高原地区慢性阻塞性肺疾病急性加重期合并慢性肺心病抗氧化治疗的研究  

Study on intervention of antioxidant in patients with chronic obstructive pulmonary disease in acute exacerbation complicated chronic cor pulmonale at high altitude areas

作　　者：杨生岳[1] 冯恩志[1] 闫自强[1] 殷和[1] 张瑛[1] 黄宁侠[1] 陈宗茹[1] 种银侠[1] 

机构地区：[1]解放军第四医院兰州军区呼吸内科中心,青海西宁810007

出　　处：《中华肺部疾病杂志（电子版）》2013年第1期20-24,共5页Chinese Journal of Lung Diseases(Electronic Edition)

基　　金：青海省应用基础研究资助项目(2011-Z-710)

摘　　要：目的探讨高原慢性阻塞性肺疾病急性加重期(AECOPD)合并慢性肺心病(CCP)患者抗氧化治疗措施。方法将126例高原(海拔2260～3500 m)AECOPD合并CCP患者随机分为红景天治疗组(A组)、氨溴索治疗组(B组)和对照组(C组),每组42例。3组患者均给予抗感染、祛痰、平喘、吸氧等常规治疗。在常规治疗基础上,A组给予口服藏药红景天胶囊,每次2.0 g,3次/d,共28 d;B组给予盐酸氨溴索30 mg静脉滴注,2次/d,共28 d。C组仅给予常规治疗。3组均在治疗前和治疗28 d后,分别测血清8-异前列腺素F2α(8-iso-PGF2α)、超氧化物歧化酶(SOD)、还原型谷胱甘肽(GSH)、丙二醛(MDA)、总抗氧化能力(T-AOC)、1 s用力呼气容积占预计值百分比(FEV1%pred)、FEV1与用力肺活量比值(FEV1/FVC)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)。结果治疗前,3组间血清8-iso-PGF2α、SOD、GSH、MDA、T-AOC水平、FEV1%pred、FEV1/FVC、PaO2、PaCO2差异无显著性(均P>0.05)。治疗后,3组血清8-iso PGF2α、MDA水平、PaCO2较治疗前显著降低(均P<0.01),SOD、GSH、T-AOC水平、FEV1%pred、FEV1/FVC、PaO2较治疗前显著升高(均P<0.01);A组和B组各项指标与对照组比较差异均有统计学意义,且A组各项指标均较B组为优(8-iso-PGF2α:6.21±1.42比8.62±1.45,SOD:89.56±7.61比79.33±7.25,GSH:42.76±4.52比35.26±4.22,MDA:5.26±1.52比7.33±1.68,T-AOC:24.60±3.46比21.67±2.78,FEV1%pred:44.33±6.05比39.84±5.88,FEV1/FVC:47.85±5.36比43.78±5.04,PaO2:53.81±5.60比48.58±5.47,PaCO2:42.82±5.18比47.67±5.54,均P<0.01)。126例患者治疗前,血清8-iso-PGF2α、MDA与FEV1%pred、FEV1/FVC、PaO2呈显著负相关(分别r=-0.754、-0.788、-0.812和-0.777、-0.654、-0.752,均P<0.01),与PaCO2呈显著正相关(分别r=0.726、0.685,均P<0.01),SOD、GSH、T-AOC与FEV1%pred、FEV1/FVC、PaO2呈显著正相关(分别r=0.685、0.716、0.733,0.805、0.746、0.657和0.635、0.702、0.733,均P<0.01),与PaCO2呈显著负相关(r=-0.716、-803、-0.752,均PObjective To investigate the antioxidant effectiveness of rhodioside and ambroxol in patients with chronic obstructive pulmonary disease in acute exacerbation （AECOPD） complicated chronic cot pulmonale （CCP） at high altitude area. Methods Designed with random digits table method, 126 patients with AECOPD and CCP were randomly divided into 3 groups with 42 cases in each：a rhodioside treated groups （ group A）, a ambroxol treated group （ group B ） and control group （ group C ）. All patients in 3 groups received routine treatment of anti-infection, expectorant, antiasthma, and oxygen therapy. Each patient in group A received 2.0 g of rhodioside orally, three times daily, in group B received 30 mg of ambroxol intravenously, two daily, and in group C received routine treatment for 28 days. Level of serum 8-iso- prostaglandinF2~ （ 8-iso-PGF2α ）, superoxidedismutase （ SOD）, reducedglutathione （ GSH ）, malondialdehyde （MDA）, total antioxidant apacity （T-AOC）, forced expiratory volume in one second/ predicated value, FEV1% pred）, FEV1/forced vital capacity（FEVJFVC ）, PaO2 and PaCO2 were measured before and 28th day after treatment. Results Before treatment, level of serum 8-iso-PGF2α, SOD, GSH, MDA, T-AOC, FEV1% pred, FEV1/FVC, PaO2 , PaCO2 showed no significantly difference among 3 groups （ all P 〉 0.05 ）. After treatment compared with before treatment in 3 groups, level of serum 8-iso PGF2α, MDA, and PaCO2 were significantly decreased （all P 〈 0.01） , SOD, GSH, T-AOC, FEV1% pred, FEV1/FVC, PaO2 were significantly increased （all P 〈 0. 01 ）. All parameters in group A and group B have significant difference compared with control group After treatment, which improved more in group A than group B （ 8-iso-PGF2α ： 6.21 ± 1.42 vs 8.62 ± 1.45, SOD：89.56 ± 7.61 vs 79.33 ± 7.25, GSH：42.76 ±4.52 vs 35.26 ±4.22, MDA：5.26 ± 1.52 vs 7.33 ± 1.68, T-AOC ：24.60 ± 3.46 vs 21.67 ± 2.78, FEV1 % pred：44.33 ± 6.05 vs 39.84 ± 5.88, FEVI/FVC ：47.85

关 键 词：肺疾病 慢性阻塞性 肺心病 抗氧化 红景天 氨溴索 高原地区 

分 类 号：R563[医药卫生—呼吸系统]