内科

目的探讨在常规治疗的基础上，胸腺肽联合辛伐他汀治疗哮喘－慢阻肺重叠综合征(ACOS)老年患者的临床效果。方法选取我科收治的ACOS老年患者80例，采用随机数字法分为两组，每组40例。对照组患者给予常规治疗，研究组患者在常规治疗基础上联合胸腺肽及辛伐他汀治疗，疗程3个月，比较两组患者的临床疗效；检测比较两组患者治疗前后的呼出气一氧化氮（FeNO）水平、肺功能、免疫功能和炎症因子水平；对两组患者进行支气管镜检查，比较两组患者治疗前后的支气管基底膜厚度（TRBM）及支气管黏膜肌纤维母细胞数量。结果治疗3个月后，研究组患者的治疗总效率（92.5%）显著高于对照组(75.0%)，差异有统计学意义（P＜0.05）；两组患者的FeNO水平均显著降低，肺功能均得到明显改善，研究组患者的FeNO水平显著低于对照组，肺功能显著优于对照组，差异有统计学意义（P＜0.05）。治疗3个月后,两组患者外周血T淋巴细胞亚群CD3+、CD4+、CD4+/CD8+水平显著增高，CD8+水平显著降低；研究组患者的CD3+、CD4+、CD4+/CD8+水平显著高于对照组，CD8+水平显著低于对照组，差异有统计学意义（P＜0.05）。治疗3个月后,两组患者的外周血TNF-α、IL-4、IL-6水平均显著降低，研究组患者的水平显著低于对照组，差异有统计学意义（P＜0.05）；两组患者的TRBM及支气管黏膜肌纤维母细胞数量均显著降低（减少），研究组患者的水平显著低于对照组，差异有统计学意义（P＜0.05）。结论在常规治疗的基础上，胸腺肽联合辛伐他汀治疗能明显提高老年哮喘－慢阻肺重叠综合征患者的临床治疗效果，减轻患者的炎性反应，改善患者的肺功能及免疫功能，抑制其气道重塑，从而改善患者的预后。

ObjectiveTo explore the clinical effect of thymosin combined with simvastatin in the treatment of elderly patients with asthma-COPD overlap syndrome (ACOS) on the basis of conventional treatment. MethodsEighty elderly patients with ACOS who were admitted to our department were selected and were divided into two groups by the random number method, with 40 cases in each group. The control group was given conventional treatment, based on which the study group was treated with the combination of thymosin and simvastatin, for a treatment course of 3 months. The clinical efficacy of the two groups was compared. The fractional exhaled nitric oxide (FeNO) levels, lung function, immune function and inflammatory factor levels of the two groups before and after treatment were measured and compared. Bronchoscopy was performed on the two groups of patients, and the thickness of the reticular basement membrane (TRBM) and the number of bronchial mucosal myofibroblasts were compared between the two groups before and after treatment. ResultsAfter 3 months of treatment, the total effective rate of the study group was superior to the control group (92.5% vs. 75.0%), with a statistically significant difference (P＜0.05). The FeNO levels significantly decreased, whereas the lung function improved in both groups, the study group yielded a lower level of FeNO, while superior lung function as compared with the control group, with statistically significant differences (P＜0.05). After 3 months of treatment, the CD3+, CD4+, CD4+/CD8+ levels of the peripheral blood T lymphocyte subsets of the two groups significantly increased, and the CD8+ levels significantly decreased, as well as the study group yielded higher CD3+, CD4+, CD4+/CD8+ levels, whereas lower CD8+ level as compared with the control group, with statistically significant differences (P＜0.05). After 3 months of treatment, the levels of TNF-α, IL-4, and IL-6 in the peripheral blood of the two groups significantly decreased, and the study group yielded lower levels of above-mentioned indexes as compared with the control group, with statistically significant differences (P＜0.05).The TRBM and numbers of bronchial mucosal myofibroblasts in the two groups significantly reduced (decreased), and the study group yielded lower levels as compared with the control group, with statistically significant differences (P＜0.05). ConclusionOn the basis of conventional treatment, thymosin combined with simvastatin treatment can significantly improve the clinical therapeutic effect of elderly patients with ACOS, reduce the patient′s inflammatory response, improve the patient’s lung function and immune function. It can inhibit the remodeling of the airway; thereby, it can also improve the patient′s prognosis.