慢性阻塞性肺疾病患者应用异丙托溴铵联合乙酰半胱氨酸治疗前后血清中TGF-β和MMP-9水平的变化及其临床意义  

Changes of serum TGF-β and MMP-9 levels in patients with chronic obstructive pulmonary disease after treated with ipratropium bromide combined with N-acety-L-cysteine and their clinical significances

作　　者：亓慧琴 张连莲[2] 邢利平[1] 孙璐瑶[3] 刘颖[1] 于振香[1] 

机构地区：[1]吉林大学第一医院呼吸内科,吉林长春130021 [2]吉林大学第四医院呼吸内科,吉林长春130011 [3]吉林大学第一医院感染症科,吉林长春130021

出　　处：《吉林大学学报（医学版）》2016年第4期777-782,共6页Journal of Jilin University：Medicine Edition

基　　金：吉林省发改委科研基金资助课题(2010021-3);吉林省卫计委科研基金资助课题(2011S006)

摘　　要：目的:研究异丙托溴铵联合乙酰半胱氨酸(NAC)对慢性阻塞性肺疾病(COPD)稳定期患者血清中转化生长因子(TGF-β)和基质金属蛋白酶9(MMP-9)水平的影响,探讨其对COPD患者气道重塑的作用。方法:COPD稳定期患者80例,随机分为NAC组(27例)、异丙托溴铵组(27例)和NAC与异丙托溴铵联合用药组(26例),同时选取健康志愿者26人做为对照组。监测各组患者治疗前后症状和体征评分及肺功能指标[用力肺活量(FVC)、第1秒钟用力呼气容积(FEV1)、第1秒钟用力呼气容积占预计值的百分比(FEV1%)及第1秒钟用力呼气容积占用力肺活量的百分比(FEV1/FVC)],检测各组患者血清中TGF-β和MMP-9水平,FEV1值与血清中TGF-β和MMP-9水平的相关性采用Spearman相关分析。结果:与治疗前比较,治疗后各用药组患者症状和体征评分均明显降低(P<0.05);与NAC组和异丙托溴铵组比较,联合用药组患者治疗后症状和体征评分降低更明显(P<0.05)。与治疗前比较,治疗后各用药组患者肺功能指标明显改善(P<0.05);与NAC组和异丙托溴铵组比较,联合用药组患者肺功能指标改善更明显(P<0.05)。与对照组比较,治疗前后各用药组患者血清中TGF-β和MMP-9水平均明显升高(P<0.05);与治疗前比较,治疗后各用药组患者血清中TGF-β和MMP-9水平均明显降低(P<0.05);与NAC组和异丙托溴铵组比较,联合用药组患者血清中TGF-β和MMP-9水平降低更明显(P<0.05)。联合用药组患者治疗前后FEV1值与血清中TGF-β和MMP-9水平呈负相关关系(治疗前:r=-0.554,r=-0.477,均P<0.05;治疗后:r=-0.415,r=-0.654,均P<0.05)。结论:异丙托溴铵联合NAC治疗可明显改善COPD患者症状、体征及肺功能,降低血清中TGF-β和MMP-9水平,在一定程度上抑制气道重塑。Objective：To study the influence of ipratropium bromide combined with N-acety-L-cysteine（NAC）in the serum MMP-9and TGF-βlevels of the patients with chronic obstructive pulmonary disease（COPD）in stable phase,and to discuss the role in airway remodeling of the COPD patients.Methods：Eighty patients with COPD in stable phase were randomly divided into NAC group（n=27）,ipratropium bromide group（n=27）,and combination group（n=26）.26 cases of healthy volunteers were selected as control group.The clinical symptom and physical sign scores and the lung function indexes（FVC,FEV1,FEV1%,and FEV1/FVC）were monitored and the serum TGF-βand MMP-9levels of the patients in various groups were detected before and after treatment.The relationships between the value of FEV1 and the serum TGF-βand MMP-9 were analyzed with Spearman analysis.Results：Compared with before treatment,the symptom and physical sign scores of the patients in various treatment groups after treatment were significantly decreased（P〈0.05）;compared with NAC group and ipratropium bromide group,the symptom and physical sign scores of the patients in combination group after treatment were significantly decreased（P〈0.05）.Compared with before treatment,the lung function indexes of the patients in various treatment groups after treatment were improved（P〈0.05）;compared with NAC group and ipratropium bromide group,the lung function indexes of the patients in combination group after treatment were significantly improved（P〈0.05）.Compared with control group,the serum TGF-βand MMP-9levels of the patients in various treatment groups before and after treatment were significantly decreased（P〈0.05）;compared with NAC group and ipratropium bromide group,the serum TGF-βand MMP-9levels of the patients in combintion group were significantly decreased（P〈0.05）.The FEV1 values of the patients in combination group had negative correlations with the serum TGF-βand MMP-9levels before and after treatment（before：r=-0.554,

关 键 词：慢性阻塞性肺疾病 异丙托溴铵 乙酰半胱氨酸 转化生长因子 基质金属蛋白酶 

分 类 号：R563[医药卫生—呼吸系统]