摘要 目的 觀察烏司他丁聯合異丙托溴銨治療慢性阻塞性肺疾病急性加重期（AECOPD）的療效及對血清炎癥因子、血管內皮功能、肺功能的影響。方法 將125例AECOPD病例依據隨機分為觀察組（64例）和對照組（61例）。對照組在常規治療的基礎上給予異丙托溴銨，觀察組在對照組的基礎上給予烏司他丁。治療1周，觀察兩組療效及血清炎癥因子（hs-CRP、TNF-α、IL-1、IL-8）、血管內皮功能相關指標（ET-1、NO、TXB2、VEGF）、肺功能（TLC、PEF、PEF25、PEF50）的差異。結果 ①療效比較 觀察組顯效率48.43%，有效率35.31%，無效率6.25；對照組顯效率29.51%，有效率60.66%，無效率9.84%。兩組療效比較差異有統計學意義（Z=-2.123 P=0.034）；②血清炎癥因子水平比較 兩組hs-CRP、TNF-α、IL-1、IL-8均明顯下降(t觀察組=23.173、19.294、8.382、16.291，P=0.000、0.000、0.000、0.000；t對照組=19.385、16.732、6.713、13.185，P=0.000、0.000、0.000、0.000)，且觀察組降幅大于對照組，同期比較差異有統計學意義（t=5.419、5.184、4.893、7.241，P=0.000、0.002、0.006、0.000）；③血管內皮功能相關指標水平比較 兩組NO、VEGF上升而ET-1、TXB2下降(t觀察組=14.728、17.482、12.103、17.827，P=0.000、0.000、0.000、0.000；t對照組=11.745、12.483、6.386、12.097，P=0.000、0.000、0.000、0.000)，且觀察組變化幅度大于對照組，同期比較差異有統計學意義（t=9.182、18.831、6.271、11.382，P=0.000、0.000、0.000、0.000）；④肺功能比較 兩組TLC、FEV1、PEF25及PEF50均上升(t觀察組=10.742、8.736、9.014、11.422，P=0.000、0.000、0.000、0.000；t對照組=7.618、6.801、7.194、8.275，P=0.000、0.000、0.000、0.000)，且觀察組變化幅度大于對照組，同期比較差異有統計學意義（t=5.402、4.927、4.238、5.701，P=0.009、0.011、0.019、0.003）。結論 烏司他丁聯合異丙托溴銨治療AECOPD的療效確切，能更有效的抑制炎癥反應、保護血管內皮功能及肺功能。
中圖分類號：R563.9 文獻標識碼：A 文章編號：
Efficacy and Effect on Serum inflammatory Factors, Vascular Endothelial Function and Pulmonary Function of Ulinastatin Combined with Ipratropium Bromide in the Treatment of AECOPD
Abstract Objective To observe the efficacy and effect on serum inflammatory factors, vascular endothelial function and pulmonary function of ulinastatin combined with ipratropium bromide in the treatment of AECOPD. Methods 125 cases of patients with AECOPD were randomly divided into observation group (64cases) and control group (61 cases).The control group were given ipratropium bromide based on conventional therapy，and the observation group were given ulinastatin based on the control group. After 1 week ,to observe the clinical efficacy and differences of serum inflammatory factors (hs-CRP, TNF-α, IL-1, IL-8), vascular endothelial function related indicators (ET-1, NO, TXB2, VEGF), and pulmonary function (TLC, PEF1, PEF25, PEF50) between the two group. Results ①Comparison of curative efficacy The observation group of excellence rate 48.43%, effective was rate 35.31%,inefficiency was 6.25%,and those of the control group was 29.51%,60.66%,9.84%. The clinical efficacy of the two groups showed significant difference(Z=-2.123 P=0.034);②Comparison of serum inflammatory factors The two groups of hs-CRP, TNF-α, IL-6, IL-8 were decreased with before (tobservation group =23.173,19.294,8.382,16.291 P=0.000,0.000,0.000,0.000;tcontrol group =19.385,16.732,6.713,13.185 P=0.000,0.000,0.000,0.000), and all indexs of the observation group improved more significantly than that of the control group, with statistical difference (t=5.419,5.184,4.893,7.241 P=0.000,0.002,0.006,0.000); ③Comparison of vascular endothelial function The two groups of NO, VEGF were decreased and ET-1,TXB2,were decreased with before (tobservation group=14.728、17.482,12.103,17.827 P=0.000,0.000,0.000,0.000;tcontrol group =11.745,12.483,6.386,12.097 P=0.000,0.000,0.000,0.000), and all indexs of the observation group improved more significantly than that of the control group, with statistical difference (t=9.182,18.831,6.271,11.382 P=0.000,0.000,0.000,0.000);④Comparison of vascular pulmonary function The two groups of TLC, PEF1, PEF25, PEF50 were increased with before (tobservation group =10.742,8.736,9.014,11.422 P=0.000,0.000,0.000,0.000;tcontrol group =7.618、6.801,7.194,8.275 P=0.000,0.000,0.000,0.000), and all indexs of the observation group improved more significantly than that of the control group, with statistical difference (t=5.402、4.927,4.238,5.701 P=0.009,0.011,0.019,0.003).Conclusion ulinastatin combined with ipratropium bromide has high efficacy in the treatment of AECOPD，and has the function of inhibiting inflammatory reaction,protecting vascular endothelial function and pulmonary function.
Keywords chronic obstructive pulmonary disease; ipratropium bromide; ulinastatin; inflammatory factors; vascular endothelial function; pulmonary function
Chinese Library Classification(CLC): R563.9 Document code: A