The Observation Of Curative Effect Of Bronchoalveolar Lavage To Silicosis Merging Stable Moderate Or Severe Chronic Obstructive Pulmonary Disease

Background: Silicosis merging chronic obstructive pulmonarydisease(COPD) is severe chronic disease of respiratory system, whichshows a high rate of mortality. It recurs frequently and leads to all kinds ofcardiopulmonary complications because of the progressive pathologicalchanges, the deterioration of pulmonary function, the reduce of immunefunction, and the harmful factors of the outside world. That affects quality oflife and safety of patients. Therefore, the treatment of silicosis merging COPDis very important. Bronchoalveolar Lavage(BAL) can remove the dust, thedust-swallowed macrophages, inflammatory cells, epithelial cells, andpulmonary fibrosis factors in the alveolar cavity and bronchial tree by themechanical washing, removing and tragic organ administration function oflavage fluid. It shows a significant effect in eliminating the cause, improvingrespiratory function, alleviating the symptoms and getting a better life. It doesa good job in preventing the progress of silicosis, and shows a markedcurative effect recently. But, the patients of silicosis merging COPD alwayssuffer from a rapid progression and poor pulmonary function before BAL.The safety of BAL to these patients is still in investigated. According to the theory and the preliminary study, it is feasible. Thus, we design theexperiment and clinical research of preview, random, comparison, to discussthe function of BAL in silicosis merging COPD treatment.Objective: Observing the curative effect of BAL to silicosis mergingstable moderate or severe COPD, to provide the basis, evaluation of curativeeffect in clinical treatment; as well as observing the function of inflammatorycell factor in silicosis merging COPD.Method: Choosing the patients of silicosis merging stable moderate orsevere COPD in the outpatient department and inpatient department in myhospital from Aug2012to Jun2013. The patients are randomly divided intotwo groups, the BAL group and the control group. The control group: Giventhe treatment of regularly oxygen inhalation, cough and asthma relieving,phlegm reducing. BAL group: Given BAL as well as the above treatment. Theindex by clinical observation:1.Pulmonary function: FEV1, FVC, and theproportion of FEV1compared with expected value, which are tested threetimes—before treatment, one month after treatment, and three months aftertreatment.2.6-minute walk test: Measure the distance of6-minute walk testfor three times—before treatment, one month after treatment, and threemonths after treatment.3. The score of SGRQ, which is also tested for threetimes—before treatment, one month after treatment, and three months aftertreatment.4. Inflammatory cell factors: Test the concentration of transforminggrowth factor-β1(TGF-β1) and tumor necrosis factor-α(TNF-α)in serum twotimes—before treatment and one month after treatment. Results:1. Comparison of pulmonary function: After the treatment of onemonth and three months, the indexes of pulmonary function of BAL groupand control group: There is no significant difference in the comparisonbetween groups, and before and after self comparison of FEV1, FVC, and theproportion of FEV1compared with expected value.2. Comparison of6-minute walk test: After the treatment of one month and three months, thedistance of6-minute walk test increases significantly of the patients in bothBAL group and control group(p<0.05). Comparison between groups:Compared with comparison group, the increasing of distance in BAL group issignificant. It shows statistical difference(p<0.01).3. Comparison of the scoreof SGRQ: After the treatment of one month and three months, the score ofboth BAL group and control group declines significantly compared with thescore before treatment.(p<0.01) Compared the score after three monthstreatment with the score after one month treatment, the decline of the clinicalpart and the affective part of control group and the affective part of BALgroup shows significant difference(p<0.05). Comparison between groups:After the treatment of one month, compared BAL group with control group,only the decline of the score of clinical part shows significantdifference(p<0.01). After the treatment of three months, compared BAL groupwith control group, the decline of the score of active part and affective partshows significant difference as well as total score(p<0.05).4. Inflammatorycell factor: Compared with it before treatment, after one-month treatment, theamount of TGF-β1and TNF-α in both BAL group and control group declined, of which the difference shows statistical significance. However, compared theamount of the two cell factors in BAL group with it in control group, thedecline shows significant difference(p<0.05).Conclusion:1. The pulmonary function of the patients with silicosis merging COPDcan’t be improved by Bronchoalveolar lavage.2. The quality of life and tolerance of activities of the patients withsilicosis merging COPD can be improved by Bronchoalveolar lavage.3. Bronchoalveolar lavage can decrease the amount of TGF-β1andTNF-α in serum of the patients with silicosis merging COPD.