目的 探討吸入糖皮質(zhì)激素丙酸氟替卡松治療穩(wěn)定期COPD的療效及對患者肺功能、炎癥因子和內(nèi)皮功能的影響。方法 收集2014年7月—2016年7月河南省新鄉(xiāng)市中心醫(yī)院收治的90例穩(wěn)定期COPD患者，隨機(jī)分為對照組和觀察組，各45例。對照組患者給予西醫(yī)常規(guī)治療，觀察組在對照組的基礎(chǔ)上給予丙酸氟替卡松霧化吸入劑250 μg/次，2次/d。兩組患者均接受6個月的治療。觀察比較治療前后兩組患者的肺功能指標(biāo)，包括用力肺活量（FVC）、1 s用力呼氣容積（FEV1）、最大呼氣中期流速（MMEF）以及呼氣峰流速（PEF）；炎癥因子，包括白細(xì)胞介素-6（IL-6）、白細(xì)胞介素-8（IL-8）、腫瘤壞死因子-α（TNF-α）以及C反應(yīng)蛋白（CRP）水平；血管內(nèi)皮功能指標(biāo)，包括內(nèi)皮依賴性血管舒張功能（FMD）、可溶性細(xì)胞間黏附因子（SICAM-1）、內(nèi)皮素1（ET-1），以及呼出一氧化氮（FENO）的變化。結(jié)果 治療后，兩組患者的肺功能指標(biāo)均有顯著改善，同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05），并且觀察組的FEV1、FEV1/FVC、MMEF及PEF顯著高于對照組，組間比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組患者的炎癥因子水平均有明顯降低，同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05），并且觀察組的IL-6、IL-8、TNF-α和CRP均顯著低于對照組，比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。觀察組的FMD較治療前顯著升高，且高于對照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；SICAM-1和ET-1較治療前明顯降低，且低于對照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。兩組的FENO均有明顯降低，但觀察組的FENO降低幅度更大，比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 吸入糖皮質(zhì)激素治療可顯著改善穩(wěn)定期COPD患者的肺功能，抑制炎癥反應(yīng)，尤其可提升內(nèi)皮細(xì)胞功能、降低呼出NO量，有助于減少心血管事件的發(fā)生。

Objective To explore the influence of inhaled corticosteroids on the curative effect and fractional exhaled nitric oxide and endothelial function for patients with stable COPD.Methods Totally 90 patients with stable COPD were collected in Xinxiang Central Hospital from July 2014 to July 2016, and divided into two groups randomly. The control group (n= 45) was treated with conventional Western medicine, the observation group (n= 45) were given fluticasone propionate inhalation atomization of 250 g per time, twice daily. The two groups received 6 months of treatment. The pulmonary function indexes including forced vital capacity (FVC), 1 s forced expiratory volume (FEV1), maximal mid expiratory flow (MMEF) and peak expiratory flow (PEF), inflammatory factors such as lnterleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α) and C reactive protein (CRP) levels, and vascular endothelial function indexes including flow-mediated vasodilation (FMD), soluble intercellular adhesion molecule-1 (SICAM-1), endothelin 1 (ET-1), and fractional exhaled nitric oxide (FENO) were compared and analyzed.Results After treatment, the pulmonary function indexes were improved significantly (P<0.05), and the FEV1, FEV1/FVC, MMEF, and PEF of observation group were higher significantly than those patients in control group (P<0.05). The levels of inflammatory factors decreased than before treatment remarkably (P<0.05), and the levels of IL-6, IL-8, TNF-α, and CRP in observation group were lower than those in control group, and which difference was significance (P<0.05). The FMD of patients in study group was higher than those in control group significantly (P<0.05). The levels of SICAM-1 and ET-1 in observation group were decreased significantly than those before treatment, and were lower than control group (P<0.05). The FENO of all patients decreased than before treatment, and reduced amplitude in observation group was more than those in control group significantly (P<0.05).Conclusion Inhaled corticosteroids for patients stable COPD could improve pulmonary functions and inhibit inflammatory response, specially, which improves endothelial function and reduces the amount of exhaled NO and occurrence of cardiovascular events.