广西医学

目的探讨哮喘控制不佳患者三联疗法疗效的影响因素。方法选择260例哮喘控制不佳的患者，均给予三联疗法（布地奈德+福莫特罗+噻托溴铵）治疗，治疗1年后根据疗效分为有效组（n=196）和无效组（n=64）。比较两组患者一般资料、肺功能指标［第一秒用力呼气量（FEV1）、用力肺活量（FVC）、肺一氧化碳弥散量、最大通气量（MVV）、FEV1/FVC%、FVC%、FEV1%<80%比例、呼出气一氧化氮（FeNO）］、呼吸肌功能指标［PaO2、PaCO2、SaO2、最大吸气压和最大呼气压（MEP）］、运动能力指标（6 min最大步行距离、最大摄氧量）及呼吸困难程度［英国医学研究委员会（MRC）评分、基础呼吸困难指数（BDI）］、营养状况（血清前清蛋白、白蛋白、血红蛋白）。采用多因素Logistic回归模型分析哮喘控制不佳患者三联疗法疗效的影响因素，绘制受试者工作特征曲线评估影响因素对其疗效的预测价值。结果有效组的吸烟史比例、哮喘家族史比例、变应性鼻炎史比例，以及病情严重程度为重度的比例低于无效组（P<0.05）。有效组的MVV、FVC%、MEP高于无效组，FeNO、MRC评分、BDI、FEV1%<80%比例低于无效组（P<0.05）。多因素Logistic回归分析结果显示，FVC%、FeNO、FEV1%<80%、BDI、MRC评分为哮喘控制不佳患者三联疗法疗效的影响因素（P<0.05）。上述5个指标联合预测哮喘控制不佳患者三联疗法疗效的曲线下面积大于其单独预测的曲线下面积（P<0.05）。结论 FVC%、FeNO、FEV1%<80%、BDI、MRC评分是哮喘控制不佳患者三联疗法疗效的影响因素，上述5个指标对其疗效有一定的预测效能，且联合预测效能更佳。

Objective To explore the influencing factors for efficacy of triple therapy in patients with poor asthma control. Methods A total of 260 patients with poor asthma control were selected, and they all received triple therapy (budesonide+formoterol+tiotropium bromide) for treatment. After 1 year of treatment, patients were assigned to effective group (n=196) or ineffective group (n=64) according to efficacy. General data, pulmonary function indices with respect to forced expiratory volume in first second (FEV1), forced vital capacity (FVC), CO diffusion capacity⁃single breath method (DLCO⁃sb), maximal voluntary ventilation (MVV), FEV1/FVC%, FVC%, and FEV1%<80% proportion, fractional exhaled nitric oxide (FeNO), respiratory muscle function indices in terms of PaO2, PaCO2, SaO2, maximal inspiratory pressure, maximal expiratory pressure (MEP), exercise capacity indices (6⁃minute maximal walking distance, maximal oxygen uptake), dyspnea degree with respect to British Medical Research Council (MRC) score, baseline dyspnea index (BDI), and nutrition states (serum prealbumin, albumin, hemoglobin) were compared between patients of the two groups. The influencing factors for efficacy of triple therapy in patients with poor asthma control were analyzed by using the multivariate Logistic regression model, and the predictive value of the influencing factors for its efficacy was evaluated by drawing the receiver operating characteristic curve. Results The effective group exhibited lower proportions of smoking history, family history of asthma, history of allergic rhinitis, and severe disease condition as compared with the ineffective group (P<0.05). The effective group yielded higher MVV, FVC%, and MEP, whereas lower FeNO, MRC score, BDI, and a lower FEV1%<80% proportion as compared with the ineffective group (P<0.05). The results of multivariate Logistic regression analysis revealed that FVC%, FeNO, FEV1%<80%, BDI, and MRC score were the influencing factors for efficacy of triple therapy in patients with poor asthma control (P<0.05). Area under the curve of 5 aforementioned indices for jointly predicting efficacy of triple therapy in patients with poor asthma control was larger than that of single prediction of the 5 indices (P<0.05). Conclusion FVC%, FeNO, FEV1%<80%, BDI, and MRC score are the influencing factors for efficacy of triple therapy in patients with poor asthma control. All these 5 aforementioned indices exert efficiency for predicting efficacy to a certain extent, and the combined prediction efficiency is superior.