目的 研究阿奇霉素联合沙美特罗/氟替卡松对慢性阻塞性肺疾病患者的疗效及对血浆B型脑钠肽（BNP）水平的影响。方法 选择2015年1月-2017年12月新疆自治区人民医院米东医院收治的60例慢性阻塞性肺疾病患者，随机分为两组。对照组吸入沙美特罗/氟替卡松治疗，观察组在对照组基础上加用阿奇霉素，每次0.25 g，每天1次。两组均治疗6个月。比较两组临床疗效、每分钟最大通气量（MVV）、用力呼气量占用力肺活量比值（FEV1/FVC），并测量两组的6分钟步行距离，观察两组肿瘤坏死因子（TNF）-α、白介素（IL）-8、高敏C-反应蛋白（hs-CRP）和血浆BNP水平改变情况，记录两组的住院时间以及出院1年后的病死率。结果 观察组总有效率为93.33%，明显高于对照组的73.33%，差异有统计学意义（P<0.05）。治疗后，两组的MVV、6 min步行距离和FEV1/FVC均明显升高，同组治疗前后比较差异有统计学意义（P<0.05）；且观察组以上指标明显高于对照组，差异有统计学意义（P<0.05）。治疗后，两组的血清hs-CRP、TNF-α、IL-8和血浆BNP水平均明显降低，同组治疗前后比较差异有统计学意义（P<0.05）；且观察组以上指标明显低于对照组，差异有统计学意义（P<0.05）。观察组的住院时间及病死率均明显低于对照组（P<0.05）。结论 阿奇霉素联合沙美特罗/氟替卡松对慢性阻塞性肺疾病患者的疗效确切，可明显减轻气道炎症反应，降低血浆BNP水平，改善肺功能，值得应用推广。

Objective To study the clinical effect of salmeterol/fluticasone combined with azithromycin on chronic obstructive pulmonary disease and its effect on plasma B-type brain natriuretic peptide level. Methods Selected 60 cases of patients with chronic obstructive pulmonary disease in our hospital from January 2013 to December 2017, divided into two groups randomly. The control group was treated with salmeterol/fluticasone inhalation, while the observation group was treated with azithromycin. Results The effective rate of the observation group was significantly higher than control group (P<0.05). After treatment, MVV, 6-minute walking distance and FEV1/FVC in both groups were significantly increased (P<0.05), especially in the observation group (P<0.05). The levels of serum hs-CRP, TNF-α, IL-8 and plasma BNP were significantly decreased in both groups, especially in the observation group (P<0.05). The hospitalization time and mortality of the observation group were significantly lower than those of the control group (P<0.05). Conclusion Salmeterol/fluticasone combined with azithromycin has definite curative effect on COPD patients. It can significantly reduce airway inflammation, reduce plasma BNP level and improve lung function. It is worth popularizing.

R974

新疆维吾尔族自治区自然科学基金资助项目（2018D01C308）