乙酰半胱氨酸雾化治疗囊状支气管扩张症的临床研究

Clinical analysis and individualized treatment of cystic bronchiectasis

目的探讨乙酰半胱氨酸雾化治疗囊状支气管扩张症(支扩症)效果。方法收集2016年1月1日至2017年11月30日首都医科大学大兴教学医院呼吸门诊收治的囊状支扩症患者84例,按电脑随机数字表分组,对照组46例给予常规治疗,包括氧疗、抗感染、吸入支气管扩张剂,观察组38例在对照组基础上给予乙酰半胱氨酸雾化治疗,治疗时间1年,期间每3个月电话随访一次。比较两组患者治疗前后改良英国医学研究委员会呼吸问卷(modified British Medical Research Council,mMRC)、莱切斯特咳嗽问卷(Leicester cough questionnaire,LCQ)、圣·乔治呼吸问卷(ST George’s respiratory questionnaire,SGRQ)评分及肺功能的差异,以及治疗1年内患者第一次急性加重时间、急性加重的次数。结果治疗1年后,观察组mMRC评分(1.92±0.96)分、LCQ评分(16.20±4.20)分、SGRQ评分(38.45±14.62)分均明显优于对照组[分别为(2.91±1.07)分、(11.82±2.60)分、(52.10±24.20)分],差异有显著性(P<0.05),但两组肺功能指标包括第1秒用力呼气容积占预计值百分比(forced expiratory volume in one second as a percentage of the expected value,FEV1%)、用力肺活量占预计值百分比(forced vital capacity as a percentage of the expected value,FVC%)、第1秒用力呼气量占用力肺活量比值(FEV1/FVC)比较,差异无显著性(P>0.05)。治疗1年内,观察组第一次急性加重时间[145(102,212)d]明显晚于对照组[104(64,156)d],差异有显著性(P=0.011);观察组1年内急性加重次数为2(0,2)次,与对照组[2(0,3)次]比较差异无显著性(P>0.05)。结论长期给予乙酰半胱氨酸雾化治疗可减轻囊状支扩症患者的临床症状,改善生活质量,但不能减少急性加重次数。

Objective To determine the impact of individualized treatment over 1 year in patients with cystic bronchiectasis.Method Eighty-four patients with cystic bronchiectasis were recruited from January 2016 to November 2017 in Daxing Teaching Hospital of Capital Medical University.Patients were randomly divided into observation group(38 cases)and control group(46 cases)according to the digital table method.The control group was given basic treatments such as oxygen inhalation,anti-Infection,inhalation aerosol bronchodilator.The observation group received twice-daily nebulized acetylcysteine 0.3g(four times per week)on the basis of the control group for 12 months.The modified British Medical Research Council(mMRC)dyspnea scale,Leicester Cough Questionnaire(LCQ),ST George’s Respiratory Questionnaire(SGRQ)and pulmonary function test were conducted,and exacerbations,during a 1-year follow-up were recorded.Result The observation group had greater improvements in mMRC(1.92±0.96),LCQ(16.20±4.20),SGRQ(38.45±14.62)than the control group(2.91±1.07,11.82±2.60,52.10±24.20,respectively),the difference is statistically significant(P<0.05).No differences were seen in respiratory function(FEV1,FVC,FEV1/FVC)(P>0.05).There was significant improvement in time to first exacerbation(P=0.011),however,the exacerbation rate was not significantly reduced(P=0.782).Conclusion Long-term nebulized acetylcysteine in patients with cystic bronchiectasis could improve symptoms and quality of life,however,nubulized acetylcysteine did not reduce exacerbation rates significantly.