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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) ›› 2020, Vol. 13 ›› Issue (02) : 174 -178. doi: 10.3877/cma.j.issn.1674-6902.2020.02.010

论著

乙酰半胱氨酸辅助治疗慢性阻塞性肺疾病急性加重期的临床分析
刘娜1, 赵然然2,†()   
  1. 1. 100013　北京，北京市东城区和平里医院呼吸科
    2. 100050　北京，北京友谊医院　呼吸内科
  • 收稿日期:2020-01-03 出版日期:2020-04-25
  • 通信作者: 赵然然
  • 基金资助:
    2018年北京市卫生科技项目(项目编号卫计研[2018]-21)

Effects of acetylcysteine adjuvant therapy on AECOPD and its influence on airway remodeling, oxidative stress status and levels of serum SP-A, SP-D and CC16

Na Liu1, Ranran Zhao2,†()   

  1. 1. Department of Respiratory, Beijing Hepingli hospital, Beijing 100013, China
    2. Beijing Friendship Hospital, Respiratory Medicine Department, Beijing 100050, China
  • Received:2020-01-03 Published:2020-04-25
  • Corresponding author: Ranran Zhao
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引用本文：

刘娜, 赵然然. 乙酰半胱氨酸辅助治疗慢性阻塞性肺疾病急性加重期的临床分析[J]. 中华肺部疾病杂志(电子版), 2020, 13(02): 174-178.

Na Liu, Ranran Zhao. Effects of acetylcysteine adjuvant therapy on AECOPD and its influence on airway remodeling, oxidative stress status and levels of serum SP-A, SP-D and CC16[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2020, 13(02): 174-178.

目的

探讨乙酰半胱氨酸辅助治疗慢性阻塞性肺疾病急性加重期(AECOPD)的临床效果及对患者气道重塑、氧化应激及血清肺表面活性蛋白-A(SP-A)、肺表面活性蛋白-D(SP-D)、克拉拉细胞蛋白(CC16)水平的影响。

方法

选择医院收治的94例AECOPD患者随机分为对照组与观察组各47例，对照组给予AECOPD基础治疗，观察组采用乙酰半胱氨酸辅助治疗，评定两组疗效，测定治疗前后两组气道重塑指标[气道壁厚度与气道管腔外径比(T/D)、气道腔面积(AI)、气道壁面积(WA)、WA占总截面积百分比(WA%)]、氧化应激指标[超氧化物歧化酶(SOD)、丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-PX)]及血清肺表面生化标志物(SP-A、SP-D、CC16)水平的变化，记录治疗不良反应。

结果

①观察组总有效率高于对照组(87.23% vs. 70.21%)(P<0.05)；②治疗前，两组气道重塑相关指标、氧化应激指标及血清生化标志物水平对比差异无统计学意义(P>0.05)，治疗4周，两组T/D、WA、WA%、MDA、SP-A、SP-D、CC16降低，AI、GSH-PX、SOD上升，观察组T/D、WA、WA%、MDA、SP-A、SP-D、CC16低于对照组，AI、GSH-PX、SOD高于对照组(P<0.05)；③两组治疗不良反应发生率比较差异无统计学意义(6.38% vs. 4.26%)(P>0.05)。

结论

AECOPD患者辅助应用乙酰半胱氨酸治疗可提升疗效，改善气道重塑及氧化应激状态，降低血清SP-A、SP-D、CC16水平，且安全性肯定。

关键词: 肺疾病, 慢性阻塞性, 急性加重期, N-乙酰半胱氨酸, 氧化应激, 气道重塑, 肺表面活性蛋白
Objective

To explore the effects of acetylcysteine adjuvant therapy on the acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and its influence on airway remodeling, oxidative stress and the levels of serum pulmonary surfactant protein-A (SP-A), pulmonary surfactant protein-D (SP-D) and Clara cell protein (CC16).

Methods

A total of 94 patients with AECOPD admitted to our hospital were randomly divided into a control group and an observation group, with 47 cases in each group. The patients in the control group received the basic treatment for AECOPD, and the patients in the observation group received the basic treatment for AECOPD and acetylcysteine adjuvant therapy. Then the efficacies of the two groups were evaluated and compared. The airway remodeling indexes including the ratio of the airway wall thickness to the airway lumen outer diameter (T/D), the airway lumen area (AI), the airway wall area (WA), and the percentage of WA in the total cross-sectional area (WA%), the oxidative stress indicators including superoxide dismutase (SOD), malondialdehyde (MDA), glutathione peroxidase (GSH-PX), and the serum lung surface biochemical markers including SP-A, SP-D and CC16 were measured before and after treatment. And the adverse treatment reactions were recorded.

Results

The total effective rate in the observation group was higher than that of the control group (87.23% vs. 70.21%, P<0.05). Before treatment, there were no statistically significant differences in the airway remodeling-related indexes, the oxidative stress indexes and the serum biochemical markers between the two groups (P>0.05). At 4 weeks of treatment, the T/D, WA, WA%, MDA, SP-A, SP-D and CC16 decreased in the two groups while the AI, GSH-PX and SOD increased. And the T/D, WA, WA%, MDA, SP-A, SP-D and CC16 in the observation group were lower than those of the control group while the AI, GSH-PX and SOD were higher than those of the control group (P<0.05). There was no statistical significant difference in the incidence rate of the adverse reactions between the two groups (6.38% vs. 4.26%, P>0.05).

Conclusion

Acetylcysteine adjuvant therapy for the AECOPD patients can improve the treatment efficacy, enhance the airway remodeling and the oxidative stress status, and reduce the levels of serum SP-A, SP-D and CC16, and it has positive safety.

Key words: Chronic obstructive pulmonary disease, Acute exacerbation, N-acetylcysteine, Oxidative stress, Airway remodeling, Pulmonary surfactant protein
表1 两组疗效对比[n(%)]
组　别 例数 显效 有效 无效 总有效率
观察组 47 18(38.30) 23(48.94) 6(12.77) 41(87.23)a
对照组 47 5(10.64) 28(59.57) 14(29.79) 33(70.21)
表2 两组治疗前后气道重塑相关指标对比(±s)
组　别 时间 T/D AI WA WA%
观察组 治疗前 0.27±0.04 14.71±2.23 27.11±5.22 70.31±7.96
  治疗4周 0.22±0.01ab 17.21±1.02ab 21.53±2.77ab 62.31±3.74ab
对照组 治疗前 0.27±0.05 14.72±2.21 27.13±5.34 70.29±7.96
  治疗4周 0.24±0.02a 16.17±0.52a 23.35±1.23a 65.02±4.01a
表3 两组治疗前后氧化应激指标比较(±s)
组　别 时间 MDA(mmol/L) GSH-PX(ng/L) SOD(U/L)
观察组 治疗前 8.17±2.15 140.42±26.78 65.11±10.79
  治疗4周 4.51±0.921ab 169.31±10.211ab 83.98±5.221ab
对照组 治疗前 8.19±2.17 141.14±27.66 65.13±11.02
  治疗4周 6.27±0.71a 153.44±9.72a 75.44±6.37a
表4 两组治疗前血清肺表面生化标志物水平比较(±s)
组　别 时间 SP-A(ng/ml) SP-D(ng/ml) CC16(pg/ml)
观察组 治疗前 2.55±0.34 2.67±0.99 0.61±0.07
  治疗4周 1.12±0.23ab 1.22±0.23ab 0.22±0.05ab
对照组 治疗前 2.54±0.35 2.69±0.97 0.62±0.06
  治疗4周 1.63±0.17a 1.72±0.16a 0.32±0.04a
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