异丙托溴铵联合乙酰半胱氨酸治疗慢性阻塞性肺疾病稳定期患者的疗效观察

Influence of ipratropium bromide combined with N-acety-L-cysteine in patients with chronic obstructive pulmonary disease in stable phase

目的 探究采用异丙托溴铵联合乙酰半胱氨酸对慢性阻塞性肺疾病（COPD）稳定期患者治疗的疗效,以及血清转化生长因子-β（TGF-β）和基质金属蛋白酶9（MMP-9）水平的影响。方法 选取2015年1月至2017年6月辽宁省鞍山市第三医院收治的90例COPD患者作为研究对象。采用抽签法将研究对象分为观察组和对照组,每组45例。对照组予以异丙托溴铵治疗,观察组予以异丙托溴铵联合乙酰半胱氨酸治疗,比较两组患者的临床疗效、肺呼吸功能改善情况及TGF-β和MMP-9水平变化。结果 观察组患者的总有效率为95.6%（43/45）,高于对照组的71.1%（32/45）,差异有统计学意义（χ 2=9.68,P=0.002）。观察组患者治疗后的1s用力呼气容积（FEV1）为（1.87±0.51）L,用力肺活量（FVC）为（1.75±0.32）L,FEV1/FVC为（63.94±5.20）%,均高于对照组[（1.62±0.42）L、（1.39±0.16）L、（55.86±6.42）%],差异均有统计学意义（t值分别为2.68、7.40、6.71,P值均〈0.01）。观察组患者治疗后的血清TGF-β和MMP-9水平分别为（82.98±7.36）ng/L和（86.25±6.98）μg/L,均低于对照组[（93.03±7.91）ng/L和（96.75±8.73）μg/L],差异均有统计学意义（t值分别为5.89和6.13,P值均〈0.01）。 结论 异丙托溴铵联合乙酰半胱氨酸治疗COPD稳定期患者的临床疗效显著,能有效降低血清TGF-β和MMP-9水平。

Objective To study the efficacy of ipratropium bromide combined with N-acety-L-cysteine in patients with chronic obstructive pulmonary disease （COPD） in stable phase, and to analyze the effect of the treatment strategy on serum transforming growth factor beta （TGF-β） and matrix metalloproteinase 9 （MMP-9） levels.Methods A total of 90 COPD patients in Third Hospitals of Anshan from January 2015 to June 2017 were selected. The subjects were divided into the observation group （45 cases） and the control group （45 cases） by draw method. Patients in the control group were treated with ipratropium bromide, whereas patients in the observation group were treated with ipratropium bromide combined with N-acety-L-cysteine. The clinical efficacy, improvement in pulmonary respiratory function, and serum MMP-9 and TGF-β levels were compared between the two groups.Results The effective rate of the observation group （95.6%, 43/45） was higher than that of the control group （71.1%, 32/45）, and the difference was statistically significant （χ 2=9.68, P=0.002）. After treatment, the forced expiratory volume in one second （FEV1; （1.87± 0.51）L）, forced vital capacity （FVC; （1.75±0.32）L） and FEV1/FVC （（63.94±5.20）%） of the observation group were better than the control group （（1.62±0.42）L, （1.39±0.16）L, （55.86±6.42）%）. The differences were statistically significant （t=2.68, 7.40, 6.71, all P〈0.01）. After treatment, the serum TGF-β （（82.98±7.36） ng/L） and MMP-9 （（86.25±6.98）μg/L） levels in the observation group were higher than those of the control group （（93.03±7.91） ng/L, （96.75±8.73）μg/L）. The difference were statistically significant （t=5.89, 6.13, all P〈0.01）. Conclusion Ipratropium bromide combined with N-acety-L-cysteine has significant efficacy in the treatment of COPD in stable phase. It can reduce the levels of TGF-β and MMP-9.