目的 探讨标准桃金娘油肠溶胶囊联合沙丁胺醇治疗慢性阻塞性肺疾病急性加重期的临床疗效。方法 纳入2024年6月—2025年6月首都医科大学附属北京友谊医院收治的168例慢性阻塞性肺疾病急性加重期患者，随机平均分为对照组和治疗组，每组各84例。对照组吸入硫酸沙丁胺醇气雾剂，2揿/次，2次/d。在对照组基础上，治疗组餐前30 min口服标准桃金娘油肠溶胶囊（成人装），1粒/次，3次/d。两组疗程均为14 d。比较两组临床疗效、主要表现缓解时间，以及治疗前后改良版英国医学研究委员会呼吸问卷（mMRC）、咳嗽和咳痰的评估问卷（CASA-Q）和慢性气道评估测试（CAAT）评分，动脉血气指标动脉血氧分压（pO₂）和动脉血二氧化碳分压（pCO₂），肺功能指标第1秒用力呼气容积（FEV1）占预计值百分比（FEV1%pred）、FEV1与用力肺活量比值（FEV1/FVC）和呼气峰流速（PEF），以及血清C反应蛋白（CRP）、白细胞介素-34（IL-34）、激活素A（ACTA）、趋化因子配体18（CCL18）、颗粒蛋白前体（PGRN）水平。结果 治疗后，治疗组总有效率为97.62%（82/84），明显高于对照组（84.52%，P＜0.05）。治疗后，治疗组各项临床表现（咳嗽、咳痰等）的缓解时间较对照组均显著缩短（P＜0.05）。治疗后，两组mMRC评分与CAAT评分均低于同组治疗前，而两组CASA-Q评分都高于同组治疗前（P＜0.05）；且治疗组评分均明显优于对照组（P＜0.05）。治疗后，两组pO₂、FEV1%pred、FEV1/FVC和PEF低高于同组治疗前，而pCO₂低低于同组治疗前（P＜0.05），且治疗组动脉血气指标与肺功能指标均优于对照组（P＜0.05）。治疗后，两组血清CRP、IL-34、ACTA、CCL18和PGRN水平都低于同组治疗前（P＜0.05），且治疗组均低于对照组（P＜0.05）。结论 采用标准桃金娘油肠溶胶囊联合沙丁胺醇治疗慢性阻塞性肺疾病急性加重期，可协同加速缓解患者症状、改善肺功能及动脉血气，有效抑制机体免疫炎症反应及气道重塑，减轻患者疾病症状负担，促进生活质量改善，且未明显增加额外用药风险。

Objective To investigate the clinical efficacy of Myrtol Standardized Enteric Coated Soft Capsules combined with salbutamol in treatment of acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods A total of 168 patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) admitted to Beijing Friendship Hospital, Capital Medical University from June 2024 to June 2025 were enrolled and randomly divided into a control group and a treatment group, with 84 cases in each group. The control group received inhalation of salbutamol sulfate aerosol, 2 puffs each time, twice daily. On the basis of the control regimen, the treatment group was additionally administered oral adult-formulated myrtol standardized enteric-coated capsules 30 minutes before meals, 1 capsule each time, three times daily. The treatment course lasted 14 days for both groups. Clinical efficacy and relief time of major symptoms were compared. The scores of modified Medical Research Council (mMRC) dyspnea scale, Cough and Sputum Assessment Questionnaire (CASA-Q) and Chronic Airway Assessment Test (CAAT), arterial blood gas parameters including partial pressure of arterial oxygen (pO₂) and partial pressure of arterial carbon dioxide (pCO₂), pulmonary function indicators including percentage of predicted forced expiratory volume in the first second (FEV1%pred), FEV1/forced vital capacity (FVC) ratio and peak expiratory flow (PEF), as well as serum levels of C-reactive protein (CRP), interleukin-34 (IL-34), activin A (ACTA), C-C motif chemokine ligand 18 (CCL18) and progranulin (PGRN) were detected before and after treatment. Results After treatment, the total effective rate of the treatment group was 97.62% (82/84), which was significantly higher than 84.52% of the control group (P < 0.05). The relief time of clinical manifestations such as cough and expectoration was markedly shorter in the treatment group (P < 0.05). In both groups, mMRC and CAAT scores decreased while CASA-Q scores increased after treatment (P < 0.05), and the treatment group achieved better results in all scale scores (P < 0.05). Both groups presented elevated pO₂, FEV1%pred, FEV1/FVC and PEF, and reduced pCO₂ after treatment (P < 0.05); the treatment group had superior arterial blood gas and pulmonary function indicators (P < 0.05). Serum levels of CRP, IL-34, ACTA, CCL18 and PGRN were decreased in both groups (P < 0.05), with lower levels observed in the treatment group (P < 0.05). Conclusion The combined treatment with myrtol standardized enteric-coated capsules and salbutamol for AECOPD exerts synergistic effects. It can accelerate symptom relief, improve pulmonary function and arterial blood gas, effectively inhibit systemic immune inflammation and airway remodeling, reduce disease burden and improve quality of life, without causing obvious additional medication-related risks.

R974

吴阶平医学基金会临床科研专项（320.6750.2022-26-15）