本文關(guān)鍵詞：呼出氣一氧化氮預(yù)測穩(wěn)定期COPD患者吸入糖皮質(zhì)激素治療療效的價值　出處：《山東大學》2016年碩士論文　論文類型：學位論文

  更多相關(guān)文章： 慢性阻塞性肺疾病 呼出氣一氧化氮 肺功能 吸入性糖皮質(zhì)激素 布地奈德/福莫特羅

【摘要】：研究背景慢性組塞性肺疾病(chronic obstructive pulmonary disease,COPD)是一種常見的慢性炎癥性呼吸系統(tǒng)的疾病,是世界范圍內(nèi)患病率與病死率較高的疾病之一,其特點是不完全可逆的氣流受限并呈進行性發(fā)展,主要表現(xiàn)為慢性的咳嗽、咳痰、氣短、胸悶、喘息及呼吸困難等癥狀。COPD的實質(zhì)為氣道和肺組織的慢性非特異性炎癥反應(yīng),與患者吸入香煙煙霧及有害顆粒等刺激有關(guān),其中主要的炎癥細胞為中性粒細胞、肺泡巨噬細胞及CD8+T細胞,另外肺的結(jié)構(gòu)細胞如肺泡上皮細胞和內(nèi)皮細胞等均參與了氣道炎癥的發(fā)生與發(fā)展。近年來有較多研究顯示嗜酸性粒細胞及肥大細胞等炎癥細胞也參與了COPD的氣道炎癥反應(yīng)的過程,尤其是在COPD急性加重期的患者中表現(xiàn)更為明顯。呼出氣一氧化氮(fraction of exhaled nitric oxide, FENO)是目前研究較多的一種氣道炎癥標志物,在呼吸系統(tǒng)的炎癥反應(yīng)及氧化應(yīng)激等方面均發(fā)揮了重要作用,尤其是在支氣管哮喘診治中的作用已逐漸受到重視,并得到了國內(nèi)外專家的肯定和廣泛的應(yīng)用。國內(nèi)外較多研究也顯示FENO能夠反應(yīng)支氣管哮喘、過敏性咳嗽、COPD慢性嗜酸性肺炎等慢性氣道炎癥性疾病的氣道炎癥水平,尤其是氣道內(nèi)嗜酸性粒細胞增多的氣道炎癥,此類氣道炎癥對糖皮質(zhì)激素類藥物治療效果的反應(yīng)性較好,因此臨床上可以用FENO檢測手段來指導(dǎo)患有氣道炎癥性疾病的患者應(yīng)用糖皮質(zhì)激素類藥物治療。COPD患者的慢性氣道炎癥能加重氣道壁的損傷、修復(fù)及重構(gòu),因此延緩COPD患者病情持續(xù)性進展及肺功能進行性減退的關(guān)鍵是控制慢性氣道炎癥的發(fā)展。糖皮質(zhì)激素在控制氣道炎癥方面起到了尤為重要的作用,其機制為直接抑制中性粒細胞、嗜酸性粒細胞、肺泡巨噬細胞等炎癥細胞的活化,并能抑制白三烯、前列環(huán)素等炎癥介質(zhì)的合成與釋放,從而舒張支氣管,改善患者的肺功能和預(yù)后。但也有研究表明,COPD患者應(yīng)用糖皮質(zhì)激素類藥物治療時能加重肺炎等并發(fā)癥的發(fā)生率,因此,臨床上迫切需要能指導(dǎo)COPD患者使用糖皮質(zhì)激素治療的輔助檢查方法。FENO作為一種有用的氣道炎癥標志物,其操作簡單、重復(fù)性好、有較高的靈敏度和特異度,因此可以用來指導(dǎo)COPD患者應(yīng)用糖皮質(zhì)激素治療。研究目的探討應(yīng)用FENO測定技術(shù)預(yù)測穩(wěn)定期COPD患者應(yīng)用ICS治療療效的價值。研究方法1.選取2015年3-7月就診于山東省立醫(yī)院呼吸內(nèi)科門診,確診為穩(wěn)定期COPD(穩(wěn)定期COPD是指患者咳嗽、咳痰、氣短等癥狀穩(wěn)定或輕微)的患者31例；2.進行單組、開放性的試驗研究,試驗前測定FENO值(將呼氣流速定為50mL/s),并行肺功能、支氣管舒張試驗檢查,肺功能測定前患者應(yīng)靜坐十分鐘,在測定過程患者中保持坐位。3.檢查后確診為COPD的患者,給予布地奈德/福莫特羅粉(信必可)吸入劑160ug/4.5ug,每天2次、每次1吸,并給予化痰、止咳等基礎(chǔ)治療,同時督促患者戒煙及指導(dǎo)患者康復(fù)鍛煉等治療,4周以后重復(fù)上述檢查。4.分別記錄患者用藥前后FENO值及相關(guān)的肺功能指標(包括FEV1.FEV1％. FVC.FEV1/FVC%等).研究結(jié)果31例穩(wěn)定期COPD患者中,其中1人因吸入布地奈德/福莫特羅粉藥物過程中出現(xiàn)咽部瘙癢干澀、刺激性咳嗽等不良反應(yīng)而中途停止用藥并退出本試驗研究,余30例穩(wěn)定期COPD患者順利地完成了本試驗研究。1.受試者的一般資料、吸煙及肺功能分級與FENO的關(guān)系基線水平FENO在不同的性別組、年齡組、體重指數(shù)組、有無吸煙史組、肺功能分級組之間差異無統(tǒng)計學意義(P均0.05)；2.基線水平FENO值與相關(guān)肺功能指標的關(guān)系基線FENO值與基線FEV1直無明顯相關(guān)性(r=0.203,P=0.281),然而,基線FENO水平與使用ICS治療后第1秒用力呼氣容積(forced expiratory volume in one second, FEV1)改善值卻有著顯著地相關(guān)性(r=0.865,P0.05)；3.吸入布地奈德/福莫特羅粉吸入劑后FENO值的變化趨勢基線FENO的值越高,使用ICS治療4周后FENO值的下降幅度越大,反之亦然。4.基線水平FEN0對穩(wěn)定期COPD患者吸入糖皮質(zhì)激素治療的預(yù)測價值對ICS治療有反應(yīng)者(FEV1增加的絕對值≥200mL)較對ICS治療無反應(yīng)者(FEV1增加的絕對值200ml)的FENO基線值明顯增高(P0.05),利用基線FENO值診斷有反應(yīng)者與無反應(yīng)者的AUC為0.931,切點值定為29. lppb。研究結(jié)論1.基線水平FENO值與穩(wěn)定期COPD的肺功能損傷的嚴重程度無明顯的相關(guān)性,FENO并不能代表COPD患者的嚴重程度分級；2.基線水平FENO的值越高,COPD患者的氣道炎癥程度越重,治療效果越好,因此FENO能反應(yīng)穩(wěn)定期COPD患者的氣道類型及炎癥的嚴重程度；3.在穩(wěn)定期COPD患者中,FENO是一個能較好的預(yù)測其吸入糖皮質(zhì)激素治療療效的指標。
[Abstract]:Background: chronic obstructive pulmonary disease (chronic obstructive pulmonary disease, COPD) is a chronic inflammatory disease of the common respiratory system, is one of the worldwide high prevalence and mortality of the disease, which is characterized by airflow limitation that is not fully reversible and progressive development, mainly for chronic cough, expectoration, shortness of breath, chest pain, breathing and breathing difficulties and other symptoms. The essence of COPD is chronic nonspecific inflammation of airway and lung tissue, and patients with inhalation of cigarette smoke and harmful particles and other stimuli, including inflammatory cells of neutrophils and alveolar macrophages and CD8+T cells, another cell lung structure such as alveolar epithelial cells and endothelial cells are involved in the occurrence and development of airway inflammation. In recent years, many studies have shown that inflammatory cells such as eosinophils and mast cells are also involved in the process of airway inflammation in COPD, especially in patients with acute exacerbation of COPD. Exhaled nitric oxide (fraction of exhaled nitric oxide, FENO) is at present. A marker of airway inflammation, has played an important role in the respiratory system inflammation and oxidative stress, especially in the diagnosis and treatment of bronchial asthma in the role has been gradually paid attention to, and obtained the domestic and foreign experts affirmed and widely used. The domestic and foreign research also showed that FENO reaction of bronchial asthma, allergic cough, COPD chronic eosinophilic pneumonia and chronic airway inflammatory disease of the airway inflammation, especially airway inflammation in the airway eosinophilia, airway inflammatory reaction of the glucocorticoid treatment effect is better, with glucocorticoid therapy in clinical FENO can be used to guide the detection means with airway inflammatory diseases. Chronic airway inflammation in patients with COPD can aggravate the damage, repair and reconstruction of airway wall. Therefore, the key to delay the progression of COPD's disease and the progressive decline of lung function is to control the development of chronic airway inflammation. Glucocorticoid in controlling airway inflammation plays a particularly important role, its mechanism is direct inhibition of neutrophils, eosinophils, macrophages and other inflammatory cell activation, and can inhibit the synthesis and release of leukotrienes, prostacyclin and other inflammatory mediators, thereby relaxing bronchia, improve lung function and prognosis of patients the. However, there are studies showing that glucocorticoid therapy can aggravate the incidence of complications such as pneumonia in COPD patients. Therefore, there is an urgent need for an auxiliary examination method that can guide COPD patients to use glucocorticoids. As a useful marker of airway inflammation, FENO is simple, reproducible, and has high sensitivity and specificity, so it can be used to guide glucocorticoid therapy in COPD patients. Objective to explore the value of using FENO technique to predict the efficacy of ICS in the treatment of stable COPD patients. Research methods 1. 3-7 month 2015 in Shangdong Province-owned Hospital from respiratory medicine clinic, diagnosed with stable COPD (stable COPD refers to patients with cough, expectoration, shortness of breath and other symptoms of stable or slight) in 31 cases of patients; 2. tests were performed on single group, open the test before the determination of FENO value (the expiratory flow rate constant 50mL/s), pulmonary function, bronchial dilation test, patients should sit for ten minutes before the lung function testing, to keep the seat in the determination of the patients. 3. diagnosed COPD patients, treated with budesonide / formoterol (Symbicort) inhalation powder 160ug/4.5ug, 2 times a day, and give 1 suction, phlegm, cough and other basic treatment, while urging patients to stop smoking and guide the patients to rehabilitation treatment, 4 weeks later, repeat the above check. 4. patients were recorded before and after treatment FENO value and related indexes of pulmonary function (including FEV1.FEV1%. FVC.FEV1/FVC%). The results of 31 patients with stable COPD patients, 1 of them due to inhaled budesonide / formoterol powder drug during the dry throat itching, irritating cough and other adverse reactions and stop medication and quit the study and more than 30 stable COPD patients successfully completed the study. 1. subjects of general information, smoking and lung function and the relationship between the FENO baseline levels of FENO in different gender groups, age groups, BMI group, smoking history, lung function between groups was not statistically significant (P < 0.05); the relationship between baseline FENO 2. baseline FENO value and correlation lung function index value had no significant correlation with baseline FEV1 (r=0.203, P=0.281), however, the baseline level of FENO and ICS after the treatment of forced expiratory volume in one second (forced expiratory volume in one second, FEV1) to improve the value has significant correlation (r=0.865, P0.05); 3. inhaled budesonide / trend the baseline FENO FENO value of formoterol fumarate powder for inhalation after the higher the value, the use of ICS after 4 weeks of treatment, the FENO value decreased, and vice versa. The value of 4. FEN0 baseline forecast of inhaled corticosteroids in the treatment of patients with stable COPD treatment responders to ICS (absolute value is more than 200mL increased FEV1) than on ICS nonresponders (absolute value of 200ml increased FEV1) FENO baseline values were significantly higher (P0.05), using the base line FENO diagnosis value responders and non responders to AUC 0.931, cut-off value was 29. lppb. Conclusion 1. baseline FENO values had no significant correlation with the severity of pulmonary function in COPD stable stage of injury, FENO does not represent the severity of COPD in patients with grade 2. at baseline; the higher the value of FENO, COPD in patients with airway inflammation severity, the treatment effect is better, so FENO can type and severity of airway the inflammatory reaction of COPD patients in the stable period; in 3. patients with stable COPD, FENO is a better prediction of the
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R563.9

【相似文獻】

相關(guān)期刊論文 前10條

1 張洪霞,曹琳彰,楊淑平;慢性阻塞性肺疾患穩(wěn)定期綜合治療的初步探討[J];職業(yè)與健康;2005年08期

2 李宗壽;王瓊芬;;治療慢性阻塞性肺疾病的穩(wěn)定期100例體會[J];昆明醫(yī)學院學報;2007年S1期

3 王紅Z，

本文編號：1341042