李仲群,余维庆,赵明聪,甄炬荃,李伟恩
LI Zhongqiu,YU Weiqing,ZHAO Mingcong,ZHEN Juquan,LI Weien

• 1:江门市中心医院药剂科
• 2:江门市中心医院呼吸科
• 3:江门市中心医院感染科

摘要(Abstract)：

目的探讨注射用丹参多酚酸盐治疗老年慢性阻塞性肺疾病(COPD)急性加重的疗效及其对肺表面活性物质蛋白(SP-D)、克拉氏细胞分泌蛋白(CC16)表达的影响。方法将2011-06~2014-06期间100例老年COPD急性加重患者按照随机数字表法分为观察组和对照组各50例。对照组给予沙美特罗替卡松粉剂治疗,观察组在对照组基础上加以注射用丹参多酚酸盐注射液治疗。统计受试者治疗前、治疗后变化期呼吸困难指数(TDI)、6 min行走距离(6MWD)、氧分压(Pa O2)、二氧化碳分压(Pa CO2)、p H值、第1秒用力呼气容积(FEV1)占预计值百分比(FEV1%)、FEV1/用力肺活量(FVC)、血清SP-D、CCl6含量。结果治疗后,观察组和对照组呼吸困难及运动耐力均获改善,且观察组呼吸困难及运动耐力改善情况优于对照组(P<0.05);治疗后24 h、48 h观察组呼吸频率较治疗前改善(P<0.05),改善幅度大于同期对照组(P<0.05);治疗后24 h、48 h观察组Pa O2较治疗前改善(P<0.05),改善幅度大于同期对照组(P<0.05);治疗后24 h、48 h观察组Pa CO2较治疗前降低(P<0.05),降低幅度大于同期对照组(P<0.05);治疗后24 h、48 h观察组p H值较治疗前改善(P<0.05),改善幅度大于同期对照组(P<0.05);治疗后观察组肺功能较治疗前明显改善(P<0.05),且改善幅度大于同期对照组(P<0.05);治疗后观察组血清SPD、CC16水平均较治疗前降低(P<0.05),且降低幅度大于同期对照组(P<0.05)。结论注射用丹参多酚酸盐可有效改善老年COPD急性加重患者运动耐力及肺功能,缓解呼吸困难症状,降低血SP-D、CC16水平。
OBJECTIVE To study curative effect of salvia miltiorrhiza polyphenols acid salt for injection in the treatment of COPD with acute exacerbation and its influence on SP-D,CC16. METHODS According to random number table method 100 cases of COPD with acute exacerbation patients between 2011 June to 2014 June were random Ly divided into the observation group( n = 50) and control group( n = 50). Patients in the control group were given salmeterol assigned powder treatment; and patients in the observation group were given salvia miltiorrhiza polyphenols acid salt for injection on the basis of the control group. Statistical subjects' TDI,6MWD,Pa O2,Pa CO2,p H value estimated value,FEV1/FVC,FEV1%( %),serum levels of SP-D,CCl6 before and after treatment were made. RESULTS 24 h,48 h after treatment Pa O2 in patients of observation group were improved than those of before the treatment( P<0.05),and the improved range were higher than those of the control group,with statistical significance( P<0.05); in observation group,Pa CO2 reduced than before the treatment 24 h,48 h after treatment( P < 0. 05),and lower than the control group,with statistically significant( P<0.05); in observation group,p H value improved than before the treatment 24 h,48 h after treatment( P<0.05),and the improved range were more than that of the control group,with statistical significance( P < 0. 05); Lung function significantly improved than before treatment in observation group after treatment( P < 0. 05),and the improved range than thao of the control group,with statistical significance( P<0.05); Before treatment,2 groups had no obvious difference was found between serum levels of SP-D,CC16,and after treatment serum levels of SP-D,CC16 observation group were lower before the treatment( P<0.05),and lower than the control group,with statistical significance( P<0.05). CONCLUSION Salvia miltiorrhiza polyphenols acid salt for injection in the treatment of COPD with acute exacerbation,which can effectively improve the patient 's clinical symptoms,blood gas index and pulmonary function,and reduce the peripheral blood SP-D,CC16 levels.

关键词(KeyWords)： 慢性阻塞性肺疾病;急性加重;注射用丹参多酚酸盐;肺表面活性蛋白D;Clara细胞蛋白
chronic obstructive pulmonary disease;acute exacerbation;salvia miltiorrhiza polyphenols acid salt for injection;pulmonary surfactant protein D;clara cell protein

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 李仲群,余维庆,赵明聪,甄炬荃,李伟恩
LI Zhongqiu,YU Weiqing,ZHAO Mingcong,ZHEN Juquan,LI Weien

参考文献(References)：

• [1]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中华结核和呼吸杂志,2013,36(4):255-264.
• [2]Agusti A,Sin DD.Biomarkers in COPD[J].Clin Chest Med,2014,35(1):131-141.
• [3]张金梅,孙丽华.慢性阻塞性肺疾病的生物标记物——肺表面活性蛋白-D、Clara细胞分泌蛋白[J].国际呼吸杂志,2012,32(19):1489-1492.
• [4]张玉婷,许西琳,牛斌等.慢性阻塞性肺疾病患者血清CC16及SP-D水平变化及意义[J].中华实用诊断与治疗杂志,2013,27(6):581-582.
• [5]Mac Nee W.Systemic inflammatory biomarkers and co-morbidities of chronic obstructive pulmonary disease[J].Ann Med,2013,45(3):291-300.
• [6]Pinto-Plata V,Casanova C,Müllerova H,et al.Inflammatory and repair serum biomarker pattern:association to clinical outcomes in COPD[J].Respir Res,2012,13(5):71.
• [7]陈文霖,黄美健.丹参多酚酸盐对慢性阻塞性肺疾病急性加重期患者血清IL-1β、IL-18水平的影响[J].浙江中医药大学学报,2013,(11):1312-1314.
• [8]贺志飚,金丽艳,柴湘平,等.丹参多酚酸盐对重度慢性阻塞性肺疾病急性加重期患者血小板和内皮细胞功能的影响[J].中国危重病急救医学,2010,22(5):279-281.
• [9]Engstrm G,Lindberg C,Gerhardsson de Verdier M,et al.Blood biomarkers and measures of pulmonary function-a study from the Swedish twin registry[J].Respir Med,2012,106(9):1250-1257.
• [10]陈明勇,陈勃江,陈斌等.吸入沙美特罗替卡松粉剂对稳定期COPD患者血清SP-D浓度的影响[J].中华哮喘杂志(电子版),2013,7(1):35-38
• [11]Liu W,Ju CR,Chen RC,et al.Role of serum and induced sputum surfactant protein D in predicting the response to treatment in chronic obstructive pulmonary disease[J].Exp Ther Med,2014,8(4):1313-1317.
• [12]Güzel A,Karadaˇg A,Okuyucu A,et al.The evaluation of serum surfactant protein D(SP-D)levels as a biomarker of lung injury in tuberculosis and different lung diseases[J].Clin Lab,2014,60(7):1091-1098.