80 mg组优于甲泼尼龙40 mg组(均P＜0.05);治疗后甲泼尼龙40 mg组和甲泼尼龙80 mg组血清IL-8、TNF-α、IL-6、CRP水平较空白对照组明显下降(F=12.65、16.17、30.99、20.04,均P＜ 0.05),而甲泼尼龙80 mg组较甲泼尼龙40 mg组下降更明显(均P＜0.05).在治疗过程中,3组患者均未出现严重的药物不良反应. 结论短期、适量糖皮质激素对AECOPD患者的治疗是有效、安全的;每日80 mg甲泼尼龙静脉注射能更明显改善AECOPD患者症状,更好地降低炎性因子水平.
목적 탐토불동제량당피질격소대만성조새성폐질병급성가중기(AECOPD)환자염성인자수평적영향화림상료효. 방법 선취2007년3월지2011년3월아원호흡과AECOPD(폐공능Ⅱ급화Ⅲ급)적환자45례,장환자수궤분성3조:갑발니룡40 mg조:갑발니룡40 mg정맥주사1차/d;갑발니룡80 mg조:갑발니룡40 mg정맥주사2차/d;공백대조조:불사용임하당피질격소.관찰3조환자치료전급치료후제7천호흡곤난평분、동맥혈기분석、림상증상평분화혈청백개소(IL)-6、IL-8、종류배사인자(TNF)-α화C-반응단백(CRP)적변화,병기록상관적약물불량반응.결과 치료후제7천3조환자중갑발니룡40 mg조화갑발니룡80 mg조적림상증상평분、Borg평분、동맥혈이양화탄분압(PaCO2)、동맥혈양분압(PaO2)개선균우우공백대조조(F=3.67、7.16、42.88、49.83,균P＜0.05),이갑발니룡80 mg조우우갑발니룡40 mg조(균P＜0.05);치료후갑발니룡40 mg조화갑발니룡80 mg조혈청IL-8、TNF-α、IL-6、CRP수평교공백대조조명현하강(F=12.65、16.17、30.99、20.04,균P＜ 0.05),이갑발니룡80 mg조교갑발니룡40 mg조하강경명현(균P＜0.05).재치료과정중,3조환자균미출현엄중적약물불량반응. 결론 단기、괄량당피질격소대AECOPD환자적치료시유효、안전적;매일80 mg갑발니룡정맥주사능경명현개선AECOPD환자증상,경호지강저염성인자수평.
Objective To explore the effect and its clinical significance of different dose of glucocorticoids on inflammation mediators in patients with acute exacerbation of chronic obstructive pulmonary diseases.Methods 45 patients admitted to our hospitals from March 2007 to March 2011 were randomly divided into 3 groups:methylprednisolone 40 mg group (methylprednisolone 40mg,iv,qd),methylprednisolone 80 mg group (methylprednisolone 80mg,iv,bid),and control group (without any glucocorticoids).The changes of dyspnea scores,arterial blood gas analysis,clinical symptom scores and serum IL-6,IL-8 and tumor necrosis factor (TNF) levels were detected in patients of each group before and at the 7th day after treatment.The related adverse drug reactions were recorded.Results The improvements in clinical symptom scores,Borg scores,PaCO2,PaO2 after treatment were higher in methylprednisolone 40 mg group and methylprednisolone 80 mg group than in control group (F=3.6747.162 and 42.88,respectively,P＜0.01 or 0.001),and the above improvements was better in methylprednisolone 80 mg group than in methylprednisolone 40 mg group (all P＜0.05).The decreases in levels of serum IL-8,TNF-α,IL-6,C-RP after the treatment were more significant in methylprednisolone 40 mg group and methylprednisolone 80 mg group than in control group (F=12.65,16.17,30.99,respectively,all P＜0.001),and the decrements were more significant in methylprednisolone 80 mg group than in methylprednisolone 40 mg group(all P＜0.05).NO serious adverse drug reactions happened during the course of treatment in the three groups.Conelusions Short-term and moderate dose of glucocorticoid treatment is effective and safe in treating the patients with acute exacerbation of chronic obstructive pulmonary diseases.Methylprednisolone 80 mg injection daily can more obviously improve AECOPD symptoms,and reduce the levels of inflammatory factors better.