Abstract:

Objective　To analyze the clinical efficacy of budesonide combined with reduced glutathione in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in the elderly. Methods　The clinical data of 85 elderly patients with AECOPD treated in the First Hospital of Yulin from May 2021 to December 2023 were retrospectively analyzed, who were divided into an observation group (42 cases) and a control group (43 cases) according to different treatment methods. In the control group, there were 22 males and 21 females, aged (72.13±4.51) years, and the duration of chronic obstructive pulmonary disease (COPD) was (6.78±1.94) years. In the observation group, there were 28 males and 14 females, aged (73.56±4.97) years, and the duration of COPD was (6.22±1.35) years. The control group was treated with intravenous drip with reduced glutathione (1.5 g), once a day; on the basis of the control group, the observation group was treated with budesonide aerosol inhalation, 1-2 in halations each time, twice a day. Both groups were treated for 14 d. The lung function, clinical efficacy, oxidative stress indexes, blood gas analysis indexes, serological indexes, and adverse reactions were compared between the two groups. χ² test and t test were used. Results　The total effective rate of the observation group was higher than that of the control group [90.48%% (38/42) vs. 72.09% (31/43)], with a statistically significant difference (χ²=4.699, P=0.030). After 14 d of treatment, the levels of forced expiratory volume in the first second (FEV₁), peak expiratory flow, FEV₁/forced vital capacity (FVC), superoxide dismutase (SOD), and arterial blood oxygen partial pressure (PaO₂) in both groups were increased (all P<0.05), and those in the observation group were higher than those in the control group (all P<0.05). The levels of malondialdehyde (MDA), arterial partial pressure of carbon dioxide (PaCO₂), serum transforming growth factor-β (TGF-β), matrix metalloproteinase-9 (MMP-9), and soluble myeloid cell trigger receptor-1 (sTREM-1) in both groups were decreased (all P<0.05), and those in the observation group were lower than those in the control group (all P<0.05). There was no statistically significant difference in the total incidence of adverse reactions between the two groups (χ²=0.445, P=0.505). Conclusion　In elderly patients with AECOPD, reduced glutathione combined with budesonide has a significant effect, which can improve the arterial blood gas, quality of life, and lung function, regulate the serum sTREM-1 expression, and reduce the oxidative stress and inflammation, with good safety.

Key words:

Acute exacerbation of chronic obstructive pulmonary disease, Old age, Budesonide, Reduced glutathione, Clinical effect, Adverse reactions

摘要：

目的　分析布地格福联合还原型谷胱甘肽治疗老年慢性阻塞性肺疾病急性加重期（AECOPD）的临床效果。方法　回顾性分析2021年5月至2023年12月在榆林市第一医院就诊的85例老年AECOPD患者临床资料，按照治疗方法不同分成对照组（43例）和观察组（42例）。对照组中男22例，女21例，年龄（72.13±4.51）岁，慢性阻塞性肺疾病（COPD）病程（6.78±1.94）年，采用还原型谷胱甘肽（1.5 g）治疗，每天静脉滴注1次；观察组中男28例，女14例，年龄（73.56±4.97）岁，COPD病程（6.22±1.35）年，在对照组基础上采用布地格福治疗，吸入布地格福气雾剂，每次1～2 吸，每天2次。两组均治疗14 d。对比两组肺功能、临床疗效、氧化应激指标、血气分析指标、血清学指标及不良反应。采用χ²检验、t检验。结果　观察组治疗总有效率高于对照组［90.48%%（38/42）比72.09%（31/43）］，差异有统计学意义（χ²=4.699，P=0.030）。治疗14 d后，两组第1秒用力呼气容积（FEV₁）、呼气流量峰值、FEV₁/用力肺活量（FVC）、超氧化物歧化酶（SOD）、动脉血氧分压（PaO₂）水平均升高（均P<0.05），且观察组均高于对照组（均P<0.05）；两组丙二醛（MDA）、动脉血二氧化碳分压（PaCO₂）、血清转化生长因子-β（TGF-β）、基质金属蛋白酶-9（MMP-9）、可溶性髓样细胞触发受体-1（sTREM-1）水平均降低（均P<0.05），且观察组均低于对照组（均P<0.05）。两组不良反应总发生率比较差异无统计学意义（χ²=0.445，P=0.505）。结论　老年AECOPD患者采用布地格福联合还原型谷胱甘肽治疗效果显著，可改善动脉血气，提高生活质量与肺功能，调节血清sTREM-1表达，减轻氧化应激反应及炎症反应，且安全性良好。

关键词:

慢性阻塞性肺疾病急性加重期, 老年, 布地格福, 还原型谷胱甘肽, 临床疗效, 不良反应