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目的 观察沙美特罗丙酸氟替卡松吸入对老年慢性阻塞性肺疾病(COPD)合并2型糖尿病(T2DM)患者糖代谢及骨密度有无不良影响.方法 将31例老年COPD合并T2DM患者按随机数字表法分为两组,对照组14例,给予常规治疗,试验组17例,另外加用沙美特罗替卡松50/500μg每日2次,每次1吸,连续用药3个月,观察两组患者空腹血糖、餐后2h血糖、糖化血红蛋白、血浆皮质醇及骨密度水平的改变.结果 试验组患者的空腹血糖、餐后2h血糖、糖化血红蛋白、骨密度水平分别由治疗前的(5.25±0.21) mmol/L、(7.14±0.33) mmol/L、(5.58±0.26)％、(1.96±0.11)g/cm2变为治疗后的(5.31±0.27) mmol/L、( 7.22±0.29) mmol/L、(5.67±0.23)％、(2.03±0.15)g/cm2,差异无统计学意义(P＞0.05)；对照组患者的相应指标分别由治疗前的(5.33±0.35) mmol/L、(7.26±0.29) mmol/L、(5.62±0.19)％、(1.88±0.20) g/cm2变为治疗后的(5.36±0.31) mmol/L、(7.30±0.35)mmol/L、(5.69±0.26)％、(1.98±0.17) g/cm2,差异无统计学意义(P＞0.05)；两组患者组间比较差异亦无统计学意义(P＞0.05).两组患者治疗前后血浆皮质醇水平比较差异无统计学意义(P＞0.05).结论 沙美特罗替卡松吸入对老年COPD合并T2DM患者的糖代谢和骨密度无不良影响.

Objective To observe the effects of salmeterol fluticasone on the glucose metabolism and bone density of the elderly patients with chronic obstructive pulmonary disease (COPD) combined with type 2 diabetes mellitus (T2DM).Methods Thirty-one patients with COPD combined with T2DM were divided into 2 groups by random digits table,14 cases in control group were given conventional therapy,17 cases in experimental group were given conventional therapy and fluticasone propionate 50/500 μg,twice a day,for 3 months.The fasting blood glucose,postprandial 2 hours glucose,glycosylated hemoglobin,plasma cortisol and bone density respectively before and after treatment were detected.Results In experimental group,the fasting blood glucose,postprandial 2 hours glucose,glycosylated hemoglobin and bone density before treatment was (5.25 ± 0.21 ) mmol/L,(7.14 ± 0.33 ) mmol/L,(5.58 ± 0.26 )％,( 1.96 ± 0.11 ) g/cm2,and after treatment was(5.31 ± 0.27 ) mmol/L,(7.22 ± 0.29 ) mmol/L,(5.67 ± 0.23 )％,(2.03 ± 0.15 ) g/cm2,there was no significant difference (P ＞ 0.05).In control groups,the fasting blood glucose,postprandial 2 hours glucose,glycosylated hemoglobin and bone density before treatment was (5.33 ± 0.35) mmol/L,( 7.26 ± 0.29 ) mmol/L,( 5.62 ± 0.19 )％,( 1.88 ± 0.20 ) g/cm2,and after treatment was ( 5.36 ± 0.31 ) mmol/L,(7.30 ± 0.35 ) mmol/L,( 5.69 ± 0.26 )％,( 1.98 ± 0.17 ) g/cm2,there was no significant difference (P ＞ 0.05 ).There was no significant difference in plasma cortisol before and after treatment in two groups (P ＞0.05).Conclusion Inhaling salmeterol fluticasone for elderly patients with COPD combined with T2DM is safe.