沙美特罗-氟替卡松联合N-乙酰半胱氨酸对稳定期慢性阻塞性肺疾病患者气道炎症的影响  

Salmeterol/fluticasone combined with N-acetylcysteine in treatment of airway inflammation of stable chronic obstructive pulmonary disease

作　　者：于世伦[1] 蒋广军[1] 郭宏[1] 李晶[1] 刘统俊[1] 查雪莉[1] 欧庆东[1] 吴大玮[2] 

机构地区：[1]济宁医学院附属滕州市中心医院呼吸内科,山东省滕州277500 [2]山东大学齐鲁医院

出　　处：《中华全科医师杂志》2008年第11期754-757,共4页Chinese Journal of General Practitioners

摘　　要：目的探讨联合应用沙美特罗-氟替卡松、N-乙酰半胱氨酸对稳定期慢性阻塞性肺疾病（COPD）患者的肺功能、体内氧化．抗氧化状态、气道炎症以及生存质量的影响。方法将60例稳定期COPD患者，以双肓随机方式分为对照组（30例）和治疗组（30例），对照组使用沙美特罗-氟替卡松吸入剂，治疗组在此基础上联合使用N-乙酰半胱氨酸，对比观察治疗4周后患者肺功能、血清和诱导痰上清液中IL-8、肿瘤坏死因子-α、超氧化物歧化酶和丙二醛以及诱导痰沉渣涂片中白细胞及其分类的变化，并进行生存质量的评估。结果治疗后对照组第-秒用力呼气容积（FEV1）、FEV1占预计值％、生存质量评分、诱导痰上清液中IL-8、肿瘤坏死因子-α、痰涂片中细胞总数和中性粒细胞比例与治疗前比较差异有统计学意义（P〈0．05或〈0．01）；治疗组FEV1、FEV1占预计值％、生存质量评分、血清超氧化物歧化酶和丙二醛、诱导痰上清液中IL-8、肿瘤坏死因子-α、血清超氧化物歧化酶、丙二醛以及痰涂片中细胞总数和中性粒细胞比例、巨噬细胞比例，治疗前后差异具有统计学意义（P〈0．05或〈0．01）。治疗后，治疗组血清超氧化物歧化酶[（93±8）×10^-6U／L]和丙二醛[（4．0±1．0）×10^-3mmol／L]、痰涂片中中性粒细胞百分比（0．5±0．3）与对照组[（85±10）×10^-6U／L、（4．2±1．1）×10^-3mmol／L、0．6±0．2]比较差异具有统计学意义（P〈0．05）。结论沙美特罗-氟替卡松与N-乙酰半胱氨酸联合应用对稳定期COPD患者的肺功能、体内氧化-抗氧化状态及其气道炎症均具有较好的作用，且能够较明显改善患者的生存质量，尤其在降低痰液中中性粒细胞比例、减轻体内氧化应激反应方面明屁优于译用沙美特罗和氟替卡松。Objective To evaluate salmeterol/fluticasone combined with N-acetylcysteine in treatment of stable chronic obstructive pulmonary disease （COPD）. Methods Sixty patients with stable COPD were randomized into treatment group（n = 30） and control group（n = 30）. Patients in control group were given salmeterol/fluticasone twice per day; while patients in treatment group in addition to salmeterol/ fluticasone, also took N-acetylcysteine 0.6 g three times per day. The course of treatment lasted for four weeks. Pulmonary function was measured in all patients; interleukin-8 （IL-8）, tumor necrosis factor α （TNF-α） , superoxide dismutase （SOD） and malondialdehyde （MDA） in blood serum and induced sputum were determined. The white cell count and classification in sputum smear was examined and the quality of life （QOL） of patients was evaluated. Results FEV1 , FEV1 %, QOL evaluation, IL-8, TNF-α, white cell count and the percentage of neutrophil granulocytes in induced sputum after treatment were significantly improved compared with those before treatment in control group （ P 〈 0. 05 or P 〈 0. 01 ）. FEV1 , FEV1% , QOL evaluation, SOD and MDA in blood serum, IL-8, TNF-α, SOD and MDA, total white cell count, the percentage of neutrophil granulocytes and macrophage in induced sputum after treatment were significantly improved in treatment group （ P 〈0.05 or P 〈0.01 ）. The differences in SOD and MDA in blood serum and the percentage of neutrophil granulocytes in induced sputum smear between treatment group and control group were statistically significant（93 ±8） × 10^-6U/L, （4. 0 ± 1.0）× 10^-3mmol/L and 0. 5 ±0. 3 vs （85 ± 10） ×10^-6U/L,（4.2± 1.1） ×10^-3mmol/L and 0.6 ±0.2; all P 〈0.05. Conclusion Combination of salmeterol/fluticasone and N-acetyicysteine has better therapeutic results in treatment of airway inflammation of stable COPD.

关 键 词：肾上腺素能Β激动剂 糖皮质激素 乙酰半胱氨酸 肺疾病 慢性阻塞性 

分 类 号：R563.9[医药卫生—呼吸系统]