羧甲司坦治疗老年慢性阻塞性肺疾病急性加重期的疗效及对血清IL-8、TNF-α和IgE水平的影响

Clinical efficacy of carbocisteine in treatment of elderly patients with acute exacerbation of chronic obstructive pulmonary disease and its impact on levels of serum IL-8,TNF-αand IgE

目的探讨羧甲司坦对老年慢性阻塞性肺疾病急性加重期(AECOPD)的疗效及对血清白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)及免疫球蛋白E(IgE)水平的影响。方法选取2018年8月—2019年8月商丘市中医院肺病科收治的128例老年AECOPD患者,随机分为对照组和治疗组,每组各64例。对照组给予常规治疗,治疗组在对照组基础上口服羧甲司坦口服溶液,10 mL/次,3次/d。两组均治疗1周。观察两组的临床疗效,比较两组肺功能指标、动脉血气指标、呼吸困难程度、运动耐力和1年随访期间第一次急性症状发作时间、发作病例,记录两组治疗前后的血清炎症指标水平和生活质量。结果治疗后,治疗组总有效率为92.19%,显著高于对照组的79.69%,差异有统计学意义(P<0.05)。治疗后,两组肺功能指标中第一秒用力呼气量(FEV1)、FEV1占用力肺活量百分比(FEV1/FVC)、氧分压(pO2)均较治疗前显著升高,但二氧化碳分压(pCO2)较治疗前显著降低(P<0.05);治疗后,治疗组肺功能指标和动脉血气指标均优于对照组(P<0.05)。治疗后,两组患者CAT问卷评分较治疗前显著降低,而6分钟步行距离(6MWT)显著较治疗前增加(P<0.05);治疗后,治疗组以上指标改善效果显著优于对照组(P<0.05)。治疗组第一次发作时间较对照组显著延后,急性发作病例显著少于对照组(P<0.05)。治疗后,两组患者IL-8、TNF-α及IgE水平较治疗前显著降低(P<0.05);治疗后,治疗组患者血清炎症水平显著低于对照组(P<0.05)。治疗后,两组SGRQ量表关于症状、活动、疾病影响3个维度评分及总分较治疗前显著降低(P<0.05);治疗后,治疗组SGRQ评分显著低于对照组(P<0.05)。结论羧甲司坦可明显改善老年AECOPD患者的氧合能力、肺功能及运动耐力,延长急性发作间期,下调炎症因子水平,且用药安全性良好。

Objective To investigate the curative effect of carbocisteine in treatment of elderly patients with acute exacerbation of chronic obstructive pulmonary disease and its impact on levels of serum IL-8,TNF-αand Ig E.Methods Elderly patients(128 cases)with AECOPD admitted to Department of Lung Disease of Shangqiu Hospital of Traditional Chinese Medicine from August 2018 to August 2019 were randomly divided into control group and treatment group,with 64 patients in each group.Patients in the control group received conventional treatment.Patients in the treatment group were po administered with Carbocisteine Oral Solution on the basis of the control group,10 m L/time,three times daily.Patients in two groups were treated for 7 d.After treatment,the clinical efficacy was evaluated,the indexes of pulmonary function,arterial blood gas,dyspnea degree,exercise endurance,the time and cases of the first onset of acute symptoms during 1-year follow-up were compared between two groups.Serum inflammatory indexes and life quality before and after treatment were recorded in two groups.Results After treatment,the total effective rate of the treatment group was 92.19%,which was significantly higher than that of the control group(79.69%),and the difference was statistically significant(P<0.05).After treatment,FEV1,FEV1/FVC and pO2 in lung function indexes of 2 groups were significantly increased compared with before treatment,but pCO2 was significantly decreased compared with before treatment(P<0.05).After treatment,pulmonary function indexes and arterial blood gas indexes in treatment group were better than those in control group(P<0.05).After treatment,CAT score in two groups was significantly lower than before treatment,while 6 MWT was significantly increased(P<0.05);After treatment,the improvement effect of the above indexes in the treatment group was significantly better than that in the control group(P<0.05).The time of the first attack in the treatment group was significantly longer than that in the control group,and the cases of acute attack were significantly less than those in the control group(P<0.05).After treatment,the levels of serum IL-8,TNF-α,and Ig E in two groups were significantly decreased compared with before treatment(P<0.05).After treatment,the serum inflammation level of treatment group was significantly lower than that of control group(P<0.05).After treatment,the scores of symptoms,activity and disease influence and the total scores of SGRQ in both groups were significantly lower than those before treatment(P<0.05).After treatment,the SGRQ score of treatment group was significantly lower than that of control group(P<0.05).Conclusion Carbocisteine can significantly improve oxygenation ability,lung function and exercise endurance in elderly patients with AECOPD,and can prolong the acute interattack period,and reduce the level of inflammatory factors,which has good drug safety.