摘要 目的 观察乌司他丁联合异丙托溴铵治疗慢性阻塞性肺疾病急性加重期（AECOPD）的疗效及对血清炎症因子、血管内皮功能、肺功能的影响。方法 将125例AECOPD病例依据随机分为观察组（64例）和对照组（61例）。对照组在常规治疗的基础上给予异丙托溴铵，观察组在对照组的基础上给予乌司他丁。治疗1周，观察两组疗效及血清炎症因子（hs-CRP、TNF-α、IL-1、IL-8）、血管内皮功能相关指标（ET-1、NO、TXB2、VEGF）、肺功能（TLC、PEF、PEF25、PEF50）的差异。结果 ①疗效比较 观察组显效率48.43%，有效率35.31%，无效率6.25；对照组显效率29.51%，有效率60.66%，无效率9.84%。两组疗效比较差异有统计学意义（Z=-2.123 P=0.034）；②血清炎症因子水平比较 两组hs-CRP、TNF-α、IL-1、IL-8均明显下降(t观察组=23.173、19.294、8.382、16.291，P=0.000、0.000、0.000、0.000；t对照组=19.385、16.732、6.713、13.185，P=0.000、0.000、0.000、0.000)，且观察组降幅大于对照组，同期比较差异有统计学意义（t=5.419、5.184、4.893、7.241，P=0.000、0.002、0.006、0.000）；③血管内皮功能相关指标水平比较 两组NO、VEGF上升而ET-1、TXB2下降(t观察组=14.728、17.482、12.103、17.827，P=0.000、0.000、0.000、0.000；t对照组=11.745、12.483、6.386、12.097，P=0.000、0.000、0.000、0.000)，且观察组变化幅度大于对照组，同期比较差异有统计学意义（t=9.182、18.831、6.271、11.382，P=0.000、0.000、0.000、0.000）；④肺功能比较 两组TLC、FEV1、PEF25及PEF50均上升(t观察组=10.742、8.736、9.014、11.422，P=0.000、0.000、0.000、0.000；t对照组=7.618、6.801、7.194、8.275，P=0.000、0.000、0.000、0.000)，且观察组变化幅度大于对照组，同期比较差异有统计学意义（t=5.402、4.927、4.238、5.701，P=0.009、0.011、0.019、0.003）。结论 乌司他丁联合异丙托溴铵治疗AECOPD的疗效确切，能更有效的抑制炎症反应、保护血管内皮功能及肺功能。
中图分类号：R563.9 文献标识码：A 文章编号：
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