中国临床药学杂志

目的 探讨福莫特罗联合格隆溴铵治疗慢性阻塞性肺疾病(COPD)急性加重高风险疗效及对肺功能、症状发作的影响。方法 应用随机数字表法将2019年3月至2021年3月收治的106例COPD急性加重高风险患者按照1:1试验原则分为2组，各53例。对照组给予福莫特罗，观察组给予福莫特罗联合格隆溴铵。疗程均为3个月。比较2组疗效、治疗前后COPD评估测试量表(CAT)评分、改良英国医学研究委员会呼吸问卷(m MRC)分级、肺功能[用力肺活量(FVC)、第1秒用力呼气容积(FEV₁)、FEV₁占预计值百分比]、气道阻力(中心气道阻力、气道总阻力、呼吸总阻抗、响应频率)、诱导痰炎症指标[白细胞介素-8(IL-8)、白细胞介素-17(IL-17)、细胞间黏附分子(ICAM-1)、白三烯B4(LTB4)、白细胞介素-13(IL-13)]和安全性。结果 观察组总有效率与对照组相比，差异无统计学意义(98.11%vs 92.45%,P> 0.05)。治疗后2组CAT评分均低于同组治疗前，且观察组低于对照组(P <0.05)。观察组治疗后m MRC分级优于对照组(P <0.05),FVC、FEV₁、FEV₁占预计值百分比均高于对照组(P <0.05)，而中心气道阻力、气道总阻力则低于对照组(P <0.05)。观察组治疗后IL-8、IL-17、ICAM-1、LTB4、IL-13低于治疗前，且低于对照组(P <0.05)。对照组不良反应发生率与观察组比较，差异无统计学意义(7.55%vs 3.77%,P> 0.05)。结论 对于COPD急性加重高风险患者，福莫特罗联合格隆溴铵治疗能显著提高疗效，抑制炎性反应，降低患者气道阻力，减轻呼吸困难症状，改善肺功能，且不会明显增加药物不良反应。

AIM To investigate the effect of formoterol combined with glycopyrrolate in the treatment of chronic obstructive pulmonary disease(COPD) with high risk of acute exacerbation and its effect on lung function and symptom onset. METHODS A total of 106 patients with high risk of acute exacerbation of COPD admitted to our hospital from March 2019 to March 2021 were divided into 2 groups according to the principle of 1 : 1 trial by using a computerized random number table method, with 53 patients in each group. The control group was given formoterol, and the observation group was given formoterol combined with glycopyrrolate. Both groups were treated for 3 months. The efficacy of 2groups, the COPD assessment test scale(CAT) score before and after treatment, the modified British Medical Research Council Respiratory Questionnaire(mMRC) classification, lung function [forced vital capacity(FVC), forced expiratory volume in one second(FEV₁), forced expiratory volume in one second as percentage of predicted value(FEV₁%)], airway resistance [central airway resistance, total airway resistance, respiration impedance, response frequency], sputum induced inflammation indicators [interleukin-8(IL-8), interleukin-17(IL-17), intercellular adhesion molecular-1(ICAM-1), leukotriene B4(LTB4), interleukin-13(IL-13)], and safety were compared. RESULTS In terms of the total effective rate, there was no significant difference between the observation group and the control group(98.11% vs 92.45%,P>0.05); the CAT scores of 2 groups after treatment were lower than those before treatment, and the observation group were lower than the control group(P<0.05). The mMRC classification of the observation group after treatment was better than that of the control group(P<0.05). FVC, FEV₁ and FEV₁% of the observation group after treatment were higher than those of the control group(P<0.05). The central airway resistance and total airway resistance after treatment of the observation group were lower than those of the control group(P<0.05). After treatment, IL-8, IL-17, ICAM-1, LTB4, and IL-13 in the observation group were lower than before treatment, and lower than the control group(P<0.05). There was no significant difference in the incidence of adverse reactions between the control group and the observation group(7.55%vs 3.77%,P > 0.05). CONCLUSION For highrisk patients with acute exacerbation of COPD, formoterol combined with glycopyrrolate can significantly improve the efficacy, inhibit the inflammatory response, reduce the patients' airway resistance, reduce the symptoms of dyspnea, improve lung function, and do not significantly increase the adverse drug reactions.