目的 研究乌司他丁联合布地奈德福莫特罗治疗慢性阻塞性肺疾病的临床疗效。方法 选择2016年1月-2019年1月安康市中医院治疗的慢性阻塞性肺疾病59例作为研究对象，用抽签法随机分为对照组（30例）和观察组（29例）。对照组患者吸入布地奈德福莫特罗粉吸入剂，1吸/次，2次/d。观察组在对照组的基础上静脉滴注乌司他丁注射液，10万U的注射用乌司他丁加于500 mL 0.5%葡萄糖溶液中静脉滴注，2次/d。两组均治疗2周。观察两组患者的临床疗效，同时比较两组治疗前后的用力肺活量（FVC）、第1秒用力呼气容积（FEV₁）、FEV₁/FVC、二氧化碳分压（pCO₂）以及氧合指数（OI）；外周血单核细胞样受体（TLR4）、C反应蛋白（CRP）、高迁移率族蛋白B1（HMGB1）和肿瘤坏死因子-α（TNF-α）水平。结果 治疗后，观察组的总有效率为93.10%，显著高于对照组的70.00%（P<0.05）。两组治疗后的FVC、FEV₁、FEV₁/FVC、pCO₂和OI均明显升高（P<0.05），且观察组的肺功能明显高于对照组（P<0.05）。两组治疗后的TLR4、CRP、HMGB1和TNF-α水平明显降低（P<0.05），且观察组的上述指标明显低于对照组（P<0.05）。结论 乌司他丁联合布地奈德福莫特罗能显著降低慢阻肺患者外周血CRP、TLR4、TNF-α和HMGB1水平，减轻炎症反应对机体产生的不良影响，有利于提高疗效，改善患者肺功能。

Objective To study the clinical effect of ulinastatin combined with budesonide and formoterol fumarate in treatment of chronic obstructive pulmonary disease. Methods Fifty-nine patients with chronic obstructive pulmonary disease treated in Ankang Hospital of Traditional Chinese Medicine from January 2016 to January 2019 were selected as study subjects, and randomly divided into control group (30 cases) and observation group (29 cases) by lottery. Patients in the control group received Budesonide and Formoterol Fumarate Powder for Inhalation, 1 inhalation/time, twice daily. Patients in the observation group was injected with Ulinastatin Injection intravenously on the basis of the control group, 100 000 U was added into 500 mL 0.5% glucose solution, twice daily. Both groups were treated for 2 weeks. The clinical efficacy in two groups was observed. Meanwhile, the FVC, FEV₁, FEV₁/FVC, pCO₂ and OI, and the levels of TLR4, CRP, HMGB1, and TNF-α in peripheral blood before and after treatment were compared. Results After treatment, the total effective rate of the observation group was 93.10%, which was significantly higher than 70.00% of the control group (P<0.05). After treatment, FVC, FEV₁, FEV₁/FVC, pCO₂ and OI in two groups were significantly increased (P<0.05), and pulmonary function in the observation group was significantly higher than that in the control group (P<0.05). After treatment, the levels of TLR4, CRP, HMGB1 and TNF-α in two groups were significantly decreased (P<0.05), and the above indexes in the observation group were significantly lower than those in the control group (P<0.05). After treatment, the levels of TLR4, CRP, HMGB1, and TNF-α in two groups were significantly decreased (P<0.05), and the above indexes in the observation group were significantly lower than those in the control group (P<0.05). Conclusion Ulinastatin combined with budesonide and formoterol fumarate can significantly reduce the levels of CRP, TLR4, TNF-and HMGB1 in peripheral blood of patients with chronic obstructive pulmonary disease, reduce the adverse effects of inflammatory reaction on the body, and is conducive to improving the curative effect and lung function of patients.

R974

陕西省中医管理局中医药科研项目（LCPT044）