大剂量N-乙酰半胱氨酸联合糖皮质激素治疗慢性阻塞性肺疾病并肺间质纤维化的临床疗效

Clinical Effect of Large-dose N-acetylcysteine Combined with Glucocorticoid in Treating COPD Patients Complicated with Pulmonary Interstitial Fibrosis

目的观察大剂量N-乙酰半胱氨酸联合糖皮质激素治疗慢性阻塞性肺疾病(COPD)并肺间质纤维化(PIF)的临床疗效。方法选取海南省儋州市人民医院2014年3月—2016年9月收治的COPD并PIF患者78例,随机分为对照组与观察组,每组39例。对照组患者给予糖皮质激素治疗,观察组患者在对照组基础上给予乙酰半胱氨酸颗粒600 mg/次治疗;两组患者均连续治疗3个月。比较两组患者治疗前后肺功能指标[第1秒用力呼气容积占预计值百分比(FEV_1%)、肺活量占预计值百分比(VC%)、单位肺泡容积的一氧化碳弥散量占预计值百分比(DLCO/VA%)]及血清转化生长因子β(TGF-β)、血管内皮生长因子(VEGF)水平,临床疗效,并观察两组患者治疗期间不良反应发生情况。结果两组患者治疗前FEV_1%、VC%、DLCO/VA%比较,差异无统计学意义(P>0.05);治疗后观察组患者FEV_1%、VC%、DLCO/VA%均高于对照组(P<0.05)。两组患者治疗前血清TGF-β、VEGF水平比较,差异无统计学意义(P>0.05);治疗后观察组患者血清TGF-β、VEGF水平低于对照组(P<0.05)。观察组患者临床疗效优于对照组(P<0.05)。治疗期间对照组患者出现肺部感染2例,观察组患者未出现不良反应。结论大剂量N-乙酰半胱氨酸联合糖皮质激素治疗COPD并PIF的临床疗效确切,可有效改善患者肺功能,降低血清TGF-β、VEGF水平,且安全性较高。

Objective To explore the clinical effect of large - dose N - acetylcysteine combined with glucocorticoid in treating COPD patients complicated with pulmonary interstitial fibrosis （PIF）. Methods A total of 78 COPD patients complicated with PIF were selected in the People＇s Hospital of Darrzhou from March 2014 to September 2016, and they were randomly divided into control group and observation group, each of 39 cases. Patients of control group received glacocorticoid, while patients of observation group received N - acetylcysteine 600 nag per time combiaed with glucocorticoid; both groups continuously treated for 3 months. Index of pulmonary function （including FEVr%, VC% and DLCO/VA% ） , serum levels of TGF-β and VEGF before and after treatment, and clinical effect were compared between the two groups, meanwhile incidence of adverse, reactions during the treatment was observed. Results No statistieaiiy signitieanl differences of FEV1 %, VC% or DLEO/VA% was found between the two groups before treatment （ P 〉 0.05 ）, while FEV1 %, VC% and DLCO/VA% of observation group were statistically siglfificantly higher than those of control group after treatment （ P 〈 0. 05 ）. No statistically significant differences of serum level of TGF-β or VEGF was found between the two groups before treatment （ P 〉 0.05） , while serum levels of TGF-β and VEGF of observation group were statistically significantly lover than those of control group after treatment （P〈0. 05）. Clinieal effect of observation group was statistically significandy better than that of control group （P 〈0. 05）. During the treatment, 2 cases of control group occurred lung infection, while no one of observation group occurred any adverse reactions. Conclusion Large -dose N -acetylcysteine combined with glucocorticoid has certain clinical effect in treating COPD patients complicated with PIF, can effectively improve the pulmonary function, reduce the serum levels of TGF-β and VEGF, with relatively high safety.