| [Purpose]In order to evaluate the efficacy of nebulized and systemic glucocorticoid therapy in patients with AECOPD,and to explore the effect of local inhalation of glucocorticoid on systemic and local inflammatory factors,we compared the difference of systemic inflammation and curative effect of different medication routes in four groups.We hope to provide a theoretical basis for the clinical evaluation of the efficacy of AECOPD by measuring the levels of inflammatory factors,and to provide experimental evidence for local inhalation of glucocorticoids in treatment of AECOPD and improvement of systemic inflammation,and to provide a reference for making more reasonable and economical treatment plan.[Methods]We collected 240 cases of moderate and severe AECOPD patients(38 cases of abscission)admitted to Yuxi People's Hospital from June 2015 to October 2017.According to the method of random alphabet,they were divided into groups A,B,C and D.There were 51 people in group A,48 people in group B,50 people in group C and 53 people in group D.Group A was given routine treatment(anti infection,antispasmodic and Anti-asthma)?Group B was given prednisone 40 mg once a day on the basis of routine treatment;Group C was given budesonide suspension 2 ug,by spray nebulizer inhalation,4 times a day;Group D was given prednisone oral plus aerosol inhalation of budesonide at the same dose.All patients were given treatment for 5 days.All patients were surveyed and scored with CAT and mMRC questionnaires before and after treatment for 5 days respectively.Pulmonary function tests were also carried out to record FEV1 and FEV1 as predicted percentage.The arterial blood was collected and the values of PO2 and PCO2 in arterial blood were measured.Venous blood was collected to determine the levels of serum inflammatory factors CRP,Fbg,IL-2,IL-6,IL-10,TNF-a and plasma PCT.The induced sputum was collected,and the contents of CRP,Fbg,IL-2,IL-6,IL-10,TNF-a and PCT in sputum were determined,and Sputum volume was recorded on the first day and one day after treatment.Then variance analysis and t test were used to analyze the differences among four groups.[Results]1.Before treatment,there was no significant difference in the CAT and mMRC scores between the four groups(p>0.05).After treatment,the scores of CAT and mMRC in the four groups were significantly decreased(p<0.05);after treatment,the scores of B,C and D groups decreased more significantly(p<0.05);but there was no significant difference among B,C and D groups(p<0.05).2.Before treatment,there was no significant difference in FEV1 and FEV1 between the four groups(p>0.05).After treatment,Group A,B,C,D showed prominent increase in FEV1 and FEV1%pred,which has statistically significant(p<0.05);the pulmonary function index of Group B,C,D were obviously higher than that of Group A(p<0.05),but there was no significant difference among Group B,C,D(p>0.05):3.Before treatment PO2 and PCO2 showed no statistical difference between the four groups(p>0.05).After treatment,PO2 in Group B,C,D were higher than that of Group A,while PCO2 were lower(p<0.05).Nevertheless,there was no statistically significant difference in blood gas analysis among Group B,C,D(p>0.05).4.Before treatment,there were no significant differences in PCT,Fbg,CRP,IL-2,IL-6,IL-10 and TNF-a levels between the four groups(p>0.05).Compared with before treatment,the levels of PCT,Fbg,CRP,IL-2,IL-6 and TNF-a in venous blood of the four groups after treatment decreased,while the levels of IL-10 increased with statistical difference(p<0.05).After treatment,the indexes in group B,C and D were significantly different from those in group A(p<0.05).However,there was no significant difference in B,C and D groups(p>0.05).5.Before treatment,there was no significant difference in the amount of sputum between groups(p>0.05);after treatment,the amount of sputum was significantly reduced compared with that before treatment.And after treatment,the amount of sputum in group B,C and D was also significantly reduced compared with that in group A(p<0.05).But there was no significant difference in B,C and D groups(p>0.05).6.Before treatment,there was no significant difference:in the levels of PCT,Fbg,CRP,IL-2,IL-6,IL-10 and TNF-a in induced sputum between the four groups(p>0.05).Compared with before treatment,the levels of PCT,Fbg,CRP,IL-2,IL-6 and TNF-a.in sputum of the four groups after treatment were lower than those before treatment,while the levels of IL-10 were higher(p<0.05).Compared with group A,group B,C and D had more significant changes(p<0.05),while group B and C had no significant differences(p>0.05),and group D had more significant changes in inflammatory indicators than group A,B and C(p<0.05).7.The incidence of adverse reactions in group B and group D was higher than that in group A and C,and the difference was statistically significant(p<0.05).[Conclusion]In this study,the lung function,inflammatory markers and clinical symptoms of the hormone group were better than no hormone group.So,it was confirmed that the use of glucocorticoids in AECOPD patients could improve clinical symptoms and pulmonary function,reduce the level of inflammatory factors in blood and sputum.This study used different ways of hormone therapy,can reduce the level of inflammatory factors in blood and sputum,but there is no difference in clinical effect.Although combined use of glucocorticoids can better reduce the level of inflammatory factors in sputum and control airway inflammation,considering the side effects of hormones,we use aerosol hormones,which not only has a good anti-inflammatory effect,but also has less side effects than oral use of hormones. |
PDF Full Text Request