N-乙酰半胱氨酸治疗慢性阻塞性肺疾病急性加重期的效果及对患者氧化应激的影响  

Efficacy of N-acetylcysteine in the treatment of acute exacerbation of chronic obstructive pulmonary disease and its effect on oxidative stress for patients

作　　者：王静[1] 苗姝[1] WANG Jing;MIAO Shu.(Department of Respiratory Medicine, the Xinhua Hospital Affiliated to Dalian University, Dalian 116021, Liaoning, CHINA)

机构地区：[1]大连大学附属新华医院呼吸内科,辽宁大连116021

出　　处：《海南医学》2018年第8期1051-1054,共4页Hainan Medical Journal

基　　金：辽宁省大连市科技项目(编号:2016-68)

摘　　要：目的观察N-乙酰半胱氨酸治疗慢性阻塞性肺疾病急性加重期(AECOPD)的效果,并探讨其对患者氧化应激的影响。方法选取2015年1月至2016年12月期间大连大学附属新华医院呼吸内科收治的AECOPD患者100例,采用随机数表法分为观察组51例和对照组49例。对照组患者给予休息、控制性氧疗、抗感染、支气管扩张剂、糖皮质激素、营养、机械通气、祛痰及其他必要的对症支持治疗;观察组患者则在对照组常规对症治疗的基础之上加用N-乙酰半胱氨酸的临床药物治疗。2周为一个疗程,连续治疗2个疗程后比较两组患者的临床疗效、超氧化物歧化酶(SOD)和丙二醛(MDA)水平、1 s用力呼气容积占预计值的百分比(FEV1)和1 s用力呼气容积占用力肺活量百分比(FEV1/FVC)、白介素-6(IL-6)、白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)等指标。结果观察组患者的临床治疗显效率为70.59%,总有效率为96.08%,明显高于对照组的51.02%和81.63%,差异均有统计学意义(P<0.05);观察组患者治疗后氧化应激指标SOD为(90.54±10.02)IU/m L,明显高于对照组的(83.06±9.37)IU/m L,而MDA为(3.47±0.42)nmol/m L,明显低于对照组的(4.02±0.50)nmol/m L,差异均有统计学意义(P<0.05);观察组患者治疗后肺功能指标FEV1和FEV1/FVC分别为(64.97±7.85)%和(58.78±6.74)%,明显高于对照组的(59.23±6.92)%和(53.06±6.45)%,差异均有统计学意义(P<0.05);观察组患者治疗后炎症因子IL-6[(23.67±3.44)ng/L]、IL-8[(0.32±0.03)μg/L]、TNF-α[(19.88±2.65)ng/L]水平均明显低于对照组[(30.98±4.82)ng/L、(0.41±0.05)μg/L、(26.05±3.74)ng/L],差异均有统计学意义(P<0.05)。结论 N-乙酰半胱氨酸对AECOPD患者临床疗效的提升,氧化应激反应的缓解,肺功能及免疫功能的改善均呈现出积极的促进作用。Objective To observation the efficacy of N-acetylcysteine in the treatment of acute exacerba-tion of chronic obstructive pulmonary disease （AECOPD）, and to probe into the effect on oxidative stress for pa-tients. Methods From January 2015 to December 2016, 100 patients with AECOPD were selected from Depart-ment of Respiratory Medicine of the Xinhua Hospital Affiliated to Dalian University. The patients were divided into theobservation group （51 cases） and the control group （49 cases） by random number table method. The patients in the con-trol group were treated with necessary symptomatic supportive treatment, including rest, controlled oxygen therapy, an-ti-infection, bronchodilator, glucocorticoid, nutrition, mechanical ventilation, and expectorant. The patients in the obser-vation group were treated with N-acetylcysteine on the basis of routine symptomatic treatment in the control group. Aftercontinuous treatment of two courses, with two weeks for a course of treatment, the clinical treatment, changes of oxida-tive stress, superoxide dismutase [SOD] and malondialdehyde [MDA], changes of pulmonary function, （1 s forced expi-ratory volume as a percentage of predicted value [FEV1] and 1 s forced expiratory volume occupancy force vital capaci-ty [FEV1/FVC]）, changes of inflammatory factors （interleukin-6 [IL-6], interleukin-8 [IL-8], tumor necrosis factor-α[TNF-α]） of the patients in two groups were compared and analyzed. Results For the patients in the observationgroup, the effective rate of clinical treatment and the total effective rate were respectively 70.59% and 96.08%, whichwere significantly higher than corresponding 51.02% and 81.63% in the control group （P〈0.05）. After the treatment, theoxidation index of SOD in the observation group was （90.54±10.02） IU/mL, which was significantly higher than （83.06±9.37） IU/mL of the control group, and the MDA was （3.47±0.42） nmol/mL, which was significantly lower than （4.02±0.50） nmol/mL of the control group （all P〈0.

关 键 词：慢性阻塞性肺疾病 N-乙酰半胱氨酸 氧化应激 疗效 

分 类 号：R563[医药卫生—呼吸系统]