摘要
目的评估吸入性糖皮质激素联合肺炎链球菌疫苗控制老年人慢性阻塞性肺疾病（COPD）急性发作的疗效。方法共纳入2014年2月至2016年5月在我院治疗的老年COPD患者150例，将其随机分为3组，其中A组（50例）在常规治疗基础上给予吸入性糖皮质激素治疗、B组（50例）在常规治疗基础上联合应用肺炎链球菌疫苗、C组（50例）在常规治疗基础上给予吸入性糖皮质激素联合肺炎链球菌疫苗治疗，比较3组患者临床症状和肺功能改善情况、急性发作的控制情况、死亡率和不良反应。结果C组患者疫苗后未出现严重不良反应。治疗后，B组患者和C组患者咳嗽、气喘和咳痰的发生率均明显低于A组患者（均P〈0．05），但C组和B组患者咳嗽、气喘和咳痰的发生率差异均无统计学意义（均P〉0．05）。治疗前3组患者第1秒用力呼气容积（FEV1）和FEV1／用力肺活量（FVC）差异均无统计学意义（F=2．301、1．290，P=0．396、0．266），治疗后3组患者的FEV1和FEV1／FVC均较治疗前明显改善（均P〉0．05）；B组、C组的FEV1和FEV，／FVC均明显高于A组，且C组的FEV1和FEV1／FVC明显高于B组（均P〈0．05）。B组和C组患者COPD急性发作次数、住院次数和住院时间均明显低于A组患者，而急性发作间隔明显高于A组患者；且C组患者COPD急性发作次数、住院次数和住院时间均明显低于B组患者，而急性发作间隔明显高于B组患者（均P〈0．05）。在随访过程中，3组患者死亡率差异无统计学意义（χ2=0．514，P=0．774）。结论吸入性糖皮质激素联合肺炎链球菌疫苗控制老年人COPD急性发作的效果显著、安全性高、不良反应小，可在临床上进一步推广应用。
Objective To evaluate the clinical efficacy of inhaled corticosteroids combined with Streptococcus pneumoniae vaccines for acute exacerbation of chronic obstructive pulmonary disease in elderly patients. Methods A total of i50 elderly patients with chronic obstructive pulmonary disease were enrolled in this study from February 2014 to May 2016 at our hospital. All patients were randomly divided into three groups with 50 cases in each group. All patients received routine therapy. Meanwhile,patients in Group A were also treated with inhaled corticosteroids, patients in Group ]3 were given pneumococcal vaccines, and patients in Group C received inhaled corticosteroids combined with Streptococcus pneumoniae vaccines. Clinical symptom improvement, pulmonary [unction, frequency of acute attacks, mortality and adverse reactions were compared between the three groups. Results There were no severe adverse reactions observed in Group C aftervaccination. After treatment,incidences of cough, asthma and expectoration in both Group B and Group C were significantly lower than those in Group A （P〈 0.05）. However, there was no statistically significant difference between Group C and Group B（P〈0.05）. Before treatment,levels of FEV1 and FEV1/FVC were comparable between the three groups（P〈0. 05）. However, after treatment, FEV1 （F = 2. 301, P = 0. 396） and FEV1/FVC （F = 1. 290, P = 0. 266） of the three groups were significantly improved compared with pre-treatment levels. Moreover,FEV1 and FEV1/FVC in Group B and Group C were significantly higher than those in Group A, and FEV1 and FEV1/FVC in Group C were significantly higher than those in Group B（P〈0.05）. In addition, the incidence of acute exacerbation, the frequency and duration of hospitalization in Group B and Group C were significantly lower than in Group A, and acute attack intervals in Group B and Group C were significantly longer than inGroup A （all P〈 0.05）. Furthermore, the incidence of acute exacerbation, the frequency and duration of hospitalization in Group C were significantly lower than in Group B,and acute attack intervals in Group C were significantly longer than inGroup B（all P〈0.05）. During follow-up, there were not statistically significant differences in mortality between the groups（P〈0.05）. Conclusions The combination of inhaled corticosteroids with Streptococcus pneumoniae vaccines is effective and safe for the treatment of acute exacerbation of chronic obstructive pulmonary disease in elderly patients.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2017年第11期1208-1211,共4页
Chinese Journal of Geriatrics
基金
四川省卫生和计划生育委员会科研基金（30305030159）
四川省科学技术厅科研基金（30305030747）
关键词
肺疾病
慢性阻塞性
糖皮质激素类
链球菌
肺炎
Pulmonary disease, chronic obstructive
Glucocorticoids
Streptococcus pneumoniae
