不同剂量N-乙酰半胱氨酸对不同病期慢性阻塞性肺疾病患者氧化应激及炎性反应介质和免疫功能的影响

Influence of different doses of N-acetyl cysteine to oxidative stress and inflammatory response mediators and immune function of patients with chronic obstructive pulmonary disease at different stages of disease

目的探讨不同剂量N-乙酰半胱氨酸对不同病期慢性阻塞性肺疾病患者氧化应激及炎性反应介质和免疫功能的影响。方法根据入选及排除标准分为急性加重期组与稳定期组,再依据住院尾号单双数分为大剂量组或常规治疗组。各组患者均不限制常规药物治疗。大剂量组(观察组)予NAC 600mg,3次/d,常规治疗组予NAC 600mg,2次/d,疗程8周。观察各组在应用N-乙酰半胱氨酸8周后氧化应激指标(MDA、SOD)和炎性介质(CRP、IL-6、IL-8)水平及T淋巴细胞亚群CD3^+、CD4^+、CD8^+和CD4^+/CD8^+的变化。结果在急性加重期与稳定期两组治疗后数据显示,SOD均较同组治疗前明显升高,与治疗前相比,MDA及各项血清炎性因子水平均明显降低,差异有统计学意义,且与对照组相比,观察组治疗后SOD水平显著增高,MDA与各项血清炎性因子水平均显著低于对照组治疗后(P<0.05)。与治疗前相比,CD3^+、CD4^+、CD4^+/CD8^+均明显升高,CD8^+明显降低,差异有统计学意义;且与对照组相比,观察组治疗后的CD3^+、CD4^+、CD4^+/CD8^+水平明显增高,CD8^+亦明显降低。结论大剂量N-乙酰半胱氨酸在治疗COPD患者时增加机体抗氧化应激能力,减少炎性细胞因子及调节T淋巴细胞亚群水平,增强细胞免疫功能方面优于常规量治疗,且临床应用安全可靠。

Objective To explore the influence of different doses of N-acetyl cysteine to oxidative stress andinflammatory response mediators and immune function of patients with chronic obstructive pulmonary disease atdifferent stages of disease.Methods According to the inclusion and exclusion criteria,they were divided into twogroups:acute exacerbation group and stable stage group.According to length of single and double tail number,theywere divided into large dose group and conventional treatment group.Patients in each group were not restricted toconventional medication.Patients in large dose group(observation group)were treated with NAC600mg,3times perday,and the routine treatment group was given NAC600mg,2times per day,course of treatment8W.The levels ofoxidative stress(MDA,SOD)and inflammatory mediators(CRP,IL-6,IL-8)were measured after the applicationof N-N-acetylcysteine8W and change of T lymphocyte subsets CD3+,CD4+,CD8+and CD4+/CD8+of each groupwere observed.Results In the acute exacerbation phase and the stable stage after treatment,the data showed thatSOD was significantly higher than that of the same group before treatment,compared with before treatment,MDAand serum inflammatory factors were significantly lower,the difference was statistically significant,comparedwith the control group,the level of SOD in the observation group was significantly increased,the levels of MDAand serum inflammatory factors were significantly lower than those of the control group(P<0.05).Compared withbefore treatment,CD3+,CD4+,CD4+/CD8+after treatment were significantly increased,CD8+were significantly decreased,the difference was statistically significant.And compared with the control group,CD3+,CD4+,CD4+/CD8+of observation group were significantly increased,CD8+were significantly decreased,the difference was statisticallysignificant.Conclusion Large doses of N-acetylcysteine can increase antioxidant stress in patients with COPD,reduce inflammatory cytokines and regulate the level of T lymphocyte subsets.Enhancing cellular immune function issuperior to routine dose therapy.And the clinical application is safe and reliable.