目的 研究烏司他丁聯(lián)合布地奈德福莫特羅治療慢性阻塞性肺疾病的臨床療效。方法 選擇2016年1月-2019年1月安康市中醫(yī)院治療的慢性阻塞性肺疾病59例作為研究對(duì)象，用抽簽法隨機(jī)分為對(duì)照組（30例）和觀察組（29例）。對(duì)照組患者吸入布地奈德福莫特羅粉吸入劑，1吸/次，2次/d。觀察組在對(duì)照組的基礎(chǔ)上靜脈滴注烏司他丁注射液，10萬(wàn)U的注射用烏司他丁加于500 mL 0.5%葡萄糖溶液中靜脈滴注，2次/d。兩組均治療2周。觀察兩組患者的臨床療效，同時(shí)比較兩組治療前后的用力肺活量（FVC）、第1秒用力呼氣容積（FEV₁）、FEV₁/FVC、二氧化碳分壓（pCO₂）以及氧合指數(shù)（OI）；外周血單核細(xì)胞樣受體（TLR4）、C反應(yīng)蛋白（CRP）、高遷移率族蛋白B1（HMGB1）和腫瘤壞死因子-α（TNF-α）水平。結(jié)果 治療后，觀察組的總有效率為93.10%，顯著高于對(duì)照組的70.00%（P<0.05）。兩組治療后的FVC、FEV₁、FEV₁/FVC、pCO₂和OI均明顯升高（P<0.05），且觀察組的肺功能明顯高于對(duì)照組（P<0.05）。兩組治療后的TLR4、CRP、HMGB1和TNF-α水平明顯降低（P<0.05），且觀察組的上述指標(biāo)明顯低于對(duì)照組（P<0.05）。結(jié)論 烏司他丁聯(lián)合布地奈德福莫特羅能顯著降低慢阻肺患者外周血CRP、TLR4、TNF-α和HMGB1水平，減輕炎癥反應(yīng)對(duì)機(jī)體產(chǎn)生的不良影響，有利于提高療效，改善患者肺功能。

Objective To study the clinical effect of ulinastatin combined with budesonide and formoterol fumarate in treatment of chronic obstructive pulmonary disease. Methods Fifty-nine patients with chronic obstructive pulmonary disease treated in Ankang Hospital of Traditional Chinese Medicine from January 2016 to January 2019 were selected as study subjects, and randomly divided into control group (30 cases) and observation group (29 cases) by lottery. Patients in the control group received Budesonide and Formoterol Fumarate Powder for Inhalation, 1 inhalation/time, twice daily. Patients in the observation group was injected with Ulinastatin Injection intravenously on the basis of the control group, 100 000 U was added into 500 mL 0.5% glucose solution, twice daily. Both groups were treated for 2 weeks. The clinical efficacy in two groups was observed. Meanwhile, the FVC, FEV₁, FEV₁/FVC, pCO₂ and OI, and the levels of TLR4, CRP, HMGB1, and TNF-α in peripheral blood before and after treatment were compared. Results After treatment, the total effective rate of the observation group was 93.10%, which was significantly higher than 70.00% of the control group (P<0.05). After treatment, FVC, FEV₁, FEV₁/FVC, pCO₂ and OI in two groups were significantly increased (P<0.05), and pulmonary function in the observation group was significantly higher than that in the control group (P<0.05). After treatment, the levels of TLR4, CRP, HMGB1 and TNF-α in two groups were significantly decreased (P<0.05), and the above indexes in the observation group were significantly lower than those in the control group (P<0.05). After treatment, the levels of TLR4, CRP, HMGB1, and TNF-α in two groups were significantly decreased (P<0.05), and the above indexes in the observation group were significantly lower than those in the control group (P<0.05). Conclusion Ulinastatin combined with budesonide and formoterol fumarate can significantly reduce the levels of CRP, TLR4, TNF-and HMGB1 in peripheral blood of patients with chronic obstructive pulmonary disease, reduce the adverse effects of inflammatory reaction on the body, and is conducive to improving the curative effect and lung function of patients.

R974

陜西省中醫(yī)管理局中醫(yī)藥科研項(xiàng)目（LCPT044）