无创正压通气联合乌司他丁治疗老年阻塞性肺气肿疗效及对血清HCY、CCL2水平的影响

Efficacy of noninvasive positive pressure ventilation combined with ulinastatin in the treatment of senile obstructive pulmonary emphysema and its effect on serum HCY and CCL2 levels

目的:探讨无创正压通气联合乌司他丁治疗老年阻塞性肺气肿的疗效以及对患者血清同型半胱氨酸(homocysteine;HCY)、趋化因子配体2(chemokineC-C motif ligand 2;CCL2)水平的影响,为临床诊疗提供参考依据。方法:回顾性分析2016年11月~2018年3月期间本院接诊的100例阻塞性肺气肿患者的诊疗情况。按照不同治疗方法,分为两组,各50例。对照组接受无创正压通气治疗,观察组接受无创正压通气+乌司他丁治疗。比较治疗后临床效果,记录患者治疗前、治疗后用力肺活量(Forced vital capacity;FVC)、第一秒用力呼吸量(First second forced breathing;FEV1)、最大自主通气量(Maximum Autonomous Ventilation Volume;MVV)、HCY、CCL2、基质金属蛋白酶-9(Matrix metalloproteinase-9;MMP-9)、C反应蛋白(C-reactive protein;CRP)、肿瘤坏死因子-α(Tumor necrosis factor-α;TNF-α)变化及不良反应发生情况。结果:观察组的总有效率(94.00%)明显高于对照组(78.00%),差异有统计学意义。治疗后,两组患者的FVC、FEV1、MVV均明显升高,且观察组明显高于对照组,差异有统计学意义。治疗后,患者的HCY、CCL2均明显降低,且观察组明显低于对照组,差异有统计学意义。治疗后,两组患者的MMP-9、CRP、TNF-α均降低,观察组明显低于对照组,差异有统计学意义。两组患者不良反应发生率比较无统计学意义。结论:无创正压通气+乌司他丁治疗老年阻塞性肺气肿疗效显著,有效改善肺功能,减少炎性反应,抑制血清HCY、CCL2水平,安全性高,值得临床推广使用。

Objective To explore the effect of noninvasive positive pressure ventilation combined with ulinastatin in the treatment of elderly obstructive pulmonary emphysema and its influence on serum homocysteine(HCY)and chemokine C-motif ligand 2(CCL2)levels,so as to provide reference for clinical diagnosis and treatment.Methods 100 patients with obstructive pulmonary emphysema received in our hospital from November 2016 to March 2018 were retrospectively analyzed.According to different treatment methods,50 cases each.The control group received noninvasive positive pressure ventilation,while the observation group received noninvasive positive pressure ventilation plus ulinastatin.The clinical effects were recorded before and after treatment,including Forced vital capacity(FVC),First second forced breathing(FEV1),Maximum Autonomous Ventilation Volume(MVV),HCY,CCL2 and Matrix m-9.The changes of etalloproteinase-9,MMP-9,C-reactive protein(CRP),Tumor necrosis factor-alpha(TNF-alpha)and adverse reactions were compared.Results The total effective rate of the observation group(94.00%)was significantly higher than that of the control group(78.00%),and the difference was statistically significant.After treatment,FVC,FEV1 and MVV of the two groups were significantly increased,and the observation group was significantly higher than the control group,the difference was statistically significant.After treatment,the levels of HCY and CCL2 in the observation group were significantly lower than those in the control group.After treatment,the levels of MMP-9,CRP and TNF-alpha in the two groups were decreased,and the difference between the observation group and the control group was significant.There was no significant difference in the incidence of adverse reactions between the two groups.Conclusion Non-invasive positive pressure ventilation plus Ulinastatin in the treatment of elderly patients with obstructive pulmonary emphysema is effective in improving pulmonary function,reducing inflammatory reaction,inhibiting serum HCY and CCL2 levels,with high safety,which is worthy of clinical application.