七叶皂苷钠对慢性阻塞性肺疾病急性加重期氧化应激和肺功能的影响

Effect of sodium aescinate on oxidative stress and pulmonary function during acute exacerbation of chronic obstructive pulmonary disease

目的探讨七叶皂苷钠对慢性阻塞性肺疾病（COPD）急性加重期氧化应激和肺功能的影响。方法120例符合COPD纳入标准的患者随机分为对照组60例和治疗组60例。所有患者均给予常规抗感染、吸氧、化痰和平喘等对症治疗，治疗组在常规对症治疗基础上加用七叶皂苷钠。两组均于治疗前及治疗后2周测定血清超氧化物歧化酶（SOD）、丙二醛（MDA）、谷胱甘肽过氧化物酶（GSH—Px）以及总抗氧化能力（T—AOC），同时进行肺功能和6min步行距离（6MWD）检测，并与60名健康体检者（健康组）进行比较。结果治疗组总有效率91．67％（55／60），对照组总有效率76．67％（46／60），差异有统计学意义（χ^2=5．065，P〈0．05）。治疗前对照组血清MDA（9．25±1．55）μmoL／L和治疗组（9．74±1．50）μmoL／L较健康组（2．06±0．29）μmoL／L高，差异均有统计学意义（P均〈0．001），而血清SOD[对照组（91．14±9．54）kU／L、治疗组（90．61±8．01）kU／L]、GSH-Px[对照组（139．38±36．56）U／L、治疗组（137．57±34．19）U／L]、T-AOC[对照组（6．48±1．15）kU／L、治疗组（6．39±1．13）kU／L]水平较健康组[（116．63±6．57）kU／L、（189．34±35．54）U／L、（13．34±1．23）kU／L]低，差异均有统计学意义（P均〈0．001）。治疗后两组各指标较治疗前均有所改善（P〈0．001），但治疗后治疗组血清MDA[（4．56±1．39）μmol/L]与对照组[（5．85±1．37）μmoL／L]比较明显下降，差异有统计学意义（t=6．517，P〈0．001），血清SOD[（103．85±7．07）kU／L]、GSH-Px[（169．65±34．51）U／L]、T-AOC[（10．52±1．09）kU／L]水平，第1秒用力呼气容秽用力肺活量（FEV1／FVC）[（60．49±6．11）％]，FEV1占预计值％[（76．62±6．35）％]以及6MWD[（394．83±10．11）m]与对照组[分别为（97．99±6．24）kU／L、（156．33±38．31）U／L、（8．82±1．41）kU／L、（53．84±2．97）％、（67．86±4．58）％、（331．19±11．03）m]比较明显升高，差异有统计学意义（t值分别为6．574、2．738、7．137、6．574、6．517、21．198，P均〈0．001）。结论氧化应激参与了COPD急性加重期的病理生理过程，七叶皂苷钠可能通过减轻COPD急性加重期患者氧化应激水平改善肺功能。

Objective To investigate the effects of sodium aescinate （SA）on oxidative stress and pulmonary function during acute exacerbation of chronic obstructive pulmonary disease（COPD）. Methods One hundred and twenty patients with COPD were randomly divided into two groups：the control group （n = 60） and the treatment group（ n = 60 ）. All patients were treated with routine anti-infection, oxygen inhalation, relieving phlegm and anti-asthma. The treatment group took SA in addition to the routine heteropathy. The changes of serum SOD, MDA, GSH-Px, T-AOC, pulmonary functions and 6 minute walk distance （6MWD） were detected before and after two-week treatment in patients of the two groups to compare with 60 healthy subjects. Results The total effective rate in the treatment group was 91.67% ,while 76. 67% in the control group. The difference was statistically significant（ χ^2 = 5. 065 ,P 〈0. 05 ）. Serum MDA level in both groups were comparatively higher than the healthy controls （ 9. 25±1.55 ） μmol/L vs. （ 9.74 ± 1.50 ） μmol/L vs. （ 2. 06 ± 0. 29 ） pμmol/L, P 〈 0. 001 ）, while the levels of SOD, GSH-Px and T-AOC were lower than the healthy controls [ SOD ： （ 91.14 ± 9. 54） kU/L vs. （ 90. 61 ± 8.01 ） kU/L vs. （ 116. 63 ± 6. 57 ） kU/L; GSH-Px ： （ 139. 38 ± 36. 56 ） U vs. （ 137.57 ± 34. 19） U/L vs. （ 189. 34 ± 35.54） U/L; T-AOC ： （6.48 ± 1.15 ） kU/L vs. （6. 39 ± 1.13 ） kU/L vs. （ 13.34 ± 1.23 ） kU/L; P 〈 0. 001 ]. After treatment, all indexes of the two groups were obviously ameliorated in comparison with before treatment （ P 〈 0. 001 ）, but the level of MDA [ （4.56 ± 1.39 ） μmol/L] in the treatment group decreased more greatly than in the control groups （ P 〈 0. 001 ）. The levels of SOD [ （ 103.85 ± 7.07 ） kU/L ], GSH-Px[ （ 169. 65 ± 34. 51 ） U/L], T-AOC [ （ 10. 52 ± 1.09 ） KU/L], forced expiratory volume in 1 second/ forced vital capacity （ FEV1/FVC ） [;（ 60. 49 ± 6. 11 ）% ], FEV1% [ （ 76. 62 ± 6. 35 ）% ] and 6MWD [ （394. 83 ± 10. 11 ）m] increased considerably more than those in the control group（P 〈 0. 001 ）. Conclusion Oxidative stress might be involved in the course of acute exacerbation of COPD. Sodium aescinate can improve the pulmonary functions by ameliorating the oxidative stress during acute exacerbation in patients with COPD.