COPD稳定期患者噻托溴铵联合沙美特罗/ 氟替卡松治疗效果的CAT量表评估-东南大学学报医学版

COPD稳定期患者噻托溴铵联合沙美特罗/ 氟替卡松治疗效果的CAT量表评估

单位：1. 东南大学附属中大医院呼吸科, 江苏南京 210009;
2. 南京市浦口医院内科, 江苏南京 210031

关键词：噻托溴铵沙美特罗/氟替卡松慢性阻塞性肺疾病慢性阻塞性肺疾病评估测试量表健康相关生活质量

分类号：R563

出版年·卷·期（页码）：2012·31·第三期（294-298）

摘要：

目的:探讨噻托溴铵联合沙美特罗/氟替卡松吸入治疗的慢性阻塞性肺疾病(COPD)稳定期患者采用观察健康相关生活质量改善情况的COPD评估测试量表(CAT)评估的意义。方法:选择重度、极重度COPD稳定期患者125例,根据患者治疗方式分为噻托溴铵联合沙美特罗/氟替卡松吸入治疗组(观察组,78例)和沙美特罗/氟替卡松吸入治疗组(对照组,47例),入组时登记临床基本资料,在入组时、3个月末、6个月末分别行肺功能检查和CAT量表评分,记录6个月中患者出现急性加重的次数。结果:入组时观察组和对照组患者各项临床指标均无显著差异。在3个月末和6个月末时,两组患者CAT评分比入组时均显著降低(均P<0.05),第1秒用力呼气容积占预计值百分比(FEV₁%)较入组时均显著升高(均P<0.05),且观察组患者CAT评分较对照组低(P<0.05),FEV₁%较对照组高(P<0.05)。患者CAT评分与FEV₁%之间中度负相关(Pearson相关系数波动于-0.58~-0.79)。在随访过程中,出现急性加重患者CAT评分比未出现急性加重患者高(P<0.05)。结论:与单一使用沙美特罗/氟替卡松治疗相比,噻托溴铵联合沙美特罗/氟替卡松吸入治疗可以更加显著地降低COPD稳定期患者的CAT评分,提高患者健康相关生活质量,改善肺功能,减少急性加重;CAT量表可以作为COPD稳定期患者噻托溴铵联合沙美特罗/氟替卡松吸入治疗前后健康相关生活质量评价的一个有效工具。

Objective: To investigate the improvement of health-related quality of life during stable stage of chronic obstructive pulmonary disease(COPD) with salmeterol/fluticasone therapy using COPD assessment test(CAT). Methods: 125 subjects with moderate-to-severe COPD treated with a combination of tiotropium bromide and salmeterol/fluticasone(observed group, n=78), or Salmeterol/fluticasone alone(control group, n=47) were enrolled into this clinical trial and were observed for six months. All patients were documented their information after inclusion. Health-related Quality of life was measured by CAT and lung function test was done at baseline, third month and sixth month. The events of acute exacerbation were also recorded. Results: No significant differences existed between the two groups at baseline. After 3 month and 6 month the average improvements(lower CAT scores and higher FEV₁%) were significant in both observed group and control group(P<0.05), and there had been a greater improvement in observed group. There were good association between CAT score and FEV₁%(-0.58 to -0.79). In patients with acute exacerbation more than once during the six month were associated with higher CAT scores(P<0.05). Conclusions: In patients with stable COPD, compared with therapy with salmeterol/fluticasone alone,tiotropium bromide combined with salmeterol/fluticasone is associated with lower CAT score, higher quality of life and fewer exacerbations, under such a situation where CAT is a reliable for assessing health-related quality of life of stable COPD patient.

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