大剂量乙酰半胱氨酸对高龄患者慢性阻塞性肺病合并肺间质纤维化急性加重期的干预作用及机制初探  

Effects of Large Doses of Acetylcysteine on Elderly Patients with COPD Combined with Pulmonary Fibrosis in Acute Exacerbation

作　　者：梁源[1] 余德文[1] 华丕虹[1] 沈珠甫[1] 苏勇[1] 王湘平[1] 

机构地区：[1]成都军区昆明总医院干部病房,云南昆明650032

出　　处：《现代生物医学进展》2011年第19期3642-3644,共3页Progress in Modern Biomedicine

摘　　要：目的:观察大剂量乙酰半胱氨酸(NAC)对高龄患者慢性阻塞性肺病(COPD)合并肺间质纤维化(PIF)急性加重期的干预作用,并对干预机制进行初步探讨。方法:年龄大于80岁COPD合并PIF患者18例,分为对照组(8例)和观察组(10例),对照组给予常规治疗,观察组在对照组治疗基础上给予口服乙酰半胱氨酸颗粒600 mg/次,3次/d,连用30天,观察两组治疗前后临床症状、肺功能指标(FVC、FEV1、FEV1/FVC)、动脉血氧分压(PaO2)、血液中细胞因子(IL-2和TNF-α)和影像学的变化。结果:观察组治疗总有效率和细菌培养转阴率显著升高(P<0.05);两组治疗后FVC、FEV1、FEV1/FVC、PaO2均较治疗前显著上升(P<0.05),血液中IL-2和TNF-α较治疗前显著下降(P<0.05);组间比较存在显著性差异(P<0.05);观察组治疗后胸部CT见感染明显控制。结论:在常规治疗基础上合用大剂量NAC可以有效治疗急性加重期COPD合并PIF的老年患者,机制可能与抑制炎性因子表达、减少细菌在呼吸道内的附着有关。Objective： To study the effects of large doses of acetylcysteine on elderly patients with chronic obstructive pulmonary disease （COPD） combined with pulmonary fibrosis in acute exacerbation and its possible mechanism. Methods： 18 cases（ages≥ 80） COPD with PIF were ran- domly divided into control group 8 cases （treated with conventional therapy only） and observation group 10 eases （treated with the con- ventional method and NAC 600 mg/per time, 3 times per-day orally for 30 days to observe the change of clinical symptoms, bacterial number and CT, and the levels of FVC, FEV1, FEV1/FVC, PaO2, IL-2 and TNF-α . Results： The achievement rate of clinical symptoms, bacterial number after treatment were higher than those in control group （P〈0.05）. The levels of FVC, FEV1, FEV1/FVC, PaO2 after treatment were significantly higher than than those before treatment in two groups （P〈0.05）, meanwhile IL-2 and TNF-α levels in blood were lower than those before treatment（P〈0.05）, and there was significant difference in two groups（P〈0.05）. And the CT changes in chest were much more significant. Conclusion： High dose NAC with conventional therapy has obviously effects on acute COPD with PIF of eld patients, the effect may be ascribed to the reduction of inflammatory factor and bacteria adhesion partly.

关 键 词：慢性阻塞性肺病(COPD) 肺间质纤维化(PIF) 乙酰半胱氨酸(NAC) 

分 类 号：R563[医药卫生—呼吸系统]