四联抗结核化疗联合N-乙酰半胱氨酸对慢性阻塞性肺疾病合并肺结核患者的影响

Effect of quadruple anti-tuberculosis chemotherapy combined with N-acetylcysteine on patients with chronic obstructive pulmonary disease and pulmonary tuberculosis

目的探讨四联抗结核化疗联合N-乙酰半胱氨酸(N-acetyl cysteine,NAC)对慢性阻塞性肺疾病(chronic obstructive pulmo-nary disease,COPD)并肺结核(pulmonary tuberculosis,PTB)患者免疫功能、炎性细胞因子、肺功能及生活质量的影响。方法选取2019年1月—2020年12月我院收治的180例COPD并PTB患者作为研究对象,采用随机数字表法分为对照组和观察组,对照组采用四联抗结核化疗,观察组采用四联抗结核化疗联合NAC治疗,比较2组治疗前、治疗6个月后免疫功能、肺功能及炎性细胞因子水平,采用圣乔治呼吸问卷(St.George’s Respiratory Questionnaire,SGRQ)于治疗前、治疗6个月后评估患者生活质量。结果治疗6个月后,观察组痰菌转阴、病灶吸收、空洞闭合率分别为97.78%、98.89%、97.78%,均高于对照组(P均<0.05);观察组CD3+T细胞百分比、CD4+T细胞百分比、CD4+/CD8+明显高于治疗前,对照组CD3+T细胞百分比、CD4+/CD8+明显高于治疗前,2组CD8+T细胞百分比、B淋巴细胞百分比均明显低于治疗前(P均<0.05),观察组CD3+T细胞百分比、CD4+T细胞百分比、CD4+/CD8+的上升幅度及CD8+T细胞百分比、B淋巴细胞百分比的下降幅度均明显高于对照组(P均<0.05);观察组与对照组TNF-α、IL-6水平均明显低于治疗前,IL-10水平均高于治疗前,观察组TNF-α、IL-6水平的下降幅度及IL-10水平的上升幅度均明显高于对照组(P均<0.05);观察组和对照组1秒用力呼气容积(forced expiratory volume in 1 second,FEVl)、用力肺活量(forced vital capacity,FVC)、FEVl/FVC、呼气峰流速(peak expiratory flow rate,PEF)、平均最大呼气流量(maximal mid-expiratory flow curve,MMEF)均明显高于治疗前,观察组FEVl、FVC、FEVl/FVC、PEF、MMEF的上升幅度均明显高于对照组(P均<0.05);观察组和对照组SGRQ症状、活动、日常生活评分均明显低于治疗前(P均<0.05),观察组SGRQ症状、活动、日常生活评分的下降幅度均明显高于对照组(P均<0.05)。结论四联抗结核化疗联合NAC可提高COPD并PTB患者抗肺结核疗效,降低炎性反应,提高免疫力和肺功能,全面提高患者的生活质量。

Objective To study the effects of quadruple anti-tuberculosis chemotherapy combined with N-acetylcysteine(NAC)on the immune function,inflammatory cytokines,lung function and quality of life of patients with chronic obstructive pulmonary disease(COPD)and pulmonary tuberculosis(PTB).Methods From January 2019 to December 2020,180 patients with COPD and PTB in our hospital were selected as the research objects.They were divided into the control group and the observation group using a random number table.The control group received quadruple anti-tuberculosis chemotherapy,and the observation group received quadruple anti-tuberculosis chemotherapy combined with NAC treatment.The immune function,lung function and inflammatory cytokine levels of 2 groups were compared before treatment and at 6 months after treatment.The St.George’s Respiratory Questionnaire(SGRQ)was used to evaluate the patient’s quality of life before treatment and at 6 months after treatment.Results After 6 months of treatment,the rates of sputum negative conversion,lesion absorption and cavity closure in the observation group were 97.78%,98.89%,and 97.78%,respectively,which were higher than those in the control group(P<0.05).Percenttage of CD3+T cells and percenttage of CD4+T cells and CD4+/CD8+in the observation group were significantly higher than those before treatment,percenttage of CD3+T cells and CD4+/CD8+in the control group were significantly higher than those before treatment,and percenttage of CD8+T cells and percenttage of B lymphocytes in 2 groups were significantly lower than those before treatment(P<0.05),and the increment of percenttage of CD3+T cells,percenttage of CD4+T cells,CD4+/CD8+and the decline of percenttage of CD8+T cells and percenttage of B lymphocytes in the observation group were significantly higher than those in the control group(P<0.05).In the observation group and control group,TNF-αand IL-6 levels were significantly lower than those before treatment,and the level of IL-10 was higher than that before treatment.The decline of TNF-αand IL-6 levels and the increment of IL-10 level in the observation group were significantly higher than those in the control group(P<0.05).In the observation group and control group,forced expiratory volume in 1 second(FEVl),forced vital capacity(FVC),FEVl/FVC,peak expiratory flow rate(PEF),maximal mid-expiratory flow curve(MMEF)were significantly higher than those before treatment,and the increment of FEV1,FVC,FEV1/FVC,PEF,MMEF in the observation group was significantly higher than that in the control group(P<0.05).SGRQ symptoms,activities and daily life scores in the observation group and control group were significantly lower than those before treatment(P<0.05),and the decline of SGRQ symptoms,activities,and daily life scores in the observation group were significantly higher than those in the control group(P<0.05).Conclusions Quadruple anti-tuberculosis chemotherapy combined with NAC can improve the anti-tuberculosis efficacy of COPD and PTB patients,reduce inflammatory response,improve immunity and lung function and comprehensively improve the patient’s quality of life.