目的 探討茶堿緩釋片聯(lián)合噻托溴銨干粉治療穩(wěn)定期慢性阻塞性肺疾?。–OPD）的臨床療效，并分析其對患者肺功能和氣道重塑的影響。方法 選擇2013年4月-10月穩(wěn)定期COPD患者90例，隨機(jī)分為對照組（43例）和治療組（47例）。對照組口服茶堿緩釋片0.1 g/次，每12小時1次。治療組在對照組治療基礎(chǔ)上應(yīng)用噻托溴銨，1 粒/次，1次/d。兩組均連續(xù)治療2個月。治療結(jié)束后，評估患者治療前后1秒鐘用力呼氣量（FEV₁）、FEV₁占預(yù)計值的百分比（FEV₁%Pred）、FEV₁/用力肺活量（FVC），采用呼吸疾病問卷（SGRQ）進(jìn)行生活質(zhì)量評估；應(yīng)用6 min步行距離（6MWD）觀察兩組患者運(yùn)動耐力的變化情況。檢測治療前后兩組患者痰液中基質(zhì)金屬蛋白酶-9（MMP-9）和白介素-8（IL-8）的水平變化。結(jié)果 治療后兩組FEV₁、FEV₁%Pred、FEV₁/FVC均高于同組治療前，經(jīng)統(tǒng)計學(xué)分析，差異均有統(tǒng)計學(xué)意義（P<0.05）。治療后，治療組FEV₁、FEV₁%Pred、FEV₁/FVC均高于對照組，兩組比較差異有統(tǒng)計學(xué)意義（P<0.05）。治療后，兩組6MWD高于治療前，同組治療前后比較差異有統(tǒng)計學(xué)意義（P<0.05），且治療組6MWD明顯高于對照組，兩組比較差異有統(tǒng)計學(xué)意義（P<0.05）。治療后兩組SGRQ評分、MMP-9、IL-8均低于同組治療前，差異有統(tǒng)計學(xué)意義（P<0.05）；治療后治療組SGRQ評分、MMP-9、IL-8顯著低于對照組，兩組比較差異有統(tǒng)計學(xué)意義（P<0.05）結(jié)論 茶堿緩釋片聯(lián)合噻托溴銨干粉對穩(wěn)定期COPD具有顯著的治療效果，能夠改善患者肺功能和氣道重塑，值得臨床推廣應(yīng)用。

Objective To explore the clinical effect of Theophylline Sustained-release Tablet combined with tiotropium in the treatment of stable chronic obstructive pulmonary disease (COPD), and to analyze its effects on pulmonary function and airway remodeling. Methods Stable COPD patients (90 cases) were selected from April to October 2013 for the study, which were divided into control (43 cases) and treatment (47 cases) groups. The patients in the control group were po administered with Theophylline Sustained-release Tablets, 0.1 g/time, once every 12 h; The patients in the treatment group were administered with tiotropium on the basis of the control group, 1 grain/time, once daily. The patients in the two groups were treated for 2 months. After the treatment, forced expiratory volume in one second (FEV₁), FEV₁ percentage of expected value (FEV₁%Pred), and FEV₁/forced vital capacity (FVC) were evaluated before and after the treatment of the patients in the two groups. Respiratory questionnaire (SGRQ) was adopted to assess the quality of life, and 6 min walking distance (6MWD) was applied to the observation on the changes of exercise endurance of the patients in the two groups. The levels of matrix metalloproteinases-9 (MMP-9) and interleukin-8 (IL-8) in sputum were detected before and after the treatment. Results After the treatment, FEV₁, FEV₁%Pred, and FEV₁/FVC of the patients in the two groups were higher than those before treatment, and the difference had statistical significance (P< 0.05). After the treatment, FEV₁, FEV₁%Pred, and FEV₁/FVC of the patients in the treatment group were higher than those of the patients in the control group, and the difference between the two groups was statistically significant (P< 0.05). After the treatment, 6MWD of the patients in the two groups was higher than that before the treatment, and that of the patients in the treatment group was higher than that of the patients in the control group with the significant difference (P < 0.05). After the treatment, SGRQ, MMP-9, IL-8 of the patients in the two groups were decreased more than those before the treatment, and the difference had statistical significance (P< 0.05). After the treatment, SGRQ, MMP-9, IL-8 of the patients in the treatment group dropped off more sharply than those of the pateints in the control group, and the difference of the patients between the two groups was statistically significant (P< 0.05). Conclusion There is significant effect of Theophylline Sustained-release Tablets combined with tiotropium in the treatment of stable COPD, which could improve the pulmonary function and airway remodeling in patients. Theophylline Sustained-release Tablets combined with tiotropium is worthy of clinical popularization and application.

國家自然科學(xué)基金資助項目（30971317）