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目的观察沙美特罗联合丙酸氟替卡松治疗慢性阻塞性肺疾病(COPD)的临床效果,并探讨其治疗机制。方法选取2013年5月—2014年5月广元市第一人民医院收治的COPD患者90例,随机分为A、B、C组各30例。在对症治疗的基础上,A组患者给予沙美特罗治疗,B组患者给予丙酸氟替卡松治疗,C组患者同时给予沙美特罗和丙酸氟替卡松治疗。比较3组患者治疗前后的肺功能指标、血清炎性因子水平及血清Janus激酶1(JAK1)和Janus激酶2(JAK2)水平。结果治疗前3组患者第1秒用力呼气容积(FEV1)、用力肺活量(FVC)和FEV1与FVC比值(FEV1/FVC)比较,差异无统计学意义(P>0.05);治疗后,A、B组患者FEV1、FVC及FEV1/FVC均低于C组(P<0.05)。治疗前3组患者血清超敏C反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)、白介素10(IL-10)水平比较,差异无统计学意义(P>0.05);治疗后A、B组患者血清hs-CRP、TNF-α及IL-10水平均高于C组(P<0.05)。治疗前3组患者血清JAK1和JAK2水平比较,差异无统计学意义(P>0.05);治疗后,A、B组患者血清JAK1和JAK2水平均高于C组(P<0.05)。结论沙美特罗联合丙酸氟替卡可有效改善COPD患者的肺功能,其机制可能与调节炎性反应、抑制JAK信号通路有关。
Objective To observe the clinical effect of salmeterol combined with fluticasone propionate in the treatment of chronic obstructive pulmonary disease (COPD) and to explore its therapeutic mechanism. Methods From May 2013 to May 2014, 90 patients with COPD admitted to Guangyuan First People’s Hospital were randomly divided into A, B and C groups of 30 cases. On the basis of symptomatic treatment, patients in group A received salmeterol treatment, patients in group B received fluticasone propionate treatment, and patients in group C received salmeterol and fluticasone propionate at the same time. Pulmonary function indexes, serum levels of inflammatory cytokines and serum levels of Janus kinase 1 (JAK1) and Janus kinase 2 (JAK2) were compared between the three groups before and after treatment. Results There was no significant difference in FEV1, FVC and FEV1 / FVC between the three groups before treatment (P> 0.05). After treatment, A, FEV1, FVC and FEV1 / FVC in group B were lower than those in group C (P <0.05). There were no significant differences in serum hs-CRP, TNF-α and IL-10 levels between the three groups before treatment (P> 0.05); after treatment The levels of serum hs-CRP, TNF-α and IL-10 in group A and group B were significantly higher than those in group C (P <0.05). There was no significant difference in serum JAK1 and JAK2 level between the three groups before treatment (P> 0.05). After treatment, the levels of JAK1 and JAK2 in group A and group B were significantly higher than those in group C (P <0.05). Conclusions Salmeterol combined with fluticasone propionate can effectively improve pulmonary function in patients with COPD, the mechanism may be related to the regulation of inflammatory response and inhibition of JAK signaling pathway.