乙酰半胱氨酸联合噻托嗅铵吸入治疗急性加重期COPD疗效及对氧化应激因子和炎症因子的影响

Efficacy of Acetylcysteine Inhalation Combined with Tiotropium Inhalation in the Treatment of Acute Exacerbation of COPD and Its Influence on Oxidative Stress Factors and Inflammatory Factors

目的:探究乙酰半胱氨酸联合噻托嗅铵吸入治疗急性加重期慢性阻塞性肺疾病(COPD)疗效及对氧化应激因子和炎症因子的影响。方法:纳入2019年1月至2021年1月期间163例COPD急性加重期患者作为研究对象,根据非随机临床同期对照研究分为两组,其中观察组92例采用乙酰半胱氨酸吸入剂联合噻托嗅铵吸入剂治疗,对照组71例采用噻托嗅铵吸入剂治疗。比较两组患者治疗2周后临床疗效,治疗前、治疗2周后肺功能[第1秒用力呼气容积(FEV1)、最大呼气峰流速值(PEF)、肺活量50%时的呼气流速(PEF50)、肺总容量(TLC)]、动脉血气指标[氧饱和度(SaO_(2))、血氧张力(PaO_(2))、二氧化碳分压(PaCO_(2))、酸碱度(PH)]、血清氧化应激指标[丙二醛(MDA)、超氧化物歧化酶(SOD)、一氧化氮(NO)]及炎症因子[降钙素原(PCT)、超敏C反应蛋白(hs-CRP)]水平变化。结果:治疗2周后,观察临床总有效率高于对照组(P<0.05);两组FEV1、PEF、PEF50、TLC均较治疗前提高,且观察组变化幅度大于对照组(P<0.05);两组SaO_(2)、PaO_(2)、PH均较治疗前提高,PaCO_(2)均较治疗前降低,且观察组变化幅度大于对照组(P<0.05);两组血清SOD水平均较治疗前提高,MDA、NO均较治疗前降低,且观察组变化幅度大于对照组(P<0.05);两组血清hs-CRP、PCT水平均较治疗前降低,且观察组变化幅度大于对照组(P<0.05)。结论:乙酰半胱氨酸联合噻托嗅铵吸入治疗急性加重期COPD可提高疗效,有效抗氧化、抑制炎症反应。

Objective:To explore the effect of acetylcysteine inhalation combined with tiotropium inhalation in the treatment of acute exacerbation of chronic obstructive pulmonary disease(COPD)and its influence on oxidative stress factors and inflammatory factors.Methods:A total of 163 patients with acute exacerbation of COPD between January 2019 and January 2021 were enrolled as the research subjects,and they were divided into two groups based on nonrandomized clinical concurrent control study.Among them,92 cases in the observation group were administered acetylcysteine inhalation combined with tiotropium inhalation,and 71 cases in the control group were treated with tiotropium inhalation.The clinical efficacy after 2 weeks’treatment,as well as lung function[forced expiratory volume in the first second(FEV1),peak expiratory flow(PEF),expiratory flow rate at 50%vital capacity(PEF50),total lung capacity(TLC)],arterial blood gas indexes[oxygen saturation(SaO_(2)),partial pressure of blood oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),PH],serum oxidative stress indicators[malondialdehyde(MDA),superoxide dismutase(SOD),nitric oxide(NO)]and inflammatory factors[procalcitonin(PCT),hypersensitive C-reactive protein(hs-CRP)]before treatment and after 2 weeks’treatment were compared between the two groups.Results:After 2 weeks’treatment,the total clinical effective rate of observation group was higher than that of control group(P<0.05).The FEV1,PEF,PEF50 and TLC of the two groups were improved compared with those before treatment,and the changes of observation group were greater than those of control group(P<0.05).The SaO_(2),PaO_(2) and PH of the two groups were increased while the PaCO_(2) was decreased compared to before treatment,and the changes were greater in observation group compared to control group(P<0.05).The level of serum SOD of the two groups was higher than that before treatment while the levels of MDA and NO were lower than those before treatment,and the changes of observation group were greater compared with those of control group(P<0.05).The levels of serum hs-CRP and PCT in the two groups were lower than those before treatment,and the changes were greater in observation group than those in control group(P<0.05).Conclusion:Acetylcysteine inhalation combined with tiotropium inhalation in the treatment of acute exacerbation of COPD can enhance the efficacy,with anti-inflammatory and antioxidant effects.