目的观察中等剂量丙酸氟替卡松(FP)短期吸入治疗对不同分型慢性阻塞性肺疾病(COPD)患者临床症状、生活质量、肺功能、气道炎症及重建的影响。方法选取66例COPD加重期患者为病例组,按痰嗜酸细胞计数将患者分为A组(嗜酸粒细胞≥3%)、B组(嗜酸粒细胞<3%)。吸入FP500μg/次,2次/d,连用8w。治疗前后记录临床症状得分、生活质量得分、FEV1、FEV1占预计值百分数(%),并测定痰中IL-8、MMP-9的含量。结果A、B两组治疗后临床症状评分及生活质量评分均下降,治疗前后有显著性差异(P<0.05)。A组FEV1治疗后〔(1.49±0.14)L〕比治疗前〔(1.28±0.12)L〕明显升高(P<0.01),B组治疗前后差异无显著性(P<0.05);A组在治疗后嗜酸粒细胞数从7%降至3.5%(P<0.01);B组治疗前后无显著性差异。结论短期吸入糖皮质激素对气道有嗜酸粒细胞浸润的COPD患者可改善临床症状和生活质量,并可提高肺功能、减少嗜酸粒细胞数,抑制嗜酸性气道炎症;但对中性粒细胞浸润为主的COPD患者的肺功能、气道炎症及气道重建均无明显作用。 Objective To observe the effects of mid-dose fluticasone propionate (FP) short-term inhalation on clinical symptoms, quality of life, pulmonary function, airway inflammation and reconstruction in patients with different types of chronic obstructive pulmonary disease (COPD). Methods Sixty-six patients with exacerbation of COPD were selected as the case group. Patients were divided into group A (eosinophils ≥ 3%) and group B (eosinophils <3%) according to sputum eosinophil count. Inhalation FP500μg / time, 2 times / d, once every 8w. Clinical symptom score, quality of life score, FEV1, FEV1 percentage of expected value (%) were recorded before and after treatment, and the levels of IL-8 and MMP-9 in sputum were measured. Results The scores of clinical symptoms and quality of life in both A and B groups decreased after treatment, with significant difference before and after treatment (P <0.05). (1.49 ± 0.14) L in group A was significantly higher than that before treatment [(1.28 ± 0.12) L] (P <0.01), and there was no significant difference in group B before and after FEV1 treatment After treatment, the number of eosinophils decreased from 7% to 3.5% (P <0.01). There was no significant difference between the two groups before and after treatment. Conclusion Short-term inhaled glucocorticoid on airway eosinophilic infiltration of COPD patients can improve clinical symptoms and quality of life, and can improve lung function, reduce eosinophil count, inhibit eosinophilic airway inflammation; but for the neutral Pulmonary function, airway inflammation and airway remodeling in granulocyte-infiltrated patients with COPD had no significant effect.