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中华临床医师杂志(电子版) ›› 2019, Vol. 13 ›› Issue (07) : 521 -526. doi: 10.3877/cma.j.issn.1674-0785.2019.07.008

所属专题: 文献

临床研究

肺康复对慢性阻塞性肺疾病稳定期患者BODE指数和血清炎症因子的影响
尹正录1, 孟兆祥1, 王继兵1, 陈波1, 杨双月1, 全逸峰1,()   
  1. 1. 225001 江苏扬州,江苏省苏北人民医院康复科
  • 收稿日期:2019-02-27 出版日期:2019-04-01
  • 通信作者: 全逸峰

Effect of pulmonary rehabilitation on BODE index and serum inflammatory factors in patients with stable chronic obstructive pulmonary disease

Zhenglu Yin1, Zhaoxiang Meng1, Jibing Wang1, Bo Chen1, Shuangyue Yang1, Yifeng Quan1,()   

  1. 1. Department of Rehabilitation, Jiangsu Northern People′s Hospital, Yangzhou 225002, China
  • Received:2019-02-27 Published:2019-04-01
  • Corresponding author: Yifeng Quan
  • About author:
    Corresponding author: Quan Yifeng, Email:
引用本文:

尹正录, 孟兆祥, 王继兵, 陈波, 杨双月, 全逸峰. 肺康复对慢性阻塞性肺疾病稳定期患者BODE指数和血清炎症因子的影响[J/OL]. 中华临床医师杂志(电子版), 2019, 13(07): 521-526.

Zhenglu Yin, Zhaoxiang Meng, Jibing Wang, Bo Chen, Shuangyue Yang, Yifeng Quan. Effect of pulmonary rehabilitation on BODE index and serum inflammatory factors in patients with stable chronic obstructive pulmonary disease[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2019, 13(07): 521-526.

目的

观察肺康复治疗对中重度慢性阻塞性肺疾病(COPD)患者稳定期BODE指数和血清炎症因子的影响。

方法

2016年1月至2017年12月期间在江苏省苏北人民医院诊断为中重度COPD稳定期患者65例,随机分为肺康复组(33例)和对照组(32例),2组均给予常规药物干预,肺康复组同时进行12周的肺康复治疗。年龄、病程,BODE各项指标及BODE指数,血清超敏C-反应蛋白(hs-CRP),白介素-6(IL-6)和肿瘤坏死因子(TNF-α)水平和成人COPD生存质量评分(COPD-QOL量表)等属于计量资料,2组治疗前、治疗12周后上述相关指标比较采用配对样本t检验,组间比较采用独立样本t检验;采用χ2检验比较性别、COPD临床严重程度分级的组间差异。

结果

最终有63例患者完成研究。治疗后肺康复组BODE指标中体质量指数(BMI)、改良呼吸困难指数(MMRC分级)、6 min步行距离(6MWD)均较治疗前有改善[(21.5±1.4)kg/m2 vs(18.7±1.2)kg/m2;(1.6±0.3)分 vs (2.1±0.3)分;(270.3±37.8)m vs (158.3±42.4)m],差异均具有统计学意义(t=2.125、2.036、5.021,P=0.036、0.046、<0.001)。对照组6MWD治疗后较治疗前有改善[(188.3±40.3)m vs (160.1±39.7)m],差异具有统计学意义(t=2.659,P=0.009)。组间比较,肺康复组治疗后BMI、MMRC和6MWD均优于对照组[(21.5±1.4)kg/m2 vs(18.6±1.3)kg/m2;(1.6±0.3)分 vs (2.1±0.4)分;(270.3±37.8)m vs (188.3±40.3)m],差异均具有统计学意义(t=2.124、2.031、4.568,P=0.038、0.016、<0.001);BODE指数比较,肺康复组改善优于对照组[(3.9±0.9)分 vs (4.5±1.3)分],差异具有统计学意义(t=2.131,P=0.037)。治疗后肺康复组IL-6、TNF-α较治疗前均降低[(62.1±6.4)pg/ml vs (95.9±5.9)pg/ml;(48.5±7.3)pg/ml vs (73.3±10.1)pg/ml],差异均具有统计学意义(t=7.872、7.136,P均<0.001);COPD-QOL总分较治疗前提高[(110.5±17.8)分 vs (96.2±20.4)分],差异具有统计学意义(t=7.521,P<0.001);组间比较,肺康复组治疗后IL-6、TNF-α和COPD-QOL总分优于对照组[(62.1±6.4)pg/ml vs (94.6±6.3)pg/ml;(48.5±7.3)pg/ml vs (71.7±7.5)pg/ml;(110.5±17.8)分 vs (96.3±21.3)分],差异均具有统计学意义(t=7.981、7.328、7.526,P均<0.001)。

结论

肺康复可以明显改善中重度COPD患者稳定期BODE指数和降低血清IL-6、TNF-α炎症因子水平,提高其生活质量。

Objective

To observe the effect of pulmonary rehabilitation on BODE index and serum inflammatory factors in patients with moderate to severe chronic obstructive pulmonary disease (COPD).

Methods

From January 2016 to December 2017, 65 patients with stable COPD at our hospital were randomly divided into two groups: pulmonary rehabilitation group (n=33) and control group (n=32). Age, disease duration, BODE index and its individual components, serum high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and tumor necrosis factor (TNF-α), and COPD quality of life score (Chinese version of the COPD-QOL scale) were measured. The relevant indicators were compared between before and after 12 weeks of treatment and between two groups by the paired sample t-test and independent sample t-test. Gender and clinical severity of COPD were compared using the χ2 test between groups.

Results

Sixty-three patients completed the study. The body mass index (BMI), modified dyspnea index (MMRC grade), and 6-minute walk test (6MWD) of the BODE index in the post-treatment group were improved compared with those before treatment [(21.5±1.4) kg/m2 vs (18.7±1.2) kg/m2; (1.6±0.3) vs (2.1±0.3); (270.3±37.8) m vs (158.3±42.4), t=2.125, 2.036, and 5.021, P=0.036, 0.046, and <0.001, respectively]. 6MWD in the control group was statistically significantly improved after treatment [(188.3±40.3) m vs (160.1±39.7) m, t=2.659, P=0.009]. The improvements of BMI, MMRC, and 6MWD in the lung rehabilitation group were significantly better than those in the control group [(21.5±1.4) kg/m2 vs (18.6±1.3) kg/m2, (1.6±0.3) vs (2.1±0.4), (270.3±37.8) m vs (188.3±40.3) m, t=2.124, 2.031, and 4.568, P=0.038, 0.016, and <0.001, respectively]. The BODE index was also significantly improved in the lung rehabilitation group than in the control group [(3.9±0.9) scores vs (4.5±1.3) scores, t=2.131, P=0.037]. After treatment, IL-6 and TNF-α in the lung rehabilitation group were significantly lower than those before treatment [(62.1±6.4) pg/ml vs (95.9±5.9) pg/ml; (48.5±7.3) pg/ml vs (73.3±10.1) pg/ml, t=7.872 and 7.136, P<0.001 for both], and the total score of COPD-QOL was significantly higher than that before treatment [(110.5±17.8) scores vs (96.2±20.4) scores, t=7.521, P<0.001). Compared with the control group, IL-6, TNF-α, and total COPD-QOL improved significantly in the lung rehabilitation group [(62.1±6.4) pg/ml vs (94.6±6.3) pg/ml, (48.5±7.3) pg/ml vs (71.7±7.5) pg/ml, (110.5±17.8) vs (96.3±21.3), t=7.981, 7.328, and 7.526, P<0.001 for all].

Conclusion

Pulmonary rehabilitation can significantly improve the BODE index, reduce serum IL-6 and TNF-α, and improve the quality of life in patients with moderate to severe COPD.

表1 2组COPD患者性别、年龄及病情等一般临床资料比较
表2 2组COPD患者治疗前后BODE指标及指数比较(±s
表3 2组COPD患者治疗前后炎症因子指标及生活质量比较(±s
[1]
陈亚红, 王辰. 2015年更新版GOLD慢性阻塞性肺疾病诊断、治疗和预防的全球策略简介[J/CD]. 中国医学前沿杂志(电子版), 2015, 7(2): 34-39.
[2]
李亮, 曾明, 王月丽, 等. 肺功能训练仪用于治疗稳定期慢性阻塞性肺疾病患者的疗效观察 [J]. 中国康复医学杂志, 2016, 31(10): 1117-1120.
[3]
何顺平, 黄江, 刘志锋, 等. 定量步行运动和呼吸锻炼在慢性阻塞性肺疾病患者社区康复治疗中的应用 [J]. 中华物理医学与康复杂志, 2013, 35(5): 371-374.
[4]
Li SY, Li JS, Wang MH, et al. Effects of comprehensive therapy based on traditional Chinese medicine patterns in stable chronic obstructive pulmonary disease: a four-center,open- label, randomized, controlled study [J]. BMC Complement Altern Med, 2012, 12(1): 1-11.
[5]
全逸峰, 孟兆祥, 尹正录, 等. 康复治疗应用于社区中重度COPD患者的临床作用探讨[J/CD]. 中华临床医师杂志(电子版), 2016, 7(4): 195.
[6]
中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南(2013年修订版) [J]. 中华结核和呼吸杂志, 2013, 36(4): 255-264.
[7]
Celli BR, Cote CG, Marn JM, et al. The body mass index, airflow obstruction, dyspnea, and capacity index in chronic obstructive pulmonary disease [J]. N Eng l Jmed, 2004, 350(10): 1005-1012.
[8]
方宗君, 蔡映云. 慢性阻塞性肺疾病病人生存质量测评表及应用 [J]. 现代康复, 2001, 5(4): 7-8.
[9]
朱迎霞, 李海峰, 王玉, 等. 康复治疗对慢性阻塞性肺疾病稳定期BODE指数及预后的影响 [J]. 昆明医科大学学报, 2013, 34(1): 106-108.
[10]
朱祈, 李亚青. BODE指数对慢性租塞性肺疾病预后评估的价值研究 [J]. 浙江医学, 2015, 37(13): 1170-1172.
[11]
Grzyma CA, Szmygin MK, Dyczko M, et al. Comorbidity of chronic heart failure and chronic obstructive pulmonary disease [J]. Pol Merkur Lekarski, 2013, 35(209): 251-253.
[12]
Ota H, Kawai H, Matsuo T. Treatment outcomes of pneumothorax with chroni c obstructive pulmonary disease [J]. Asia Cardiovasc Thorac Ann, 2014, 22(4): 448-454.
[13]
王丽, 谭焰, 谷伟. 慢性阻塞性肺病缓解期患者血清中TNF-α、IL-6和IL-8表达的研究[J].临床肺科杂志, 2011, 16(6): 835-836.
[14]
胡来明, 吴永红. 老年慢性阻塞性肺疾病患者血清炎性因子与BODE指数的相关性 [J]. 中国临床保健杂志, 2015, 2(18): 146-149.
[15]
齐咏, 马芸, 王凯, 等. 慢性阻塞性肺疾病患者BODE指数与炎性因子的相关性分析 [J]. 中国综合临床, 2013, 29(3): 255-257.
[16]
师晨曦, 王佳妮, 肖倩, 等. 基于移动健康平台的自我管理干预在慢性阻塞性肺疾病患者肺康复中的应用 [J]. 中国康复理论与实践, 2019, 25(6): 734-739.
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