Abstract: Objective To explore the effect of Tiotropium Bromide onon the clinical efficacy and immune factors in patients with frequent acute exacerbations of COPD. Methods A total of 118 frequent acute COPD patients from January 2018 to June 2020 were selected as the research objects, and they were divided into a combination group and a routine group with 59 cases in accordance with the order of treatment. The routine group was treated with anti-infection, supportive treatment and Fluticasone propionate/terbutaline; Tiotropium Bromide was added to the conventional group in the combination group. The differences in pulmonary function, blood gas parameters, peripheral blood programmed death-1 （PD-1）, programmed cell death-ligand 1 （PD-L1）, exhaled breath condensate inflammation-related indicators, and serum CC16 levels before and after treatment were compared between the two groups. Results Before treatment, there was no significant difference in various pulmonary function indicators, blood gas indicators, the serum levels of PD-1/PD-L1/CC16, and the inflammatory mediators in exhaled breath condensate （IL-17, IL-10, and 8-iso-PG） between the two groups （P>0.05）. After treatment, the FVC, FEV1 and PEF in the combined group were statistically significantly higher than those in the conventional group （P<0.05）, and the PaCO₂ value in the combined group was lower than that in the conventional group （P<0.05）. After treatment, the PD-1 and PD-L1 levels in the peripheral blood of the combined group were lower than those in the conventional group. In additional, the IL-17 and 8-iso-PG of exhaled breath condensation in the combined group were lower than those in the conventional group （P<0.05）, but IL-10 of exhaled breath condensation in the combined group was higher than that in the conventional group （P<0.05）. Meanwhile, the efficacy was evaluated after treatment, and the efficacy of the patients in the combined group was better than that in the conventional group （P<0.05）. Conclusion The combination of Tiotropium Bromide/Fluticasone Propionate/Terbutaline and basic methods in the treatment of frequent acute exacerbations COPD patients is beneficial to alleviate the degree of inflammatory response, improve lung function and blood gas level, and expects to help reduce the contraindications of surgery.

Key words: Tiotropium Bromide, chronic obstructive pulmonary disease, frequent acute exacerbation, Fluticasone propionate, terbutaline

摘要： 目的 探讨塞托溴铵治疗频繁急性加重慢性阻塞性肺疾病（COPD）患者的效果及对血清PD-1/PD-L1、CC16、呼出气冷凝液中炎症指标的影响。方法 选取2018年1月~2020年6月入院的118例待实施外科择期手术的频繁急性加重COPD患者作为研究对象,根据患者就诊顺序分为联合组、常规组各59例,常规组采用抗感染、支持治疗+丙酸氟替卡松+特布他林治疗,联合组在常规组基础上加用塞托溴铵;对比两组患者治疗前后肺功能、血气参数、外周血程序死亡受体-1（PD-1）、细胞程序死亡-配体1（PD-L1）、呼出气冷凝液炎症相关指标、血清CC16水平的差异。结果 治疗前,两组患者间肺功能指标、血气指标、血清PD-1/PD-L1/CC16水平、呼出气冷凝液中炎症介质（IL-17、IL-10、8-iso-PG）的差异无统计学意义（P>0.05）。治疗后联合组FVC、FEV1、PEF较常规组有统计学意义（P<0.05）,联合组PaCO₂值较常规组低（P<0.05）。治疗后联合组外周血PD-1、PD-L1水平低于常规组。联合组呼出气冷凝的IL-17、8-iso-PG低于常规组（P<0.05）,但联合组呼出气冷凝的IL-10高于常规组（P<0.05）。同时发现,联合组患者疗效优于常规组（P<0.05）。结论 塞托溴铵+丙酸氟替卡松+特布他林结合基础方法治疗频繁急性加重COPD患者,更有助于改善肺功能及血气水平,有助于减少手术的禁忌症。

关键词: 塞托溴铵, 慢性阻塞性肺疾病, 频繁急性加重, 丙酸氟替卡松, 特布他林