目的 探讨噻托溴铵联合莫西沙星治疗轻中度慢性阻塞性肺疾病急性加重期的临床疗效。方法 回顾性收集2019年12月—2022年11月首都医科大学北京友谊医院平谷医院呼吸科收治的78例轻中度慢性阻塞性肺疾病急性加重期患者的病例资料，根据治疗方案的不同将患者分为对照组和治疗组，每组各39例。对照组静脉滴注盐酸莫西沙星氯化钠注射液，0.4 g/次，每次输液时间≥90 min。治疗组在对照组基础上使用噻托溴铵吸入粉雾剂，1粒/次，通过粉雾吸入器吸入给药装置吸入使用，1次/d。两组疗程为10 d。观察两组临床疗效，比较治疗前后两组咳嗽、咳痰评估问卷（CASA-Q）评分、血气分析指标、改良版英国医学研究委员会呼吸困难问卷（mMRC）评分及外周血中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）和血清C反应蛋白（CRP）水平。结果 治疗后，治疗组总有效率是97.44%，较对照组的79.49%显著提高（P＜0.05）。治疗后，两组CASA-Q中咳嗽症状、咳嗽影响、咳痰症状、咳痰影响评分及其总分均较治疗前显著增加（P＜0.05）；且治疗后，治疗组CASA-Q评分高于对照组（P＜0.05）。治疗后，两组动脉血氧分压（pO₂）均显著上升，而动脉血二氧化碳分压（pCO₂）均显著下降（P＜0.05）；且治疗后，治疗组患者血气指标改善优于对照组（P＜0.05）。治疗后，两组患者mMRC评分均显著降低（P＜0.05）；且治疗后，治疗组mMRC评分低于对照组（P＜0.05）。治疗后，两组外周血NLR、PLR和血清CRP水平均显著下降（P＜0.05）；且治疗后，NLR、PLR和血清CRP水平均以治疗组降低更显著（P＜0.05）。结论 噻托溴铵联合莫西沙星治疗轻中度慢性阻塞性肺疾病急性加重期患者具有良好的疗效，能安全有效地缓解患者呼吸道症状，改善动脉血气和肺功能，调节机体炎症状态。

Objective To investigate the clinical efficacy of tiotropium combined with moxifloxacin in treatment of acute exacerbation of mild to moderate chronic obstructive pulmonary disease. Methods Data of 78 patients with acute exacerbation of mild to moderate chronic obstructive pulmonary disease admitted to the Respiratory Department of Pinggu Hospital, Beijing Friendship Hospital Affiliated to Capital Medical University from December 2019 to November 2022 were retrospectively collected. According to different treatment plans, the patients were divided into control group and treatment group, with 39 cases in each group. Patients in the control group were iv administered with Moxifloxacin Hydrochloride and Sodium Chloride Injection, 0.4 g/time, each infusion time ≥ 90 min. Patients in the treatment group were given Tiotropium Bromide Powder for inhalation on the basis of the control group, 1 capsule/time, and the drug delivery device was inhaled through a powder mist inhaler, once daily. The two groups were treated for 10 d. The clinical efficacy of the two groups was observed. The scores of Cough and Sputum Assessment Questionnaire (CASA-Q) score, blood gas analysis indexes, modified Medical Research Council Dyspnea Questionnaire (mMRC) score, peripheral blood neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and serum C-reactive protein (CRP) were compared between the two groups before and after treatment. Results After treatment, the total effective rate of the treatment group was 97.44%, which was significantly higher than that of the control group (79.49%) (P＜0.05). After treatment, the scores of cough symptoms, cough effects, sputum symptoms, sputum effects and total scores of CASA-Q in 2 groups were significantly increased compared with those before treatment (P＜0.05). After treatment, the CASA-Q score in the treatment group was higher than that in the control group (P＜0.05). After treatment, the arterial partial pressure of oxygen (pO₂) increased significantly, while the arterial partial pressure of carbon dioxide (pCO₂) decreased significantly in both groups (P＜0.05). After treatment, the blood gas index in the treatment group was better than that in the control group (P＜0.05). After treatment, mMRC scores in both groups were significantly decreased (P＜0.05). After treatment, the mMRC score of the treatment group was lower than that of the control group (P＜0.05). After treatment, the levels of peripheral blood NLR, PLR, and serum CRP in both groups were significantly decreased (P＜0.05). After treatment, the levels of NLR, PLR, and serum CRP were significantly decreased in the treatment group (P＜0.05). Conclusion Tiotropium combined with moxifloxacin has a good therapeutic effect in treatment of acute exacerbation of mild to moderate chronic obstructive pulmonary disease, and can safely and effectively relieve respiratory symptoms, improve arterial blood gas and lung function, which can regulate the inflammatory state of the body.

R974

吴阶平医学基金会临床科研专项资助基金（320.6750.18528）