目的 研究阿奇霉素聯(lián)合沙美特羅/氟替卡松對(duì)慢性阻塞性肺疾病患者的療效及對(duì)血漿B型腦鈉肽（BNP）水平的影響。方法 選擇2015年1月-2017年12月新疆自治區(qū)人民醫(yī)院米東醫(yī)院收治的60例慢性阻塞性肺疾病患者，隨機(jī)分為兩組。對(duì)照組吸入沙美特羅/氟替卡松治療，觀察組在對(duì)照組基礎(chǔ)上加用阿奇霉素，每次0.25 g，每天1次。兩組均治療6個(gè)月。比較兩組臨床療效、每分鐘最大通氣量（MVV）、用力呼氣量占用力肺活量比值（FEV1/FVC），并測(cè)量?jī)山M的6分鐘步行距離，觀察兩組腫瘤壞死因子（TNF）-α、白介素（IL）-8、高敏C-反應(yīng)蛋白（hs-CRP）和血漿BNP水平改變情況，記錄兩組的住院時(shí)間以及出院1年后的病死率。結(jié)果 觀察組總有效率為93.33%，明顯高于對(duì)照組的73.33%，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組的MVV、6 min步行距離和FEV1/FVC均明顯升高，同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；且觀察組以上指標(biāo)明顯高于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組的血清hs-CRP、TNF-α、IL-8和血漿BNP水平均明顯降低，同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；且觀察組以上指標(biāo)明顯低于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。觀察組的住院時(shí)間及病死率均明顯低于對(duì)照組（P<0.05）。結(jié)論 阿奇霉素聯(lián)合沙美特羅/氟替卡松對(duì)慢性阻塞性肺疾病患者的療效確切，可明顯減輕氣道炎癥反應(yīng)，降低血漿BNP水平，改善肺功能，值得應(yīng)用推廣。

Objective To study the clinical effect of salmeterol/fluticasone combined with azithromycin on chronic obstructive pulmonary disease and its effect on plasma B-type brain natriuretic peptide level. Methods Selected 60 cases of patients with chronic obstructive pulmonary disease in our hospital from January 2013 to December 2017, divided into two groups randomly. The control group was treated with salmeterol/fluticasone inhalation, while the observation group was treated with azithromycin. Results The effective rate of the observation group was significantly higher than control group (P<0.05). After treatment, MVV, 6-minute walking distance and FEV1/FVC in both groups were significantly increased (P<0.05), especially in the observation group (P<0.05). The levels of serum hs-CRP, TNF-α, IL-8 and plasma BNP were significantly decreased in both groups, especially in the observation group (P<0.05). The hospitalization time and mortality of the observation group were significantly lower than those of the control group (P<0.05). Conclusion Salmeterol/fluticasone combined with azithromycin has definite curative effect on COPD patients. It can significantly reduce airway inflammation, reduce plasma BNP level and improve lung function. It is worth popularizing.

R974

新疆維吾爾族自治區(qū)自然科學(xué)基金資助項(xiàng)目（2018D01C308）