盐酸氨溴索对AECOPD患者p38丝裂原活化蛋白激酶通路的影响研究

Effect of hydrochloride ambroxol on p38 MAP kinase pathway in patients with AECOPD

目的探讨盐酸氨溴索对慢性阻塞性肺疾病急性加重(AECOPD)患者p38丝裂原活化蛋白激酶(p38MAPK)通路的影响。方法 90例AECOPD患者在给予抗感染、解痉平喘等对症支持治疗的基础上,根据应用祛痰药物不同,随机分为生理盐水组、溴己新组、氨溴索组,每组30例,监测治疗过程中白细胞计数(WBC)、中性粒细胞比例(N%)、超敏C-反应蛋白(hs-CRP)、红细胞沉降率(ESR)变化;测定3组患者入院当天及用药治疗7d后血清中p38MAPK、白细胞介素(IL)-8、IL-10的变化情况。结果经治疗后患者血常规、CRP、ESR较治疗前明显下降;并且氨溴索组改善情况优于溴己新组;氨溴索组治疗后第7天,与生理盐水组、溴已新组治疗后第7天比较,以氨溴索组的p38MAPK、IL-8、IL-10下降最明显,3组比较差异有统计学意义(P<0.01)。结论氨溴索通过下调p38MAPK通路活化,调节AECOPD患者血清IL-8、IL-10,是其抗炎作用机制之一。

Objective To investigate the effect of hydrochloride ambroxol on p38 MAP kinase pathway in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD）. Methods 90 patients with AE- COPD were divided into different groups according to expectorant drugs prescribed after anti-infection, spasmolysis and other supportive treatment, including saline group, bromhexine group and ambroxol group, 30 cases for each group. White blood cell counting （WBC）, neutrophil ratio （N%）, high sensitive C reactive protein （hs-CRP） and erythrocyte sedimentation rate （ESR） were monitored during treatment. Serum levels of p38MAPK, interleukin （IL）- 8 and IL-10 were detected at the 1st and 7th day of treatment. Results After treatment, WBC, CRP and ESR levels significantly decreased, and ambroxol group might be better than bromhexine group. At the 7th day of treatment, the deceasing tendency of p38MAPK, IL-8 and IL-10 in ambroxol group was more significant than saline group and bromhexine group, and there were significant differences between the three groups （P^0.01）. Conclusion Ambroxol could regulate serum levels of IL-8 and IL-10 by down-regulation of p38MAPK pathway activation in patients with AECOPD, which might be its anti-inflammatory mechanism in AECOPD.