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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2019, Vol. 12 ›› Issue (06) : 738 -742. doi: 10.3877/cma.j.issn.1674-6902.2019.06.014

论著

乙酰半胱氨酸+甲基强的松龙对IIP患者血气指标、肺功能及血清炎症因子的影响
曹路1, 高宝安1,†(), 官莉1, 陈世雄1   
  1. 1. 443000　宜昌，三峡大学呼吸疾病研究所·宜昌市中心人民医院呼吸与危重症医学科
  • 收稿日期:2019-06-17 出版日期:2019-12-20
  • 通信作者: 高宝安

Effects of acetylcysteine tablets combined with methylprednisolone on blood gas indexes, pulmonary function and serum inflammatory factors in patients with idiopathic interstitial pneumonia

Lu Cao1, Baoan Gao1,†(), Li Guan1, Shixiong Chen1   

  1. 1. Department of Respiratory and Critical Care Medicine, Yichang Central People′s Hospital/Institute of Respiratory Diseases, Three Gorges University, Yichang 443000, China
  • Received:2019-06-17 Published:2019-12-20
  • Corresponding author: Baoan Gao
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曹路, 高宝安, 官莉, 陈世雄. 乙酰半胱氨酸+甲基强的松龙对IIP患者血气指标、肺功能及血清炎症因子的影响[J/OL]. 中华肺部疾病杂志(电子版), 2019, 12(06): 738-742.

Lu Cao, Baoan Gao, Li Guan, Shixiong Chen. Effects of acetylcysteine tablets combined with methylprednisolone on blood gas indexes, pulmonary function and serum inflammatory factors in patients with idiopathic interstitial pneumonia[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2019, 12(06): 738-742.

目的

探讨乙酰半胱氨酸+甲基强的松龙对特发性间质性肺炎(IIP)患者血气指标、肺功能及血清炎症因子的影响。

方法

选择宜昌市中心人民医院呼吸与危重症医学科收治的80例IIP患者随机分为观察组(42例)、对照组(38例)，对照组采用常规对症治疗+甲基强的松龙抗炎，观察组在对照组基础上加用乙酰半胱氨酸片治疗；测定各组治疗前，治疗1周，治疗2周后的临床疗效、血气指标[动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)]、肺功能[用力肺活量(FVC)、一氧化碳弥散量与肺泡通气量比值(DLCO/VA)、第1 s用力呼气容积占预计值百分比(FEV1%)]、血清转化生长因子-β(TGF-β)、血管内皮生长因子(VEGF)、超敏C反应蛋白(hs-CRP)水平与不良反应。

结果

观察组治疗有效率为85.00%，明显高于对照组65.00%(P<0.05)；治疗1周、2周后两组PaO2均高于治疗前，而PaCO2低于治疗前，且观察组治疗1周、2周后PaO2较对照组高，PaCO2较对照组低(P<0.05)；观察组治疗后FVC、DLCO/VA、FEV1%高于对照组(P<0.05)；观察组治疗后血清TGF-β、VEGF、hs-CRP水平明显低于对照组(P<0.01)；两组不良反应发生率比较差异无统计学意义(P>0.05)。

结论

乙酰半胱氨酸片+甲基强的松龙治疗IIP疗效优于单用甲基强的松龙，可明显改善患者血气分析、肺功能，抑制肺纤维化，值得在临床推广实践。

关键词: 乙酰半胱氨酸片, 甲基强的松龙, 特发性间质性肺炎, 血气分析, 肺功能, HRCT
Objective

To analyze the effects of acetylcysteine tablets combined with methylprednisolone on blood gas indexes, pulmonary function and serum inflammatory factors in the patients with idiopathic interstitial pneumonia (IIP).

Methods

A total of 80 patients with IIP who were admitted to the Department of Respiratory and Critical Care Medicine, Yichang Central People′s Hospital, were randomly divided into an observation group (n=42) and a control group (n=38). The control group received routine symptomatic treatment and anti-inflammatory treatment with methylprednisolone. On this basis, the observation group received an additional treatment of acetylcysteine tablets. At two weeks after treatment, the clinical curative effect, the blood gas indexes [the arterial partial pressure of oxygen (PaO2) and the arterial partial pressure of carbon dioxide (PaCO2)], the lung functions [the forced vital capacity (FVC), the ratio of diffusing capacity of carbonic oxide and the alveolar volume (DLCO/VA), and the percentage of forced expiratory volume in one second in the predicted value (FEV1%)], the levels of serum transforming growth factor-β (TGF-β), the vascular endothelial growth factor (VEGF), and the high-sensitivity C-reactive protein (hs-CRP), and the adverse reactions were observed.

Results

The effective rate of the observation group was significantly higher than that of the control group (85.00% vs. 65.00%, P<0.05). The PaO2 was increased in both groups after 1 week and 2 weeks of treatment, while the PaCO2 was decreased. The PaO2 was higher in the observation group than the control group after 1 week and 2 weeks of treatment, while the PaCO2 was lower in the observation group than the control group (P<0.05). The FVC, DLCO/VA and FEV1% were higher in the observation group than the control group (P<0.05). After treatment, the levels of serum TGF-β, VEGF and hs-CRP in the observation group were significantly lower than those of the control group (P<0.01). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05).

Conclusion

The curative effect of acetylcysteine tablets combined with methylprednisolone is better than that of methylprednisolone alone on IIP, which can significantly improve the blood gas indexes and the pulmonary function and inhibit pulmonary fibrosis.

Key words: Acetylcysteine tablets, Methylprednisolone, Idiopathic interstitial pneumonia, Blood gas analysis, Pulmonary function, HRCT
表1 两组血气分析指标变化比较
组　别 例数 治疗前 治疗1周 治疗2周 F值 P值
PaO2(mmHg)            
  观察组 42 43.57±4.48 54.12±5.61a 70.64±7.18a 261.693 <0.001
  对照组 38 44.01±4.46 48.69±4.92a 60.59±6.13a 107.355 <0.001
  t值   0.440 4.602 6.733    
  P值   0.661 0.000 0.000    
组　别 例数 治疗前 治疗1周 治疗2周 F值 P值
PaCO2(mmHg)            
  观察组 42 41.26±4.28 37.10±3.85a 34.45±3.52a 31.057 <0.001
  对照组 38 41.54±4.23 39.06±4.10a 37.19±3.86a 11.520 <0.001
  t值   0.294 2.204 3.317    
  P值   0.769 0.030 0.001    
表2 两组肺功能变化比较
组　别 例数 FVC(L) DLCO/VA(%) FEV1%(%)
治疗前 治疗后 治疗前 治疗后 治疗前 治疗后
观察组 42 60.45±6.18 76.20±7.71a 62.48±6.35 70.41±7.10a 64.25±6.80 70.67±7.15a
对照组 38 60.29±6.23 65.32±6.68a 61.96±6.48 64.99±6.37a 64.19±6.85 67.49±6.83a
t值   0.115 6.745 0.362 3.594 0.039 2.034
P值   0.908 0.000 0.718 0.000 0.969 0.045
表3 两组血清炎症因子水平比较
组　别 例数 TGF-β(ng/L) VEGF(ng/L) hs-CRP(mg/L)
治疗前 治疗后 治疗前 治疗后 治疗前 治疗后
观察组 42 0.54±0.06 0.34±0.05a 420.59±43.11 276.54±28.59a 7.03±0.73 2.87±0.31a
对照组 38 0.53±0.05 0.42±0.06a 421.65±42.87 317.44±32.68a 6.95±0.71 4.10±0.46a
t值   0.810 6.478 0.110 5.957 0.497 14.024
P值   0.420 0.000 0.912 0.000 0.621 0.000
1
Yamakawa H, Hagiwara E, Kitamura H, et al. Clinical Features of Idiopathic Interstitial Pneumonia with Systemic Sclerosis-Related Autoantibody in Comparison with Interstitial Pneumonia with Systemic Sclerosis[J]. PLoS One, 2016, 11(8): e0161908.
2
Lee HE, Myong JP, Kim HR, et al. Incidence and prevalence of idiopathic interstitial pneumonia and idiopathic pulmonary fibrosis in Korea[J]. Int J Tuberc Lung Dis, 2016, 20(7): 978-984.
3
蒋小惠. 糖皮质激素治疗特发性间质性肺炎的疗效观察及护理[J/CD]. 中华肺部疾病杂志(电子版), 2015, 8(4): 110-111.
4
曾凡洪，欧阳刚，陈　章，等. N-乙酰半胱氨酸联合甲基强的松龙治疗放射性肺损伤临床研究[J]. 西部医学，2015, 27(2): 262-264.
5
黄　慧，李　珊，徐作军，等. 特发性间质性肺炎国际多学科分类新标准(摘译)——美国胸科学会/欧洲呼吸病学会官方共识[J]. 中华结核和呼吸杂志，2014, 37(9): 648-651.
6
Margaritopoulos GA, Harari S, Caminati A, et al. Smoking-related idiopathic interstitial pneumonia: A review[J]. Respirology, 2016, 21(1): 57-64.
7
Kobayashi S, Karube Y, Nishihira M, et al. Postoperative pyothorax a risk factor for acute exacerbation of idiopathic interstitial pneumonia following lung cancer resection[J]. Gen Thorac Cardiovasc Surg, 2016, 64(8): 476-480.
8
钟春蕾，张志强. 糖皮质激素联合N-乙酰半胱氨酸、大环内酯类治疗特发性肺纤维化[J]. 实用医学杂志，2017, 33(3): 501-502.
9
鲍志坚. 乙酰半胱氨酸联合糖皮质激素对重度哮喘患者免疫功能及炎性因子的影响[J]. 中华全科医学，2017, 15(8): 1429-1432.
10
熊　方，林洁如，叶贤伟，等. N-乙酰半胱氨酸联合糖皮质激素治疗特发性肺纤维化41例临床分析[J]. 贵州医药，2015, 39(1): 30-31.
11
鞠善良，李　超，王在义，等. N-乙酰半胱氨酸联合小剂量糖皮质激素治疗特发性肺间质纤维化疗效的Meta分析[J]. 中国循证医学杂志，2013, 13(6): 717-722.
12
Martínez-Montiel O, Valencia-Martinez G, Blanco-Bucio P, et al. Treatment of elbow epicondylitis with platelet rich plasma versus local corticosteroids[J]. Acta Ortop Mex, 2015, 29(3): 155-158.
13
蒋小民. 乙酰半胱氨酸联合甲基强的松龙治疗特发性间质性肺炎的临床研究[D]. 广西中医药大学，2015.
14
徐　虹，卢慧宇. 糖皮质激素、硫唑嘌呤联合乙酰半胱氨酸治疗特发性间质性肺炎的效果[J]. 广东医学，2016, 37(16): 2492-2493.
15
赵丽琴. 乙酰半胱氨酸对特发性间质性肺炎患者血气分析的影响[J]. 基因组学与应用生物学，2017, 36(8): 3374-3378.
16
Gupta SK, Kamendulis LM, Clauss MA, et al. A randomized, placebo-controlled pilot trial of N-acetylcysteine on oxidative stress and endothelial function in HIV-infected older adults receiving antiretroviral treatment[J]. AIDS, 2016, 30(15): 2389-2391.
17
阳　俊，胡　克. 低分子肝素联合乙酰半胱氨酸治疗特发性间质性肺炎的临床疗效评价[J]. 临床和实验医学杂志，2015, 14(6): 438-442.
18
陈珊珊，李华敏，陈建寿，等. 大剂量N-乙酰半胱氨酸联合糖皮质激素治疗慢性阻塞性肺疾病并肺间质纤维化的临床疗效[J]. 实用心脑肺血管病杂志，2017, 25(3): 97-100.
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