目的 探讨茶碱缓释片联合噻托溴铵干粉治疗稳定期慢性阻塞性肺疾病（COPD）的临床疗效，并分析其对患者肺功能和气道重塑的影响。方法 选择2013年4月-10月稳定期COPD患者90例，随机分为对照组（43例）和治疗组（47例）。对照组口服茶碱缓释片0.1 g/次，每12小时1次。治疗组在对照组治疗基础上应用噻托溴铵，1 粒/次，1次/d。两组均连续治疗2个月。治疗结束后，评估患者治疗前后1秒钟用力呼气量（FEV₁）、FEV₁占预计值的百分比（FEV₁%Pred）、FEV₁/用力肺活量（FVC），采用呼吸疾病问卷（SGRQ）进行生活质量评估；应用6 min步行距离（6MWD）观察两组患者运动耐力的变化情况。检测治疗前后两组患者痰液中基质金属蛋白酶-9（MMP-9）和白介素-8（IL-8）的水平变化。结果 治疗后两组FEV₁、FEV₁%Pred、FEV₁/FVC均高于同组治疗前，经统计学分析，差异均有统计学意义（P<0.05）。治疗后，治疗组FEV₁、FEV₁%Pred、FEV₁/FVC均高于对照组，两组比较差异有统计学意义（P<0.05）。治疗后，两组6MWD高于治疗前，同组治疗前后比较差异有统计学意义（P<0.05），且治疗组6MWD明显高于对照组，两组比较差异有统计学意义（P<0.05）。治疗后两组SGRQ评分、MMP-9、IL-8均低于同组治疗前，差异有统计学意义（P<0.05）；治疗后治疗组SGRQ评分、MMP-9、IL-8显著低于对照组，两组比较差异有统计学意义（P<0.05）结论 茶碱缓释片联合噻托溴铵干粉对稳定期COPD具有显著的治疗效果，能够改善患者肺功能和气道重塑，值得临床推广应用。

Objective To explore the clinical effect of Theophylline Sustained-release Tablet combined with tiotropium in the treatment of stable chronic obstructive pulmonary disease (COPD), and to analyze its effects on pulmonary function and airway remodeling. Methods Stable COPD patients (90 cases) were selected from April to October 2013 for the study, which were divided into control (43 cases) and treatment (47 cases) groups. The patients in the control group were po administered with Theophylline Sustained-release Tablets, 0.1 g/time, once every 12 h; The patients in the treatment group were administered with tiotropium on the basis of the control group, 1 grain/time, once daily. The patients in the two groups were treated for 2 months. After the treatment, forced expiratory volume in one second (FEV₁), FEV₁ percentage of expected value (FEV₁%Pred), and FEV₁/forced vital capacity (FVC) were evaluated before and after the treatment of the patients in the two groups. Respiratory questionnaire (SGRQ) was adopted to assess the quality of life, and 6 min walking distance (6MWD) was applied to the observation on the changes of exercise endurance of the patients in the two groups. The levels of matrix metalloproteinases-9 (MMP-9) and interleukin-8 (IL-8) in sputum were detected before and after the treatment. Results After the treatment, FEV₁, FEV₁%Pred, and FEV₁/FVC of the patients in the two groups were higher than those before treatment, and the difference had statistical significance (P< 0.05). After the treatment, FEV₁, FEV₁%Pred, and FEV₁/FVC of the patients in the treatment group were higher than those of the patients in the control group, and the difference between the two groups was statistically significant (P< 0.05). After the treatment, 6MWD of the patients in the two groups was higher than that before the treatment, and that of the patients in the treatment group was higher than that of the patients in the control group with the significant difference (P < 0.05). After the treatment, SGRQ, MMP-9, IL-8 of the patients in the two groups were decreased more than those before the treatment, and the difference had statistical significance (P< 0.05). After the treatment, SGRQ, MMP-9, IL-8 of the patients in the treatment group dropped off more sharply than those of the pateints in the control group, and the difference of the patients between the two groups was statistically significant (P< 0.05). Conclusion There is significant effect of Theophylline Sustained-release Tablets combined with tiotropium in the treatment of stable COPD, which could improve the pulmonary function and airway remodeling in patients. Theophylline Sustained-release Tablets combined with tiotropium is worthy of clinical popularization and application.

国家自然科学基金资助项目（30971317）