目的 探讨吸入糖皮质激素丙酸氟替卡松治疗稳定期COPD的疗效及对患者肺功能、炎症因子和内皮功能的影响。方法 收集2014年7月—2016年7月河南省新乡市中心医院收治的90例稳定期COPD患者，随机分为对照组和观察组，各45例。对照组患者给予西医常规治疗，观察组在对照组的基础上给予丙酸氟替卡松雾化吸入剂250 μg/次，2次/d。两组患者均接受6个月的治疗。观察比较治疗前后两组患者的肺功能指标，包括用力肺活量（FVC）、1 s用力呼气容积（FEV1）、最大呼气中期流速（MMEF）以及呼气峰流速（PEF）；炎症因子，包括白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、肿瘤坏死因子-α（TNF-α）以及C反应蛋白（CRP）水平；血管内皮功能指标，包括内皮依赖性血管舒张功能（FMD）、可溶性细胞间黏附因子（SICAM-1）、内皮素1（ET-1），以及呼出一氧化氮（FENO）的变化。结果 治疗后，两组患者的肺功能指标均有显著改善，同组治疗前后比较差异有统计学意义（P<0.05），并且观察组的FEV1、FEV1/FVC、MMEF及PEF显著高于对照组，组间比较差异有统计学意义（P<0.05）。治疗后，两组患者的炎症因子水平均有明显降低，同组治疗前后比较差异有统计学意义（P<0.05），并且观察组的IL-6、IL-8、TNF-α和CRP均显著低于对照组，比较差异具有统计学意义（P<0.05）。观察组的FMD较治疗前显著升高，且高于对照组，差异有统计学意义（P<0.05）；SICAM-1和ET-1较治疗前明显降低，且低于对照组，差异有统计学意义（P<0.05）。两组的FENO均有明显降低，但观察组的FENO降低幅度更大，比较差异具有统计学意义（P<0.05）。结论 吸入糖皮质激素治疗可显著改善稳定期COPD患者的肺功能，抑制炎症反应，尤其可提升内皮细胞功能、降低呼出NO量，有助于减少心血管事件的发生。

Objective To explore the influence of inhaled corticosteroids on the curative effect and fractional exhaled nitric oxide and endothelial function for patients with stable COPD.Methods Totally 90 patients with stable COPD were collected in Xinxiang Central Hospital from July 2014 to July 2016, and divided into two groups randomly. The control group (n= 45) was treated with conventional Western medicine, the observation group (n= 45) were given fluticasone propionate inhalation atomization of 250 g per time, twice daily. The two groups received 6 months of treatment. The pulmonary function indexes including forced vital capacity (FVC), 1 s forced expiratory volume (FEV1), maximal mid expiratory flow (MMEF) and peak expiratory flow (PEF), inflammatory factors such as lnterleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α) and C reactive protein (CRP) levels, and vascular endothelial function indexes including flow-mediated vasodilation (FMD), soluble intercellular adhesion molecule-1 (SICAM-1), endothelin 1 (ET-1), and fractional exhaled nitric oxide (FENO) were compared and analyzed.Results After treatment, the pulmonary function indexes were improved significantly (P<0.05), and the FEV1, FEV1/FVC, MMEF, and PEF of observation group were higher significantly than those patients in control group (P<0.05). The levels of inflammatory factors decreased than before treatment remarkably (P<0.05), and the levels of IL-6, IL-8, TNF-α, and CRP in observation group were lower than those in control group, and which difference was significance (P<0.05). The FMD of patients in study group was higher than those in control group significantly (P<0.05). The levels of SICAM-1 and ET-1 in observation group were decreased significantly than those before treatment, and were lower than control group (P<0.05). The FENO of all patients decreased than before treatment, and reduced amplitude in observation group was more than those in control group significantly (P<0.05).Conclusion Inhaled corticosteroids for patients stable COPD could improve pulmonary functions and inhibit inflammatory response, specially, which improves endothelial function and reduces the amount of exhaled NO and occurrence of cardiovascular events.