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目的:探讨慢性阻塞性肺疾病(COPD)稳定期患者血清皮质醇(Cor)不同水平患者,短期全身使用小剂量糖皮质激素后血清Cor变化及临床疗效。方法:将COPD稳定期且Cor减低患者126例随机分为A组和B组;COPD稳定期且Cor正常患者128例随机分为C组和D组。各组患者均予常规治疗,A组和C组在此基础上加用泼尼松片10 mg.d~(-1),连用4周后逐渐停药.比较各组患者治疗前后肺功能、血清Cor水平、生活质量评分(圣乔治呼吸问卷总评分)、药品不良反应等指标。结果:治疗后,4组圣乔治呼吸问卷总评分均较前下降,肺功能明显改善(P<0.05);A组总评分与肺功能指标均明显优于B组(P<0.05),而C组与D组的总评分与肺功能比较差异无统计学意义(P>0.05)。治疗后A组患者血清Cor水平较治疗前升高(P<0.01)。结论:Cor正常患者不建议使用全身糖皮质激素治疗,对治疗无明显获益。Cor减低患者在常规治疗基础上短期加用全身小剂量糖皮质激素,可改善肺通气功能,提升生活质量,升高血清Cor水平,且不良反应小。
Objective: To investigate the changes of serum Cor in patients with chronic obstructive pulmonary disease (COPD) with stable levels of serum cortisol (Cor) at different levels after short-term systemic administration of low-dose glucocorticoids and its clinical efficacy. Methods: One hundred and sixty-six patients with stable COPD and Cor were randomly divided into group A and group B. In the stable COPD group, 128 Cor patients were randomly divided into group C and group D. The patients in each group were treated routinely, and prednisone tablets (10 mg.d ~ (-1)) were added to group A and group C. Four weeks later, they were discontinued gradually.Comparing the changes of lung function, Serum Cor level, quality of life score (St. George’s Respiratory Questionnaire total score), adverse drug reactions and other indicators. Results: After treatment, the total scores of St George’s Respiratory Questionnaire in all four groups were significantly lower than before (P <0.05); the total score of group A and the indexes of lung function were significantly better than those in group B (P <0.05) There was no significant difference between the total score and the lung function in group D and group D (P> 0.05). After treatment, serum Cor levels in patients in group A were significantly higher than those before treatment (P <0.01). CONCLUSIONS: Cor normal patients are not recommended for systemic glucocorticoid therapy and have no clear benefit in treatment. Cor reduce patients with conventional treatment based on short-term plus systemic low-dose glucocorticoid, can improve pulmonary ventilation, improve quality of life, raise serum Cor levels, and adverse reactions.