N-乙酰半胱氨酸联合有氧运动对慢性阻塞性肺疾病稳定期患者肺功能、生活质量及血清氧化因子的影响

Effect of N-acetylcysteine combined with aerobic exercise on the pulmonary function,quality of life and serum oxidation factor in patients with stable chronic obstructive pulmonary disease

目的探讨N-乙酰半胱氨酸(NAC)联合有氧运动对慢性阻塞性肺疾病(COPD)稳定期患者肺功能、生活质量及血清氧化因子的影响。方法选择2016年10月至2017年10月于新乡医学院第一附属医院就诊的42例COPD稳定期患者,随机分为对照组和观察组,每组21例。对照组患者给予沙美特罗替卡松吸入治疗;观察组患者在对照组治疗的基础上给予NAC泡腾片0.6 g,口服,每日1次,同时进行有氧运动,即每日匀速行走1次或2次,每次20~30 min;疗程12周。分别于治疗前后采用分光光度法检测2组患者血清谷胱甘肽过氧化物酶(GSH-PX)、超氧化物歧化酶(SOD)水平,硫代巴比妥法检测丙二醛(MDA)水平,使用肺功能检测仪检测用力肺活量(FVC)、1秒用力呼气量(FEV_1)及FEV_1/FVC,采用圣乔治呼吸问卷(SGRQ)进行生活质量评估,采用6 min步行试验(6MWT)进行运动耐力评估。结果治疗前,2组患者血清GSH-PX、SOD、MDA水平、SGRQ评分、6MWT及FVC、FEV_1、FEV_1/FVC比较差异均无统计学意义(P>0.05)。治疗12周后,2组患者血清GSH-PX、SOD水平及6MWT均较治疗前显著增高(P<0.05),MDA水平及SGRQ评分均较治疗前显著降低(P<0.05),FVC、FEV_1、FEV_1/FVC与治疗前比较差异无统计学意义(P>0.05)。治疗12周后,观察组患者血清GSH-PX、SOD水平及6MWT显著高于对照组(P<0.05),MDA水平及SGRQ评分显著低于对照组(P<0.05),FVC、FEV_1、FEV_1/FVC与对照组比较差异无统计学意义(P>0.05)。结论NAC联合有氧运动治疗COPD能有效清除患者血清中的氧化产物,改善患者的生活质量,提高运动耐力。

Objective To investigate the effect of N-acetylcysteine（ NAC） combined with aerobic exercise on the pulmonary function,quality of life and serum oxidation factor in patients with stable chronic obstructive pulmonary disease（ COPD）. Methods A total of 42 patients with stable COPD were selected from October 2016 to October 2017 in the First Affiliated Hospital of Xinxiang Medical University. The patients were randomly divided into control group and observation group,with 21 cases in each group. The patients in the control group were treated with salmeterol xinafoate and fluticasone propionate by inhalation. Based on these,the patients in the observation group were treated with 0. 6 g NAC effervescent tablet by oral,once a day; at the same time,the patients performed uniform walking aerobic exercise for 20-30 minutes,1 or 2 times a day for 12 weeks. The levels of serum glutathione peroxidase（ GSH-PX）,superoxide dismutase（ SOD） were detected by spectrophotometry,the level of malondialdehyde（ MDA） was detected by penthiobarbital before and after treatment in the two groups.The forced vital capacity（ FVC）,forced expiratory volume in one second（ FEV1） and FEV1/FVC were tested by pulmonary function test apparatus. The quality of life was evaluated by the St George’ s respiratory questionnaire（ SGRQ）. The exercise endurance was evaluated by the 6 minutes walking test（ 6 MWT）. Results There was no significant difference in the levels of serum GSH-PX,SOD,MDA,SGRQ score,6 MWT,FVC,FEV1 and FEV1/FVC between the two groups before treatment（ P 〉0. 05）. The serum GSH-PX,SOD levels and 6 MWT after 12 weeks of treatment were significantly higher than those before treatment（ P 〈 0. 05）,and the MDA level and SGRQ score were significantly lower than those before treatment in the two groups（ P 〈 0. 05）. There was no significant difference in FVC,FEV1 and FEV1/FVC between 12 weeks after treatment and before treatment（ P 〉 0. 05）. The levels of serum GSH-PX,SOD and 6 MWT in the observation group were significantly higher than those in the control group（ P 〈 0. 05）,and the serum MDA level and the SGRQ score were significantly lower than those in the control group after 12 weeks of treatment（ P 〈 0. 05）. There was no significant difference in FVC,FEV1 and FEV1/FVC between the two groups at 12 weeks after treatment（ P 〉 0. 05）. Conclusion NAC combined with aerobic exercise can effectively clear the serum oxidation products,improve the quality of life and improve the exercise endurance of patients with stable COPD.