氨溴索诱导痰在老年慢性阻塞性肺疾病患者气道炎症中的应用

The application of ambroxol induced sputum on airway inflammation in elderly patient with chronic obstructive pulmonary disease

目的观察老年慢性阻塞性肺疾病(COPD)患者氨溴索诱导痰的安全性及有效性和急性加重期及稳定期老年COPD患者氨溴索诱导痰中细胞组分和可溶性介质水平变化,探讨其在气道炎症中的作用。方法将老年COPD急性加重期患者40例随机分为氨溴索组和高渗盐水组,每组20例。高渗盐水组雾化吸入3%高渗盐水4ml,氨溴索组给予3%高渗盐水2ml+氨溴索2ml诱导排痰。对比2组患者不良反应发生率、排痰成功率、痰液中细胞组分及炎性递质含量。测定氨溴索组患者急性加重期、稳定期诱导痰中细胞总数、单核细胞百分比、中性粒细胞百分比、白细胞介素-8(IL-8)及肿瘤坏死因子-α(TNF-α)浓度及其第1秒用力呼气容积(FEV1)、FEV1占预计值百分比。结果 2组不良反应发生率、排痰成功率比较差异均有统计学意义(P<0.05)。氨溴索组患者急性加重期诱导痰液中细胞总数、单核细胞百分比、中性粒细胞百分比、IL-8及TNF-α浓度与稳定期比较,差异均有统计学意义(P<0.05);氨溴索组患者痰液中细胞总数、单核细胞及中性粒细胞百分比、IL-8及TNF-α浓度和FEV1占预计值百分比呈负相关(急性加重期及稳定期r值分别为-0.728、-0.793、-0.816、-0.794、-0.605及-0.635、-0.746、-0.721、-0.658、-0.654)。结论氨溴索诱导痰是一种安全、有效的方法,在阐明老年COPD患者气道炎症的发生、发展及病情检测中有指导意义。

Objective To establish an improved method by inhaling hyperosmotic saline and mucosolvan ampoule and to observe the security and validity in old patients with chronic obstructive pulmonary disease（COPD）.To observe the changes of cell component and soluble substance in the induced sputum of the elderly patients with COPD at their acute and stable stage,explore the role of these substance in airway inflammation.Methods 40 cases old patients with COPD divided into ambroxol group and hyperosmotic saline group,each of 20 cases.Hyperosmotic saline group inhaled 3% hyperosmotic saline 4ml,ambroxol group were given 3% hyperosmotic saline＋ambroxol 2ml.Compared adverse reaction rates,the success rate of expectoration,sputum inflammatory cell components and transmitter contentsof 2 geoups.Determined acute exacerbation,stabilization of the total number of induced sputum cells,monocyte percentage,neutrophil percentage,interleukin-8（IL-8） and tumor necrosis factor-α（TNF-α） concentration and forced expiratory volume in 1 second（FEV1）,FEV1 percentage of predicted value percentage.Results The incidence of adverse reactions,the success rate of sputum in 2 groups were significant differences（P0.05）.Acute exacerbation of the total number of induced sputum cells,monocyte percentage,neutrophil percentage,IL-8 and TNF-α concentration in ambroxol group,compared those of stabilization,the difference were significant（P0.05）;The total number of cells in sputum of patients,monocyte and neutrophil percentage,IL-8 and TNF-α concentration and FEV1 percentage of predicted value in ambroxol group were negatively correlated with the percentage（acute exacerbation and stable r values were-0.728,-0.793,-0.816,-0.794,-0.605 and-0.635,-0.746,-0.721,-0.658,-0.654）.Conclusion Ambroxol induced sputum is a safe and effective method,in elderly COPD patients to clarify the occurrence of airway inflammation,development and significance has disease detection.