铝碳酸镁联合PPI治疗COPD合并咽喉反流的疗效及对AECOPD的预防作用

doi:10.12092/j.issn.1009-2501.2018.11.012

中国临床药理学与治疗学 ›› 2018, Vol. 23 ›› Issue (11): 1270-1275.doi: 10.12092/j.issn.1009-2501.2018.11.012

铝碳酸镁联合PPI治疗COPD合并咽喉反流的疗效及对AECOPD的预防作用

陆亚君¹，黄晓颖²，傅中明³

¹温州医科大学附属慈溪医院特需病房，宁波 315300，浙江;²温州医科大学附属第一医院呼吸内科，温州 325000，浙江; ³宁波市鄞州人民医院呼吸与危重症医学科，宁波 315040，浙江

收稿日期:2018-09-03 修回日期:2018-10-01 出版日期:2018-11-26 发布日期:2018-11-22
通讯作者: 黄晓颖，女，博士，主任医师，研究方向：呼吸内科。 Tel：13819711719 E-mail：zjwzhxy@126.com
作者简介:陆亚君，女，本科，主治医师，研究方向：呼吸内科。 Tel：13600610396 E-mail：xbjhzfy@126.com
基金资助:
浙江省医药卫生科技计划项目（2017KY617）

Effects of hydrotalcite combined with PPI on COPD combined with laryngology reflux and its preventive effect on AECOPD

LU Yajun¹, HUANG Xiaoying ², FU Zhongming ³

¹Department of Special Needed Ward, Cixi Hospital Affiliated to Wenzhou Medical University, Ningbo 315300, Zhejiang, China; ² Department of Respiratory Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China; ³Department of Respiratory and Critical Care Medicine, Ningbo People's Hospital, Ningbo 315040, Zhejiang, China

Received:2018-09-03 Revised:2018-10-01 Online:2018-11-26 Published:2018-11-22

摘要/Abstract

摘要：

目的: 探究铝碳酸镁联合质子泵抑制剂（PPI）治疗慢性阻塞性肺疾病（COPD）合并咽喉反流的疗效及对慢性阻塞性肺疾病急性加重（AECOPD）的预防作用。方法: 选取2015年6月到2017年6月于本院就诊的98例COPD合并咽喉反流患者，随机数字表法分为研究组和对照组，各49例。两组患者均给予常规COPD药物治疗，对照组患者给予PPI治疗，研究组在此基础上给予铝碳酸镁联合治疗，院外随访12个月。比较两组患者临床疗效、治疗前后咽喉部24 h连续pH监测情况、肺功能和咽喉反流指标，应用Kaplan-Meier法绘制生存曲线，分析两组患者AECOPD发作和死亡风险间的差异。结果: 两组患者临床疗效存在差异（Z=-1.976，P=0.048），且研究组治疗有效率显著高于对照组（97.96%和79.59%，χ ²=8.295，P=0.004）；治疗后两组患者酸反流次数、Ryan指数和酸反流总时间均显著减少，且研究组显著低于对照组，差异具有统计学意义（P<0.05）；治疗后，两组患者第1秒用力呼气容积占预计值百分比（FEV1%）和第1秒用力呼气容积/用力肺活量（FEV1/FVC）均显著升高，自我评估测试（CAT）、反流症状指数评分量表（RSI）和反流体征评分量表（RFS）评分均显著降低，且研究组FEV1%和FEV1/FVC均显著高于对照组，CAT、RSI和RFS评分均显著低于对照组，差异具有统计学意义（P<0.05）；对照组和研究组在出院后12个月内的急性发作率分别为69.39%（34/49）和46.94%（23/49），研究组的急性发作风险显著低于对照组（HR=0.513, 95%CI［0.318,0.904］, P=0.015）；对照组和研究组在出院后12个月内分别有2例和1例死亡病例，研究组和对照组的死亡风险间无明显差异（HR=0.489, 95%CI［0.050, 4.709］, P=0.551）。结论: 铝碳酸镁联合PPI治疗COPD合并咽喉反流能显著提高临床疗效，有效改善患者肺功能和咽喉反流症状，明显降低COPD急性发作发生风险，值得临床推广。

关键词: 铝碳酸镁, 质子泵抑制剂, 慢性阻塞性肺疾病, 咽喉反流

Abstract:

AIM: To investigate the efficacy of magnesium aluminium carbonate combined with proton pump inhibitor (PPI) on the treatment of chronic obstructive pulmonary disease(COPD) complicated with laryngopharyngeal reflux and its preventive effect on acute exacerbation of chronic obstructive pulmonary disease(AECOPD). METHODS: Ninety-eight COPD patients with laryngopharyngeal reflux from June 2015 to June 2017 were divided into research group and control group by the random number table.Both groups were given conventional COPD medication, and the patients in the control group were treated with PPI, while the study group was given extra hydrotalcite combined PPI therapy. The patients were followed up for 12 months.The clinical efficacy, 24-hour continuous pH monitoring, lung function and laryngopharyngeal reflux were compared between the two groups. The survival curve was drawn by Kaplan-Meier method, and the differences of AECOPD attack and death risk between the two groups were analyzed. RESULTS: There were significant differences in clinical efficacy between the two groups (Z=-1.976，P=0.048), and the treatment efficiency of the study group was significantly higher than that of the control group (97.96% and 79.59%, χ ²=8.295, P=0.004). After treatment, the levels of acid reflux,Ryan index and total acid reflux time of the two groups were significantly reduced, and the study group was significantly lower than the control group (P<0.05). After treatment,the FEV1% and FEV1/FVC were significantly increased, CAT score, RSI and RFS were significantly decreased, among which, the FEV1% and FEV1/FVC in the study group were significantly higher than those in the control group, CAT score, RSI and RFS were significantly lower than those in the control group (P<0.05). The acute onset rate within 12 months after discharge was 69.39% (34/49) and 46.94% (23/49), respectively.The risk of acute onset in the study group was significantly lower than that in the control group (HR=0.513, 95% CI［0.318,0.904］, P=0.015). And there were 2 and 1 deaths in the control group and the study group within 12 months after discharge,respectively. There was no significant difference in risk (HR=0.489, 95% CI［0.050, 4.709］, P=0.551). CONCLUSION: Magnesium aluminium carbonate combined with PPI in the treatment of COPD with laryngopharyngeal reflux can significantly improve the clinical efficacy, lung function and laryngopharyngeal reflux symptoms, while reduce the risk of acute attack of COPD. It is worthy of clinical promotion.

Key words: hydrotalcite, proton pump inhibitor, chronic obstructive pulmonary disease, laryngopharyngeal reflux

中图分类号:

陆亚君，黄晓颖，傅中明. 铝碳酸镁联合PPI治疗COPD合并咽喉反流的疗效及对AECOPD的预防作用[J]. 中国临床药理学与治疗学, 2018, 23(11): 1270-1275.

LU Yajun, HUANG Xiaoying, FU Zhongming. Effects of hydrotalcite combined with PPI on COPD combined with laryngology reflux and its preventive effect on AECOPD [J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2018, 23(11): 1270-1275.

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铝碳酸镁联合PPI治疗COPD合并咽喉反流的疗效及对AECOPD的预防作用

Effects of hydrotalcite combined with PPI on COPD combined with laryngology reflux and its preventive effect on AECOPD

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