关键词: 肺疾病, 慢性阻塞性；噻托溴铵；呼吸锻炼；机体免疫功能；生活质量

Abstract: Objective　To determine the effect and clinical significance of tiotropium bromide combined with respiratory training on immune function and quality of life in patients with chronic obstructive pulmonary disease（COPD） during the early stable phase.Methods　Ninety patients with stable COPD who were treated at People's Hospital of Quzhou in Zhejiang from January 2015 to June 2016 were divided into the untreated group（n=30，diagnosed with early-stage stable COPD but refused medical treatment），tiotropium group（n=30，only treated by tiotropium） and combination therapy group（n=30， treated by tiotropium and respiratory training）according to the treatment plan.Thirty healthy individuals were selected as controls during the same period.All patients in the three groups were followed up for 12 months after admission（at the 1st，3rd，6th，9th and 12th month after enrollment）.Peripheral blood lymphocyte subsets（CD3+，CD4+，CD8+，CD4+/CD8+），serum immunoglobulin（IgG，IgA），pulmonary function test，and COPD assessment test（CAT） were performed，and the number of exacerbations was recorded at admission and at each follow-up visit.The changes in related indicators collected during the follow-up period were analyzed and compared.Results　An interaction between grouping and time was observed between CD3+，CD4+，CD8+，CD4+/CD8+，IgG，IgA，FEV1，CAT scores，and annual acute exacerbations（P<0.05）.The main effects of grouping on CD3+，CD4+，CD8+，CD4+/CD8+，IgG，and IgA were significant（P<0.05），and the main effects of time on all indicators were significant（P<0.05）.CD3+ in the 6th，9th and 12th month，CD4+ in the 1st，3rd，6th，9th and 12th month，CD4+/CD8+ in the 1st，3rd，6th，9th and 12th month，IgG in the 6th， 9th and 12th month，and IgA in the 3rd，6th，9th and 12th month，were higher in the combination therapy group than in the untreated group and tiotropium bromide group and were higher in the tiotropium bromide group than in the untreated group（P<0.05）.CD8+ in the 3rd，6th，9th and 12th month，were lower in the combination therapy group than in the untreated group and tiotropium bromide group and were lower in the tiotropium bromide group than in the untreated group（P<0.05）.A positive correlation between CD3+，CD4+，CD8+，CD4+/CD8+，IgA，IgG and FEV1 was observed in all three groups，and a negative correlation between CAT score and the number of acute exacerbations was observed（P<0.05）.Conclusion　In patients with early-stage stable COPD，there is a decline in immune function，and the correlation between lung function and quality of life.In addition，the changes in immune function during this period can reflect the patient's condition.Tiotropium combined with respiratory exercise training can improve immune function，delay the decline of lung function，and reduce the incidence of acute exacerbations.Compared with tiotropium alone，combination therapy results in greater benefits to patients.

Key words: Pulmonary disease, chronic obstructive；Tiotropium；Breathing exercises；Immune function；Quality of life