發(fā)布時(shí)間：2018-04-28 22:34

  本文選題：支氣管擴(kuò)張癥 + 氟替卡松/沙美特羅��； 參考：《山東大學(xué)》2012年碩士論文

【摘要】：背景：支氣管擴(kuò)張癥是由于各種微生物的反復(fù)感染或慢性感染引起的慢性支氣管炎癥導(dǎo)致永久氣道擴(kuò)張,首次由Rene Theophile Laennec在1819年描述。支氣管擴(kuò)張癥的特點(diǎn)是支氣管局部管腔擴(kuò)張、粘液分泌、粘膜炎癥,導(dǎo)致痰量增多和慢性咳嗽。 支氣管擴(kuò)張癥分為非纖維化支氣管擴(kuò)張癥(NCFB,以下簡(jiǎn)稱(chēng)支擴(kuò))和纖維化伴發(fā)支氣管擴(kuò)張癥,其中后者為繼發(fā),不屬于本課題范圍。支擴(kuò)的病因是復(fù)雜的,但有共同的病理生理過(guò)程,其中包含三個(gè)主要因素[2-31：炎癥,感染和破壞(酶的作用)。由于各種病因,機(jī)體不能及時(shí)清除呼吸道局部微生物的定植,從而導(dǎo)致感染,進(jìn)一步導(dǎo)致炎癥反應(yīng)。炎癥可以抵御外來(lái)物的侵襲,但這種反應(yīng)未能及時(shí)正確消除外來(lái)物時(shí),可能會(huì)變成慢性炎癥,從而誘發(fā)支氣管壁破壞和不可逆的擴(kuò)張。出現(xiàn)這種由細(xì)菌感染引起的呼吸道炎癥反應(yīng)過(guò)度,甚至在細(xì)菌感染控制后仍持續(xù)存在,從而導(dǎo)致促炎因子和／或不受控制的活化效應(yīng)細(xì)胞持續(xù)存在。支氣管擴(kuò)張癥的炎性細(xì)胞是單核細(xì)胞和中性粒細(xì)胞,單核細(xì)胞和中性粒細(xì)胞也是導(dǎo)致氣流受限的慢性支氣管阻塞和頻繁的支氣管高反應(yīng)性的炎性細(xì)胞。 有統(tǒng)計(jì)顯示[4],支氣管擴(kuò)張患者大約有50%存在氣流受限。而肺功能改變與病變的范圍及性質(zhì)有密切的關(guān)系。病變局限者,肺功能一般無(wú)改變；柱狀擴(kuò)張對(duì)肺功能影響輕微,囊狀擴(kuò)張的支氣管破壞嚴(yán)重,可并發(fā)阻塞性肺氣腫。資料顯示,支氣管擴(kuò)張癥患者的肺功能變化以阻塞性通氣功能障礙為多見(jiàn)(80%患者),少數(shù)為混合性通氣功能障礙,33%-76%患者存在氣道高反應(yīng)性。 目前,關(guān)于支氣管擴(kuò)張穩(wěn)定期的治療沒(méi)有一個(gè)明確有效的長(zhǎng)期治療方案。研究顯示[7-8],高劑量糖皮質(zhì)激素(ICS)應(yīng)用能改善支氣管擴(kuò)張病人的臨床癥狀和生活質(zhì)量,減輕支氣管粘膜的炎癥,但是它不能完全清除氣道炎癥,而副作用的出現(xiàn)如咳嗽、口干、發(fā)聲困難、口腔潰瘍、噴嚏及口腔念珠菌感染等卻令人擔(dān)心；而小劑量吸入激素(500μ g/天氟替卡松),副作用小,但不能明顯改善臨床癥狀和生活質(zhì)量。ICS+LABA[9]聯(lián)合吸入治療降低了激素用量,表現(xiàn)出一個(gè)良好的臨床安全性和有效性,國(guó)外已有小樣本研究的報(bào)道,發(fā)現(xiàn)在癥狀、運(yùn)動(dòng)耐量、生活質(zhì)量等方面較治療前明顯改善,但肺功能改善無(wú)統(tǒng)計(jì)學(xué)意義。我國(guó)支擴(kuò)發(fā)病率高,病因分布與國(guó)外也有較大的不同,ICS+LABA長(zhǎng)期應(yīng)用是否對(duì)我國(guó)支擴(kuò)穩(wěn)定期患者有效未見(jiàn)報(bào)道。 目的：評(píng)價(jià)氟替卡松/沙美特羅(F/S)在治療非纖維化(NCFB)支氣管擴(kuò)張癥合并不可逆的氣流受限患者吸入治療的療效和安全性。 材料與方法：這項(xiàng)臨床試驗(yàn)是一項(xiàng)6個(gè)月的隨機(jī)、對(duì)照、前瞻性研究,收集的患者從2010年6月至2011年8月。60例支氣管擴(kuò)張癥、有不可逆的氣流受限患者都要經(jīng)過(guò)高分辨率CT、肺功能檢查確診。隨機(jī)分為兩組：A組接受F/S聯(lián)合治療(50/250u g吸入BID)+常規(guī)治療；B組接受常規(guī)治療(按需應(yīng)用沙丁胺醇、抗菌藥物、祛痰藥)。在研究期間,所有的患者在需要時(shí)都允許應(yīng)用吸入沙丁胺醇治療。分別于治療3個(gè)月、6個(gè)月觀察臨床狀況、健康相關(guān)生活質(zhì)量(HRQL)、急性發(fā)作次數(shù)、肺功能、β2-腎上腺素能激動(dòng)劑(沙丁胺醇)使用量、病原微生物(PPMs)的菌株、藥物副作用等,對(duì)以上指標(biāo)應(yīng)用SPSS13.0軟件進(jìn)行統(tǒng)計(jì)分析,以P0.05為統(tǒng)計(jì)學(xué)意義。 結(jié)果：(1)接受F/S的綜合治療的A組在呼吸困難評(píng)分、咳嗽次數(shù)、不使用β2-腎上腺素受體激動(dòng)劑的天數(shù)方面與對(duì)照組有顯著性差異。(2)HRQL的改善方面有顯著性差異。(3)兩組肺功能、PPMs的分離無(wú)統(tǒng)計(jì)學(xué)差異,雖然A組在肺功能方面有一定的改善。(4)A組急性發(fā)作次數(shù)明顯少于對(duì)照組。(5)兩組不良反應(yīng)無(wú)顯著性差異。 結(jié)論：對(duì)非囊性纖維化支氣管擴(kuò)張癥合并不可逆的氣流受限患者,聯(lián)合吸入F/S治療是有效和安全的。
[Abstract]:Background: bronchiectasis is a chronic bronchitis caused by repeated infection of various microbes or chronic bronchitis caused by chronic bronchitis, resulting in permanent airway dilatation. It is first described in 1819 by Rene Theophile Laennec. Bronchiectasis is characterized by localized bronchiectasis, mucus secretions, mucous inflammation, increased phlegm and chronic cough. Cough.
Bronchiectasis is divided into non fibrotic bronchiectasis (NCFB, hereinafter referred to as bronchiectasis) and fibrosis associated bronchiectasis. The latter is secondary and does not belong to the subject. The etiology of the bronchiectasis is complex but has a common pathophysiological process, including three main factors, [2-31: inflammation, infection and destruction (enzyme action). Because of various causes, the body can not remove the colonization of the local microorganism in the respiratory tract in time, which leads to infection and further causes the inflammatory response. The inflammation can resist the invasion of foreign objects, but this reaction may become chronic inflammation when it fails to eliminate foreign objects correctly in time, which induces the destruction of the bronchial wall and the irreversible expansion. The inflammation of the respiratory tract caused by bacterial infection is excessive and even persists after the bacterial infection control, which leads to the persistence of pro-inflammatory and / or uncontrolled activated cells. The inflammatory cells of bronchiectasis are mononuclear cells and neutrophils, monocytes and neutrophils also lead to gas. Flow limited chronic bronchial obstruction and frequent bronchial hyperresponsiveness of inflammatory cells.
Statistics show that about 50% of the patients with bronchiectasis have airflow limitation, and the changes in pulmonary function are closely related to the range and nature of the lesion. The pulmonary function is generally not changed in those with localized lesions; the pulmonary function is slightly affected by the columnar dilatation, and the cystic dilatation of the bronchiectus is severe, which can be complicated by obstructive pulmonary emphysema. Data display, bronchiectasis, and bronchiectasis. The pulmonary function changes in patients with tracheal dilatation are more common in obstructive ventilation dysfunction (80% patients), a few are mixed ventilation dysfunction, and 33%-76% patients have airway hyperresponsiveness.
At present, there is no clear and effective long-term treatment for the treatment of bronchiectasis. The study shows that [7-8], high dose glucocorticoid (ICS) application can improve the clinical symptoms and quality of life of bronchiectasis patients and reduce the inflammation of bronchial mucosa, but it can not completely eliminate airway inflammation and side effects. Such as coughing, dry mouth, dysporia, oral ulcers, sneezing and oral Candida infection, but small dose inhaled hormone (500 g/ days fluticasone), with small side effects, can not significantly improve the clinical symptoms and quality of life.ICS+LABA[9] combined inhalation treatment to lower the hormone dosage, showing a good clinical safety and clinical safety. It has been reported that the symptoms, the exercise tolerance, the quality of life and other aspects are obviously improved, but the improvement of lung function is not statistically significant. The incidence of bronchiectasis in China is high and the distribution of the etiology is different from that of foreign countries. The long-term application of ICS+LABA has not been reported effectively for patients with stable period of Chinese bronchiectasis. Avenue.
Objective: To evaluate the efficacy and safety of fluticasone / Shah Mette Lo (F/S) in the treatment of patients with non fibrosis (NCFB) bronchiectasis with irreversible airflow limitation.
Materials and methods: This clinical trial was a 6 month randomized, controlled, prospective study of bronchiectasis in.60 cases from June 2010 to August 2011. Patients with irreversible airflow were diagnosed with high resolution CT and lung function examination. The patients were randomly divided into two groups: group A received F/S combined therapy (50/250u g inhaled BI). D) + routine treatment; group B received routine treatment (using salbutamol, antibacterials, expectorant). During the study, all patients were allowed to use inhaled salbutamol for 3 months, 6 months of clinical observation, health related life quality (HRQL), acute attack times, lung function, beta 2- adrenaline The dosage of the agonist (salbutamol), the strain of the pathogenic microorganism (PPMs), the side effects of the drug, and so on. The above index was statistically analyzed with the SPSS13.0 software, and P0.05 was statistically significant.
Results: (1) the A group receiving F/S comprehensive treatment had significant difference with the control group in the score of dyspnea, the number of coughing times and the number of days without beta 2- adrenergic receptor agonist. (2) there were significant differences in the improvement of HRQL. (3) there was no statistical difference between the two groups of lung function and the separation of PPMs, although the A group had some changes in the lung function. Good. (4) the number of acute attacks in group A was significantly less than that in control group. (5) there was no significant difference in adverse reactions between the two groups.
Conclusion: combined inhalation of F/S is effective and safe for patients with non cystic fibrosis bronchiectasis and irreversible airflow limitation.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類(lèi)號(hào)】：R562.22

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