Effect of salmeterol/fluticasone propionate on airway inflammation in COPD: a randomised controlled trial
Effect of salmeterol/fluticasone propionate on airway inflammation in COPD: a randomised controlled trial
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DOI：
10.1136/thx.2006.071068
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发表时间：
2007-11-01
期刊：
影响因子：
10
通讯作者：
Hamid, Qutayba
中科院分区：
文献类型：
--
作者：
Bourbeau, Jean;Christodoulopoulos, Pota;Hamid, Qutayba
背景：慢性阻塞性肺疾病（COPD）气道炎症的特征是CD8(+) T细胞和CD68（+）巨噬细胞的浸润和中性粒细胞数量的增加，而很少有研究描述嗜酸性粒细胞的存在。虽然皮质类固醇对稳定型COPD的抗炎作用尚不清楚，但最近的研究表明，联合治疗可能是有益的。因此，开展了一项研究，评估沙美特罗/丙酸氟替卡松（SFC）联合用药和丙酸氟替卡松（FP）单独用药对COPD患者气道炎症细胞的影响。方法：患者在随机、双盲、平行组、安慰剂对照试验中接受50mg沙美特罗和500mg FP的联合治疗，每日两次（SFC, n = 19, 19名男性，平均年龄62岁），500mg FP每日两次（n = 20, 15名男性，平均年龄64岁）或安慰剂（n = 21, 17名男性，平均年龄66岁），疗程3个月。在治疗开始和结束时进行支气管镜检查和支气管活检，测量CD8(+) T淋巴细胞、CD68（+）巨噬细胞、中性粒细胞和嗜酸性粒细胞的数量。结果：与安慰剂相比，SFC显著减少CD8（+）细胞(差异298.05个细胞/mm(2)；95% CI 2143.14 ~ 252.9；p 0.001)。单独使用FP（244.67个细胞/mm(2)）没有明显的效果；95% CI 290.92 ~ 1.57；P = 0.06)。与安慰剂相比，SFC也减少了CD68+巨噬细胞（差异231.68个细胞/ mm2； 95% CI 261.07至22.29;p = 0.03），但FP没有。与安慰剂相比，SFC没有显著改变中性粒细胞和嗜酸性粒细胞。结论：SFC具有单独吸入皮质类固醇所没有的气道抗炎作用。
Background: Airway inflammation in chronic obstructive pulmonary disease (COPD) is characterised by infiltration of CD8(+) T cells and CD68(+) macrophages and an increased number of neutrophils, whereas few studies have described the presence of eosinophils. Although the anti-inflammatory effects of corticosteroids in stable COPD are unclear, recent studies suggest that combination therapy could be beneficial. A study was therefore undertaken to evaluate combined salmeterol/fluticasone propionate (SFC) and fluticasone propionate (FP) alone on inflammatory cells in the airways of patients with COPD.Methods: Patients were treated in a randomised, double blind, parallel group, placebo-controlled trial with either a combination of 50 mg salmeterol and 500 mg FP twice daily (SFC, n = 19, 19 men, mean age 62 years), 500 mg FP twice daily (n = 20, 15 men, mean age 64 years) or placebo (n = 21, 17 men, mean age 66 years) for 3 months. At the start and end of treatment bronchoscopy with bronchial biopsies was performed and the numbers of CD8(+) T lymphocytes, CD68(+) macrophages, neutrophils and eosinophils were measured.Results: CD8(+) cells were significantly reduced by SFC compared with placebo (difference 298.05 cells/mm(2); 95% CI 2143.14 to 252.9; p, 0.001). Such a marked effect was not seen with FP alone (244.67 cells/mm(2); 95% CI 290.92 to 1.57; p = 0.06). CD68+ macrophages were also reduced by SFC compared with placebo ( difference 231.68 cells/ mm2; 95% CI 261.07 to 22.29; p = 0.03) but not by FP. SFC did not significantly change neutrophils and eosinophils compared with placebo. Conclusions: SFC has airway anti- inflammatory effects not seen with inhaled corticosteroids alone.