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

doi:10.3877/cma.j.issn.1674-6902.2020.02.010

Abstract

Abstract:

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

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.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhfbjbzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6902.2020.02.010

https://zhfbjbzz.cma-cmc.com.cn/EN/Y2020/V13/I02/174

Figures/Tables 4

References 32

1	任成山，王关嵩，钱桂生. 慢性阻塞性肺疾病的成因及其治疗的困惑与希望[J/CD]. 中华肺部疾病杂志(电子版), 2019, 12(2): 127-141.
2	Lareau SC, Fahy B, Meek P, et al. Chronic obstructive pulmonary disease[J]. Am J Respir Crit Med, 2019, 199(1): P1-P2.
3	苗连海，董吉云，蔡后荣，等. N-乙酰半胱氨酸在老年慢性阻塞性肺疾病急性加重期治疗中应用[J]. 临床军医杂志，2018, 46(7): 800-802.
4	Wu W, Awab A, Metcalf JP. N-acetylcysteine protection in COPD: an alternative mechanism of action.[J]. Chest, 2014, 145(1): 193-194.
5	Hirai DM, Jones JH, Zelt JT, et al. Oral N-acetylcysteine and exercise tolerance in mild chronic obstructive pulmonary disease[J]. J Appl Physiol, 2017, 122(5): 1351-1361.
6	汪宏苗，唐　冬，李　刚. N-乙酰半胱氨酸雾化吸入治疗老年AECOPD患者的临床观察[J]. 临床肺科杂志，2017, 22(8): 1437-1439.
7	Taylor M, Bhagwandas K. N-acetylcysteine in trichotillomania: a panacea for compulsive skin disorders？[J]. Br J Dermatol, 2014, 171(5): 1253-1255.
8	郝文东，王国芳，张彩莲，等. N-乙酰半胱氨酸联合双水平气道正压通气治疗AECOPD合并Ⅱ型呼吸衰竭的疗效及作用机制研究[J]. 现代中西医结合杂志，2018, 27(7): 724-727.
9	Małgorzata Frankowska, Joanna Jastrzbska, Nowak E, et al. The effects of N-acetylcysteine on cocaine reward and seeking behaviors in a rat model of depression[J]. Behav Brain Res, 2014, 266(2): 108-118.
10	中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南(2013年修订版)[J]. 中华结核和呼吸杂志，2013, 36(4): 255-264.
11	Turkyilmaz S, Usta A, Cekic AB, et al. N-acetylcysteine amid reduces pancreatic damage in a rat model of acute necrotizing pancreatitis.[J]. J Surgl Res, 2016, 203(2): 383-389.
12	宁晶娜，吴艳玲，欧阳卿. N-乙酰半胱氨酸辅助治疗AECOPD的疗效及其对患者血清CRP的影响[J]. 海南医学，2017, 28(9): 1409-1410.
13	王　静，苗　姝. 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[J]. 海南医学，2018, 29(8): 1051-1054.
14	Jastrzbska J, Frankowska M, Filip M, et al. N-acetylcysteine amide (AD4) reduces cocaine-induced reinstatement[J]. Psychopharmacology, 2016, 233(18): 1-12.
15	秦　篙. 联合N-乙酰半胱氨酸对AECOPD患者的治疗效果[J]. 热带医学杂志，2016, 16(4): 483-485, 509.
16	He X, Wu X, Shi W, et al. Comparison of N-acetylcysteine and cysteine in their ability to replenish intracellular cysteine by a specific fluorescent probe[J]. Chem Commun, 2016, 52(60): 9410-9413.
17	王　峰，肖海励，王华启. N-乙酰半胱氨酸对慢性阻塞性肺疾病急性加重期患者的治疗效果及对氧化应激的影响[J]. 国际呼吸杂志，2017, 37(9): 659-662.
18	彭晓东，冼　倩，杨春兰，等. N-乙酰半胱氨酸对慢性阻塞性肺疾病大鼠炎症反应的抑制作用[J]. 中国老年学杂志，2018, 38(14): 3488-3490.
19	袁晓梅，李华旭，孙致远，等. N-乙酰半胱氨酸对慢性阻塞性肺疾病急性加重期患者肺功能及血清炎性因子的影响[J]. 新乡医学院学报，2018, 35(4): 306-309.
20	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.
21	陈一萍，赵丽敏. N-乙酰半胱氨酸治疗慢性阻塞性肺疾病机制研究[J]. 中国实用内科杂志，2016, 36(11): 1006-1008.
22	Vries ID. Recommendations for the paracetamol treatment nomogram and side effects of N-acetylcysteine[J]. Neth J Med, 2014, 72(5): 251-257.
23	王新杰，王　霞，尚　磊，等. 慢性阻塞性肺疾病患者血清Clara细胞分泌蛋白CC16和SP-D水平与肺功能的关系[J]. 标记免疫分析与临床，2016, 23(8): 870-873.
24	陈忠仁，秦　篙. SP-D、CCL18、CC16在慢性阻塞性肺疾病急性加重期血清和呼气冷凝液中的变化及临床价值[J]. 重庆医学，2015, 44(19): 2638-2640, 2643.
25	唐佳佳. N-乙酰半胱氨酸对慢性阻塞性肺疾病患者呼吸道病原菌抑制作用的影响因素分析[J]. 内科急危重症杂志，2017, 23(6): 495-497, 500.
26	Wang LL, Huang YH, Yan CY, et al. N-acetylcysteine ameliorates prostatitis via miR-141 regulating keap1/Nrf2 signaling[J]. Inflammation, 2016, 39(2): 938-947.
27	Manniello MD, Del GP, Aquino RP, et al. Clarithromycin and N-acetylcysteine co-spray-dried powders for pulmonary drug delivery: A focus on drug solubility[J]. Int J Pharm, 2017, 533(2): 463-469.
28	Chen CH, Young YH. N-acetylcysteine as a single therapy for sudden deafness[J]. Acta OtoLaryngol, 2016, 137(1): 58-62.
29	Hobbs BD, Jong KD, Lamontagne M, et al. Genetic loci associated with chronic obstructive pulmonary disease overlap with loci for lung function and pulmonary fibrosis[J]. Nat Gene, 2017, 49(3): 426-432.
30	Zhou Y, Zhong NS, Li X, et al. Tiotropium in early-stage chronic obstructive pulmonary disease[J]. N Engl J Med, 2017, 377(10): 923-935.
31	Bremmer DN, Disilvio BE, Hammer C, et al. Impact of procalcitonin guidance on management of adults hospitalized with chronic obstructive pulmonary disease exacerbations[J]. J Gen Intern Med, 2018, 33(3): 692-697.
32	尚立芝，季　书，谢文英，等. 二陈汤加味对COPD急性期患者CC16，SP-D及HAT/HDAC的影响[J]. 中国实验方剂学杂志，2017, 23(10): 163-170.

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)

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)

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±0.01^ab	17.21±1.02^ab	21.53±2.77^ab	62.31±3.74^ab
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±0.02^a	16.17±0.52^a	23.35±1.23^a	65.02±4.01^a

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±0.01^ab	17.21±1.02^ab	21.53±2.77^ab	62.31±3.74^ab
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±0.02^a	16.17±0.52^a	23.35±1.23^a	65.02±4.01^a

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±0.921^ab	169.31±10.211^ab	83.98±5.221^ab
对照组	治疗前	8.19±2.17	141.14±27.66	65.13±11.02
	治疗4周	6.27±0.71^a	153.44±9.72^a	75.44±6.37^a

Please choose a citation manager

Content to export