氟替卡松/沙美特罗、噻托溴铵对中重度慢性阻塞性肺疾病患者动脉弹性功能的影响

Effects of fluticasone propionate/salmeterol and tiotropium on arterial elastic function of patients with moderate to severe chronic obstruction pulmonary disease

摘要:

目的：观察沙美特罗/氟替卡松（舒利迭）（fluticasone propionate/salmeterol，FSC）、噻托溴铵（tiotropium）对稳定期中重度慢性阻塞性肺疾病（chronic obstruction pulmonary disease，COPD）患者动脉弹性功能的影响。方法：将入选的136例COPD患者随机分为F组（45例）、T组（45例）、B组（46例）。B组患者仅予常规治疗，F组及T组在此基础上分别加用舒利迭、噻托溴铵。12周后观察各组臂踝脉搏波传导速度（brachial-angle pulse wave velocity，baPWV）、桡动脉增强指数（augmentation index，ＡＩ）、大小动脉顺应性、超敏C反应蛋白的变化。结果：①多元逐步回归分析发现，在研究因素中，病程（P=0.000）、超敏C反应蛋白（P=0.000）、体质指数（P=0.000）、吸烟指数（P=0.002）与baPWV正相关，第一秒用力呼气容积与baPWV负相关（P=0.000）；②12周后，F组、T组的大小动脉顺应性、超敏C反应蛋白均有改善，组内比较差异均有统计学意义（P＜0.01）；且F组改善更明显（P＜0.05）。治疗后，F组、T组分别与B组比较，均有统计学差异（P＜0.05）。B组患者的动脉弹性指标及F组、T组的ＡＩ均未见明显改善（P ＞0.05）。③F组、T组baPWV均随着时间下降且F组下降更明显，F组基线处baPWV越大，其下降越明显。B组baPWV未见明显下降趋势。结论：和噻托溴铵相比，舒利迭能显著改善COPD患者的动脉弹性。

Abstract:

Objective：To explore the effects of fluticasone propionate/salmsalmeterol（FSC）and tiotropium on arterial stiffness in pa－tients with stable chronic obstruction pulmonary disease（COPD）. Methods：All 136 patients with stable COPD were randomly divided into three groups：FSC group（group F，n=45），tiotropium group（group T，n=45） and blank control group（group B，n=46）. Patients in group B received the conventional therapy while those in group F FSC per day for 12 weeks and those in group T inhaled tiotropium per day for 12 weeks. Changes in brachial-angle pulse wave velocity（baPWV），large and small arterial compliance（C1 and C2），augementation index（AI），high sensitive C-reactive protein（hsCRP） were observed. Results：①Multiple stepwise regression analysis demonstrated that body mass index（P=0.000），course of disease（P=0.000），hsCRP（P=0.000） and smoking index（P=0.002） were pos－itively associated with baPWV while the forced expiratory volumein one second（FEV1）（P=0.000） was negatively associated with baPWV. ②At 12 weeks after the treatment，hsCRP and C1，C2 were improved compared with those before the treatment（P＜0.01），more obviously in group F（P＜0.05）. Significant differences presented in the above indexes in comparison between group F，group T and group B after the treatment（P＜0.05）. The arterial elastic paramenters of group B and AI of group F and group T were not sig－nificantly improved（P ＞0.05）. ③baPWV of group F and group T was decreased along with the time，more obvious in group F and most significantly in group c（baPWV＞21.21 m/s） among subgroups of group F. No decrease of baPWV was observed in group B. Conclusion：Fluticasone propionate/salmsalmeterol had broader impacts on arterial stiffness of patients with COPD compared with tiotropium.