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目的:探讨布地奈德福莫特罗联合噻托溴铵治疗哮喘-慢性阻塞性肺疾病重叠(asthma COPD overlap，ACO)的临床效果及安全性。方法:选择2016年1月至2018年12月开滦总医院林西医院呼吸内科收治的ACO且符合入组标准的160例患者作为观察对象，采取前瞻性队列研究进行观察分析。160例患者应用计算机随机数字法分成研究组和对照组，每组80例。两组患者均接受常规治疗，在此基础上，对照组给予布地奈德福莫特罗粉吸入剂，1吸/次，2次/d，研究组在对照组的基础上加用噻托溴铵1粒/次，1次/d。两组患者均治疗12个月。比较两组患者的临床疗效，肺功能，血气分析，炎症因子以及T淋巴细胞水平的变化。结果:研究组总控制率87.5%(70/80)明显高于对照组70.0%(56/80)，差异有统计学意义(χn 2＝7.32，n P<0.05)。治疗后两组患者哮喘控制测试表(asthma control test，ACT)评分明显升高，组间比较，研究组哮喘控制测试表评分[(23.12±3.12)分]明显高于对照组[(20.45±4.28)分，n t＝4.51，n P<0.05]。治疗后两组患者慢性阻塞性肺疾病评估测试量表(COPD assessment test，CAT)评分明显下降，组间比较，研究组慢性阻塞性肺疾病评估测试量表评分[(14.25±3.03)分]明显低于对照组[(18.69±3.52)分，n t＝8.55，n P<0.05]。治疗后两组患者1 s用力呼气容积(forced expiratory volume in 1s，FEV1)、1 s用力呼气容积占预计值百分比(FEV1%)、FEV1与用力肺活量(forced vital capacity，FVC)的比值(FEV1/ FVC)、吸气分数[深吸气量/肺总量，inspiratory capacity / total lung capacity，IC/TLC(%)均明显升高，组间比较，研究组FEV1[(2.20±0.47)L]、FEV1%[(68.62±7.89)%]、FEV1/ FVC[(67.63±7.59)%]和IC/TLC[(48.84±4.86)%]均明显高于对照组[(1.93±0.49)L、(61.88±7.65)%、(62.88±8.41)%、(43.22±5.15)%](n t值分别为3.56、5.49、3.75、7.10，n P均<0.05)。治疗后两组患者动脉血氧分压(partial pressure of oxygen，PaOn 2)水平明显升高，组间比较，研究组PaOn 2水平[(78.12±6.45) mmHg]明显高于对照组[(72.45±7.52) mmHg](n t＝5.12，n P<0.05)。治疗后两组患者动脉血二氧化碳分压(partial pressure of carbon dioxide，PaCOn 2)水平明显下降，组间比较，研究组PaCOn 2水平[(46.73±7.13) mmHg]明显低于对照组[(49.81±8.02) mmHg](n t＝2.57，n P<0.05)。治疗后两组患者白细胞介素6(interleukin-6，IL-6)、超敏C反应蛋白(high sensitivity C-reactive protein，hs-CRP)和肿瘤坏死因子α(tumor necrosis factor-α，TNF-α)水平明显下降，组间比较，研究组IL-6[(15.35±6.72) ng/L]、hs-CRP[(18.14±7.62) mg/L]和TNF-α[(56.84±4.92) ng/L]水平明显低于对照组[(21.42±5.35) ng/L、(23.35±8.64) mg/L、(69.45±8.51) ng/L](n t值分别为6.32、4.05、11.47，n P均<0.05)。治疗后两组患者CD4n ＋和CD4n ＋/ CD8n ＋水平明显升高，组间比较，研究组CD4n ＋[(44.20±6.02)%]和CD4n ＋/ CD8n ＋水平(1.82±0.31)明显高于对照组[(38.52±5.56)%、(1.43±0.29)](n t值分别为6.20、8.22，n P均<0.05)。治疗后两组患者CD8n ＋水平明显下降，组间比较，研究组CD8n ＋水平[(23.62±7.89)%]明显低于对照组[(27.42±7.65)%](n t＝3.09，n P<0.05)。n 结论:布地奈德福莫特罗联合噻托溴铵治疗ACO具有较好的临床疗效，降低机体炎症水平，缓解COPD和哮喘的临床症状，改善患者的呼吸功能、肺功能，同时对于提高细胞免疫功能具有良好的作用。“,”Objective:To investigate the clinical efficacy of budesonide formoterol combined with tiotropium bromide in the treatment of asthma chronic obstructive pulmonary disease(COPD) overlap (ACO).Methods:From January 2016 to December 2018, 160 ACO patients who met the inclusion criteria in the Department of Respiratory Medicine, Linxi Hospital, Kailuan General Hospitalwere selected as the observation objects.Prospective cohort study was used for observation and analysis.The patients were divided into study group and control group with 80 cases in each group by random number table.Both groups received conventional treatment, on this basis, control group received budesonide and formoterol powder inhalation, 1 inhalation/time, 2 times/d, study group received tiotropium bromide 1 granule/time, once a day based on the control group.Both groups were treated for 12 months.The clinical efficacy, lung function, blood gas analysis, inflammatory factors and T lymphocyte levels were compared between the two groups.Results:The total control rate in study group was 87.5%(70/80), significantly higher than that in control group (70.0%(56/80)), the difference was statistically significant (χn 2=7.32, n P<0.05). After treatment, the asthma control test (ACT) scores in both groups increased significantly, while ACT scores in study group((23.12±3.12) point )was significantly higher than that in control group ((20.45±4.28) point,n t=4.51, n P<0.05). After treatment, the COPD assessment test (CAT) scores in both groups decreased significantly, while CAT scores in study group ((14.25±3.03) point ) was significantly lower than that in control group ((18.69±3.52) point,n t=8.55, n P<0.05). After treatment, the forced expiratory volume in 1s (FEV1), FEV1%, FEV1 /Forced vital capacity (FEV1/ FVC) and Inspiratory capacity / total lung capacity (IC/TLC) levels in both groups increased significantly, while FEV1((2.20±0.47)L), FEV1%((68.62±7.89)%), FEV1/ FVC((67.63±7.59)%)and IC/TLC levels(48.84±4.86)%) in study group were significantly higher than those in control group ((1.93±0.49)L, (61.88±7.65)%, (62.88±8.41)%, (43.22±5.15)%)(t value were 3.56, 5.49, 3.75, 7.10, alln P<0.05). After treatment, the level of partial pressure of oxygen (PaOn 2) in both groups increased significantly, while PaOn 2 level in study group((78.12±6.45) mmHg) was significantly higher than that in control group ((72.45±7.52) mmHg)(n t=5.12, n P<0.05). After treatment, the arterial partial pressure of carbon dioxide (PaCOn 2) level in both groups decreased significantly, while PaCOn 2 level in study group((46.73±7.13) mmHg) was significantly lower than that in control group((49.81±8.02) mmHg) (n t=2.57, n P<0.05). After treatment, the levels of IL-6, hs CRP and TNF-α in the two groups were decreased significantly, while IL-6, hs-CRP and TNF-α levels in study group((15.35±6.72) ng/L, (18.14±7.62) mg/L, (56.84±4.92) ng/L) were significantly lower than those in control group((21.42±5.35) ng/L, (23.35±8.64) mg/L, (69.45±8.51) ng/L) (t value were 6.32, 4.05, 11.47, alln P<0.05). After treatment, the levels of CD4n + and CD4n +/CD8n + levels in both groups increased significantly, while CD4n + and CD4n +/CD8n + levels in study group((44.20±6.02)%, (1.82±0.31)) were significantly higher than those in control group((38.52±5.56)%, (1.43±0.29)) (n t=6.20, 8.22, all n P<0.05). CD8n + level in both groups decreased significantly, while CD8n + level in study group((23.62±7.89)%) was significantly lower than that in control group((27.42±7.65)%)(n t=3.09, n P<0.05).n Conclusion:Budesonide and formoterol combined with tiotropium bromide in the treatment of ACO has good clinical efficacy, reduce the level of inflammation, relieve the clinical symptoms of COPD and asthma, improve the respiratory function and lung function of patients, and have a good effect on improving the cellular immune function.