阿法骨化醇对慢性阻塞性肺疾病患者肺功能、CAT评分、6 min步行距离的影响-东南大学学报医学版

阿法骨化醇对慢性阻塞性肺疾病患者肺功能、CAT评分、6 min步行距离的影响

单位：上海市浦东新区浦南医院, 上海 200125

分类号：R563;R453

出版年·卷·期（页码）：2021·40·第三期（380-384）

摘要：

目的：探讨口服阿法骨化醇软胶囊对慢性阻塞性肺疾病（COPD）患者肺功能、CAT评分、6 min步行距离的影响。方法：本研究以240例存在骨量减少（骨密度T值为-2.5~-1.0）的C、D级COPD患者为研究对象，按照随机数字表法分为对照组（A组）、阿法骨化醇组（B组）、阿法骨化醇联合碳酸钙组（C组）（每组均为80例患者）。3组患者均随访1年，随访期间3组患者每天均常规吸入噻托溴铵，B组每天加服阿法骨化醇，C组每天加服阿法骨化醇及碳酸钙。患者入组时、随访第6个月及第12个月均测定患者的骨密度、肺功能、CAT评分、6 min步行距离，比较3组患者不同时间点各观察指标的差异，计算骨密度与肺功能、CAT评分、6 min步行距离之间的相关性。结果：3组患者入院时骨密度、FEV₁/FVC、FEV₁%、CAT评分、6 min步行距离等指标之间的差异均无统计学意义（均P>0.05）。3组患者在随访6、12个月时，B、C组骨密度、FEV₁/FVC、FEV₁%、6 min步行距离均明显高于A组、而CAT评分明显低于A组（均P<0.05）。各组内之间比较，A组患者随访12个月时骨密度、FEV₁/FVC、FEV₁%、6 min步行距离均明显低于入院时、而CAT评分明显高于入院时（均P<0.05）。B、C两组患者随访12个月时骨密度、FEV₁/FVC、FEV₁%、6 min步行距离均明显高于入院时、而CAT评分明显低于入院时（均P<0.05）。A、B、C 3组患者入院时、随访6、12个月时骨密度均与FEV₁/FVC、FEV₁%、6 min步行距离呈正相关（均P<0.05），与CAT评分呈负相关（均P<0.05）。结论：阿法骨化醇可以增加COPD患者的骨密度、改善肺功能、降低CAT评分、增加6 min步行距离。

Objective: To investigate the effects of Alfacalcidol on lung function, CAT score and 6-minute walking distance in patients with chronic obstructive pulmonary disease(COPD). Methods: In this study, 240 patients with Grade C and D COPD with reduced bone mass[bone mineral density(BMD) T value ranging from-2.5 to -1.0]were randomly divided into control group(group A), Alfacalcidol soft capsules group(group B), Alfacalcidol soft capsules combined with calcium carbonate group (group C)(80 patients in each group) according to random number table. All patients in the 3 groups were followed up for 1 year. During the follow-up period, all patients in the 3 groups were routinely inhaled tiotropium bromide every day, group B was given Alfacalcidol soft capsules daily, and group C was given Alfacalcidol soft capsules and calcium carbonate daily. BMD, lung function, CAT score and 6-minute walking distance were measured at the time of enrollment, and at the 6th and 12th month of follow-up. The differences of observation indexes at different time points in the 3 groups were compared, and the correlation between BMD and lung function, CAT score and 6-minute walking distance was calculated. Results: There were no significant differences in BMD, FEV₁/FVC, FEV₁%, CAT score and 6-minute walking distance among 3 groups at admission(all P>0.05). After 6 and 12 months of follow-up, BMD, FEV₁/FVC, FEV1% and 6-minute walking distance in groups B and C were significantly higher than those in group A, while CAT score was significantly lower than that in group A(all P<0.05).Within each group BMD, FEV₁/FVC, FEV₁% and 6-minute walking distance in group A were significantly lower than those at admission at 12 months follow-up, while CAT score was significantly higher than that at admission(all P<0.05). BMD, FEV₁/FVC, FEV₁% and 6-minute walking distance in group B and C were significantly higher than those at admission at 12 months follow-up, while CAT score was significantly lower than that at admission(all P<0.05).The BMD of group A, B and C was positively correlated with FEV₁/FVC, FEV₁% and 6-minute walking distance at admission, 6 months' follow-up and 12 months' follow-up(all P<0.05), and negatively correlated with CAT score(P<0.05).Conclusion: Alfacalcidol increases BMD, improves lung function, reduces CAT score, and increases 6-minute walking distance in patients with COPD.

参考文献：

[1] CALVERLEY P M, ANDERSON J A, CELLI B, et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease[J]. N Engl J Med, 2007, 356(8):775-789.
[2] 刘伟新, 苗亚飞, 刘丁君.慢性阻塞性肺疾病患者合并骨质疏松的患病情况及危险因素[J]. 中国卫生工程学, 2018, 17(3):465-467.
[3] 杨金金, 程彩芹, 赵国阳.慢性阻塞性肺疾病患者与骨质疏松[J]. 中国骨质疏松杂志, 2020, 26(9):1378-1381.
[4] 朱嘉年, 杨俊华.老年慢性阻塞性肺疾病合并骨质疏松患者相关危险因素分析[J]. 临床合理用药, 2019, 12(6):114-115.
[5] 中华医学会骨质疏松和骨矿盐疾病分会.原发性骨质疏松症诊疗指南(2017)[J]. 中华骨质疏松和骨矿盐疾病杂志, 2017, 10(5):413-443.
[6] GOLD(2018).Global strategy of the diagnosis, management, and prevention of chronic obstructive pulmonary disease[EB/OL].http://www.goldcopd.org.
[7] 王丽萍, 荆淑华, 孙丽萍.双能X线骨密度测定腰椎和股骨颈对诊断骨质疏松检出率的比较[J]. 中国骨质疏松杂志, 2017, 23(12):1556-1559, 1586.
[8] 刘明, 张青, 丁薇, 等. 动脉血乳酸与老年慢性阻塞性肺疾病相关肺动脉高压的相关性研究[J]. 老年医学与保健, 2018, 24(1):54-57.
[9] 付明, 王玉波.COPD合并骨质疏松症的研究进展[J]. 检验医学与临床, 2020, 17(7):999-1001.
[10] KJENSLI A, MOWINCKEL P, RYG M S, et al. Low bone mineral density is related to severity of chronic obstructive pulmonary disease[J]. Bone, 2007, 40(2):493-497.
[11] 丁美.阿法骨化醇加碳酸钙D 3片治疗老年糖尿病合并骨质疏松症的临床疗效分析[J]. 中国医药指南, 2016, 14(2):128.
[12] 孟永生, 温利君.阿法骨化醇治疗骨质疏松症对骨相关指标的影响[J]. 中国医药导刊, 2017, 19(6):590-591.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录