2026 年第 4 期 第 21 卷

布地格福吸入气雾剂联合茶碱缓释片治疗对支气管扩张合并重度慢性阻塞性肺疾病患者呼吸困难程度及小气道功能的影响

Effect of budesonide, glycopyrronium bromide and formoterol fumarate inhalation aerosol combined with theophylline sustained-release tablets on dyspnea severity and small airway function in patients with bronchiectasis complicated with severe chronic obstructive pulmonary disease

作者：南光日王曼蕊

英文作者：Nan Guangri Wang Manrui

单位：中国人民解放军总医院海南医院呼吸内科，三亚572000

英文单位：Department of Respiratory Medicine Hainan Hospital of Chinese PLA General Hospital Sanya 572000 China

关键词：支气管扩张合并重度慢性阻塞性肺疾病；布地格福吸入气雾剂；茶碱缓释片；小气道功能

英文关键词：Bronchiectasiscomplicatedwithseverechronicobstructivepulmonarydisease;Budesonide,glycopyrroniumbromideandformoterolfumarateinhalationaerosol;Theophyllinesustained-releasetablets;Smallairwayfunction

• 摘要：

• 目的 观察布地格福吸入气雾剂联合茶碱缓释片治疗支气管扩张合并重度慢性阻塞性肺疾病（BCOS）患者的临床效果，并探讨其对BCOS患者呼吸困难及小气道功能改善的作用。方法 选取2023年1月至2024年1月于中国人民解放军总医院海南医院就诊的90例BCOS患者作为研究对象。根据治疗方案的不同将患者分为对照组（45例，布地格福气雾剂）和观察组（45例，布地格福气雾剂联合茶碱缓释片）。比较2组临床资料、疗效，建立双重差分模型评估2组治疗前后综合评分变化。采用重复测量方差分析法分析25%肺活量时的最大呼气流量（MEF25）、50%肺活量时的最大呼气流量（MEF50）变化。分析治疗期间MEF25、MEF50对疗效的影响。结果 2组患者临床资料比较差异均无统计学意义（均P>0.05）。治疗后，2组患者慢性阻塞性肺疾病评估测试（CAT）、圣乔治呼吸问卷（SGRQ）、改良版英国医学研究委员会呼吸困难问卷（mMRC）评分均低于治疗前，且观察组均低于对照组，差异均有统计学意义（均P＜0.05）。双重差分模型结果显示，治疗后CAT、SGRQ、mMRC评分平均降低了9.782、5.462、8.102。组别×时间的系数对综合评分产生明显影响，观察组在治疗后综合评分降低幅度高于对照组，分别多出7.631、3.019、6.932。患者MEF25、MEF50水平组间效应、时间效应、交互效应均具有统计学意义（均P<0.05）。观察组治疗总有效率高于对照组［95.6%（43/45）比82.2%（37/45）］（χ2=6.133，P=0.047）。分层分析结果显示在治疗12周MEF25、MEF50各分层水平，观察组治疗效果均强于对照组（均P<0.001）。结论 布地格福吸入气雾剂联合茶碱缓释片可提升BCOS患者临床疗效，减少呼吸困难，改善小气道功能。

• Objective To observe the clinical efficacy of budesonide, glycopyrronium bromide and formoterol fumarate inhalation aerosol combined with theophylline sustained-release tablets in the treatment of patients with bronchiectasis complicated with severe chronic obstructive pulmonary disease (BCOS), and to explore its effect on improving dyspnea and small airway function in BCOS patients. Methods A total of 90 BCOS patients admitted to Hainan Hospital of Chinese PLA General Hospital from January 2023 to January 2024 were enrolled as research subjects. According to different treatment regimens, the patients were divided into the control group (45 cases, budesonide, glycopyrronium bromide and formoterol fumarate inhalation aerosol alone) and the observation group (45 cases, budesonide, glycopyrronium bromide and formoterol fumarate inhalation aerosol combined with theophylline sustained-release tablets). The clinical data and therapeutic efficacy were compared between the two groups. A difference-in-differences model was established to evaluate the changes in comprehensive scores before and after treatment in the two groups. Repeated measures analysis of variance was used to analyze the changes in maximal expiratory flow at 25% of forced vital capacity (MEF25) and maximal expiratory flow at 50% of forced vital capacity (MEF50). The effects of MEF25 and MEF50 on therapeutic efficacy during treatment were analyzed. Results There were no statistically significant differences in clinical data between the two groups (all P>0.05). After treatment, the scores of chronic obstructive pulmonary disease assessment test (CAT), St. George′s respiratory questionnaire (SGRQ) and modified medical research council dyspnea scale (mMRC) in both groups were significantly lower than those before treatment, and the scores in the observation group were significantly lower than those in the control group (all P<0.05). The results  of the difference-in-differences model showed that the CAT, SGRQ and mMRC scores decreased by 9.782, 5.462 and 8.102 on average after treatment. The interaction coefficient of group×time had a significant effect on the comprehensive scores. The reduction amplitude of comprehensive scores in the observation group after treatment was higher than that in the control group, with an increase of 7.631, 3.019 and 6.932 respectively. There were statistically significant differences in the inter-group effect, time effect and interaction effect of MEF25 and MEF50 levels in patients (all P<0.05). The total effective rate of treatment in the observation group was significantly higher than that in the control group ［95.6%(43/45) vs 82.2%(37/45)］(χ2=6.133, P=0.047). The results  of stratified analysis showed that at each stratified level of MEF25 and MEF50 at 12 weeks of treatment, the therapeutic effect of the observation group was stronger than that of the control group (both P<0.001). Conclusion Budesonide, glycopyrronium bromide and formoterol fumarate inhalation aerosol combined with theophylline sustained-release tablets can improve the clinical efficacy of BCOS patients, alleviate dyspnea and improve small airway function.