N-乙酰半胱氨酸治疗肺癌合并慢性阻塞性肺疾病的疗效观察  

Efficacy observation of N-acetylcysteine in the treatment of lung cancer complicated with chronic obstructive pulmonary disease

作　　者：刘颖[1] 曾宪红[1] 王玉红[1] Liu Ying;Zeng Xianhong;Wang Yuhong(Department of Respiratory and Critical Care Medicine,Beijing Tongren Hospital,Capital Medical University,Beijing 100005,China)

机构地区：[1]首都医科大学附属北京同仁医院呼吸与危重症医学科,100005

出　　处：《北京医学》2022年第12期1092-1097,共6页Beijing Medical Journal

基　　金：北京市医卫健康公益基金会(GXYB-005)。

摘　　要：目的探讨N-乙酰半胱氨酸(N-acetylcysteine,NAC)对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并肺癌患者的治疗效果及生活质量的影响。方法选取2016年10月至2020年11月首都医科大学附属北京同仁医院收治的COPD合并肺癌患者400例,按照动态随机法分为常规组和NAC组,每组200例。常规组采用常规疗法,给予吸氧、抗炎、化痰平喘治疗,适当予以机械通气,制订功能康复锻炼计划并督促执行;NAC组采用常规疗法联合NAC治疗。统计分析两组患者的血气指标、疗效、肺功能、细胞免疫功能、不良反应及生活质量。结果治疗后,两组CAT评分和PaCO_(2)值较治疗前明显下降,PaO_(2)值较治疗前明显升高,差异均有统计学意义(P<0.05);NAC组治疗后的CAT评分和PaCO_(2)值显著低于常规组[(20.13±4.02)分比(24.35±3.13)分、(36.17±5.78)mmHg比(41.84±7.39)mmHg,1 mmHg=0.133 kPa],PaO_(2)值高于常规组[(89.76±5.47)mmHg比(74.36±5.24)mmHg],差异均有统计学意义(P<0.01)。治疗后,两组用力肺活量(forced vital capacity,FVC)、第1秒用力呼气容积(forced expiratory volume in first second,FEV1)及FEV1/FVC均较治疗前明显升高,差异有统计学意义(P<0.05);NAC组治疗后的FVC、FEV1及FEV1/FVC均明显高于常规组[(3.86±0.77)L比(3.13±0.83)L、(2.19±0.37)L比(1.65±0.55)L、(60.11±3.55)%比(55.14±3.24)%],差异有统计学意义(P<0.01)。治疗后,两组CD3^(+)、CD4^(+)和CD4^(+)/CD8^(+)均较治疗前明显升高,CD8^(+)较治疗前明显降低,差异有统计学意义(P<0.05);NAC组治疗后的CD3^(+)、CD4^(+)和CD4^(+)/CD8^(+)明显高于常规组[(65.07±4.55)%比(62.03±4.91)%、(39.75±3.94)%比(35.44±3.37)%、(1.66±0.15)比(1.28±0.13)],CD8^(+)明显低于常规组[(28.15±2.42)%比(33.17±2.44)%],差异均有统计学意义(P<0.01)。治疗后,两组36项健康调查简表(short form 36 health survey questionnaire,SF-36)各项评分均较治疗前明显升高,差异有统计学意义(P<0.05);NAC组Objective To investigate the clinical effect of N-acetylcysteine(NAC)on patients with chronic obstructive pulmonary disease(COPD)complicated with lung cancer.Methods A total of 400 patients with COPD and lung cancer who were admitted to Beijing Tongren Hospital,Capital Medical University from October 2016 to November 2020 were selected,and were divided into conventional group and NAC group according to the dvnaimc randomization method,with 200 cases in each group.The conventional group was treated with conventional therapy,including oxygen inhalation,anti-inflammation,phlegm-reducing and asthma-relieving treatment,and appropriate mechanical ventilation,formulate functional rehabilitation exercise plan and supervise its implementation.NAC group was treated with conventional therapy combined with NAC.The blood gas indexes,curative effect,lung function,cellular immune function,adverse reactions and quality of life of the two groups were statistically analyzed.Results After treatment,the CAT score and PaCO_(2)value of the two groups decreased significantly compared with that before treatment,and the PaO_(2)value increased significantly compared with that before treatment,the differences were statistically significant(P<0.05).After treatment,the CAT score and PaCO_(2)value in NAC group were significantly lower than those in conventional group[(20.13±4.02)score vs.(24.35±3.13)score,(36.17±5.78)mmHg vs.(41.84±7.39)mmHg,1 mmHg=0.133 kPa],and the PaO_(2)value was higher than that in conventional group[(89.76±5.47)mmHg vs.(74.36±5.24)mmHg],the differences were statistically significant(P<0.01).After treatment,the forced vital capacity(FVC),forced expiratory volume in first second(FEV1)and FEV1/FVC in the two groups were significantly higher than those before treatment(P<0.05).After treatment,the FVC,FEV1and FEV1/FVC in NAC group were significantly higher than those in conventional group[(3.86±0.77)L vs.(3.13±0.83)L,(2.19±0.37)L vs.(1.65±0.55)L,(60.11±3.55)%vs.(55.14±3.24)%],the differences were statistically si

关 键 词：慢性阻塞性肺疾病 肺癌 N-乙酰半胱氨酸 肺功能 细胞免疫 

分 类 号：R563.9[医药卫生—呼吸系统] R734.2[医药卫生—内科学]