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1、沙美特罗/丙酸氟替卡松吸入治疗中重度COPD的临床观察（作者:单位:邮编:）【摘要】目的探讨吸入型肾上腺糖皮质激素（ICS）与长效P2受体激动剂（LABA）的预混制剂沙美特罗/丙酸氟替卡松（SAL/FP）对中重度慢性阻塞性肺疾病（COPD）的治疗作用。方法COPD病人70例（全部病例入组前未使用过任何剂型的激素、受体激动剂、抗胆碱药，无氧疗史），随机分成两组，A组35例，吸入沙美特罗/丙酸氟替卡松（SAL/FP）干粉剂，1吸/次,2次/天;B组35例，不吸入上述药物;两组病人均服用沐舒坦30mg/tide观察治疗3月、6月、12月三个时间点病人临床症状、乔
2、治生活质量评分、肺功能、血中IL8和TNFa的水平、急性发作次数、住院次数、住院费用。结果观察期各不同时间点A、B两组肺功能、圣•乔治生活质量评分（SGRQ）、急性加重发生次数及、健康状态和住院次数、等各项观察指标差异有显著性（P0.05）;A组明显优于B组，治疗前后诱导痰IL8和TNFa明显减低（P0.05）;但住院费用A、B两组无明显差别（P0.05b结论ICS与LABA治疗中重度COPD具有良好协同作用，其预混制剂(SAL/FP50/250pg)干粉剂使用方便，近期疗效好，有临床应用价值，可短期改善COPD的FEV1的水平，对全身炎症反应无明显抑制作
3、用，医疗费用没有明显增加。【关键词】慢性阻塞性肺疾病；糖皮质激素；p2激动剂；联合用ABSTRACTObjectiveTodiscussthecurativeeffectofinhaledglucocorticoid(ICS)incombinationwithIong-acting02agonist(LABA)onpatientswithmoderateandseverechronicobstructivepulmonarydisease(COPD).Methods70patientswithCOPDwererandomlydividedinto2grou
4、ps:GroupAandGroupB,35ineachgroup;allthepatients,beforethistreatment,hadnoapplicationhistoryofanytypeofhormones,receptoragonistsandanticholinergicdrugsandtheyneverhadoxygentherapy;ambroxolwasgiventoallthepatientsinbothgroups,30mgonceand3timesaday,andforpatientsinGroupA,inhalationof
5、SeretideDryPowder(salmeterol/fluticasone,SM/FP,50pgofsalmeterol/259pgoffluticasone)wasaddedtwiceaday;anobservationwasmadeat3timepoints(3months,6monthsand12monthsaftertreatment)tothefollowing:theclinicalsymptoms,thescoreofSt.George'srespiratoryquestionnaire(SGRQ),pulmonaryfunction,
6、thelevelofbloodinterleukin-8(IL8)andTNFa,theacuteexacerbations,timesandexpensesofhospitalization.ResultsThedifferencebetweenthe2groupsinpulmonaryfunction,thescoreofSGRQ,theacuteexacerbation,thehealthstatusandthetimesofhospitalizationwasofsignificanee(P<0.05);thelevelofIL8ininduced
7、sputumandTNFainGroupAdecreasedsignificantly(P<0.05);thecomparisonofhospitalizationexpensesbetweenthe2groupswasofnoobviousdifference(P<0.05).ConclusionsICSandLABAplaygoodsynergeticeffectonmoderateandsevereCOPD,theadministrationofSM/FP(50/250pg)issimpleandtheshort-termcurativeeffect
8、isgood,itcansoonimproveFEV1buthas
