乙酰半胱氨酸溶液联合特布他林治疗慢性阻塞性肺疾病急性加重期的临床研究

Clinical study of acetylcysteine solution combined with terbutaline in treatment of acute exacerbation of chronic obstructive pulmonary disease

目的探讨乙酰半胱氨酸溶液联合特布他林治疗慢性阻塞性肺疾病急性加重期(AECOPD)的临床效果。方法选取2018年2月—2020年2月天津市第五中心医院(北京大学滨海医院)急诊留观病房收治的106例AECOPD患者,根据随机数字表法将其分为对照组(n=53)和治疗组(n=53)。对照组给予硫酸特布他林气雾剂吸入治疗,0.5 mg/次,3次/d。治疗组在对照组基础上给予吸入用乙酰半胱氨酸溶液雾化吸入,3 mL/次,2次/d。所有患者均连续治疗14 d。观察两组临床疗效及典型表现的缓解时间,比较治疗前后两组咳嗽和咳痰的评估问卷(CASA-Q)总分、慢性阻塞性肺疾病患者自我评估测试(CAT)问卷评分、第1秒用力呼气容积(FEV1)与用力肺活量比值(FEV1/FVC)、FEV1占预计值、最大自主通气量(MVV)、深吸气量(IC)及血清和肽素(copeptin)、总抗氧化能力(TAC)、谷胱甘肽过氧化物酶(GSH-Px)、8-羟基脱氧鸟苷(8-OHdG)、内皮素-1(ET-1)水平。结果治疗后,治疗组患者总有效率是94.3%,较对照组81.1%显著提高(P<0.05)。治疗组各项典型表现(喘息、咳痰、咳嗽、肺部哮鸣音)的缓解时间均显著短于对照组(P<0.05)。治疗后,两组CASA-Q总分均显著增加,CAT问卷评分则显著降低(P<0.05);且治疗后,治疗组CASA-Q总分、CAT问卷评分改善优于对照组(P<0.05)。治疗后,两组FEV1/FVC、FEV1占预计值、MVV、IC值均较本组治疗前显著提高(P<0.05);且治疗后,治疗组肺功能参数值的提高作用较同期对照组更显著(P<0.05)。治疗后,两组血清copeptin、8-OHdG及ET-1水平均较本组治疗前显著下降,但血清TAC、GSH-Px水平则均显著上升(P<0.05);治疗后,治疗组血清学指标改善优于对照组(P<0.05)。结论乙酰半胱氨酸溶液联合特布他林治疗AECOPD总体疗效确切,能安全有效且迅速地缓解患者呼吸道症状,改善患者肺功能及生活质量,可能与机体炎症及氧化应激反应的显著减轻有关。

Objective To investigate the clinical effect of acetylcysteine solution combined with terbutaline in treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD). Methods A total of 106 AECOPD patients admitted to the emergency observation ward of Tianjin Fifth Central Hospital(Peking University Binhai Hospital) from February 2018 to February 2020 were selected and divided into control group(n=53) and treatment group(n=53) according to random number table method. The control group was treated with Terbutaline Sulfate Aerosol, 0.5 mg/time, 3 times daily. The treatment group was given Acetylcysteine Solution for Inhalation on the basis of the control group, 3 mL(1 ampoule)/time, twice daily. All patients were treated for 14 d. The clinical efficacy and remission time of typical symptoms of the two groups were observed. The total score of cough and sputum assessment Questionnaire(CASA-Q), the score of CAT questionnaire for patients with chronic obstructive pulmonary disease, the ratio of forced expiratory volume(FEV1) to forced pulmonary capacity(FEV1/FVC), the percentage of FEV1 in the estimated value%, the maximum spontaneous ventilation(MVV) and deep inspiratory volume(IC) were compared between the two groups before and after treatment. The levels of serum copeptin, total antioxidant capacity(TAC), glutathione peroxidase(GSH-Px), 8-hydroxydeoxyguanosine(8-OHdG) and endothelin-1(ET-1) were determined. Results After treatment, the total effective rate in the treatment group was 94.3%, significantly higher than that in the control group(81.1%)(P < 0.05). The relief time of typical symptoms(wheezing,expectoration, cough and pulmonary wheezing) in treatment group was significantly shorter than that in control group(P < 0.05). After treatment, CASA-Q scores in both groups were significantly increased, while CAT questionnaire scores were significantly decreased(P < 0.05). After treatment, CASA-Q total score and CAT questionnaire score in the treatment group were improved better than those in the control group(P < 0.05). After treatment, FEV1/FVC, FEV1%, MVV and IC values in two groups were significantly increased compared with those before treatment(P < 0.05);After treatment, the improvement of lung function parameters in the treatment group was more significant than that in the control group(P < 0.05). After treatment, the levels of serum Copeptin, 8-OHdG and ET-1 in two groups were significantly decreased compared with before treatment, but the levels of serum TAC and GSH-Px were significantly increased(P < 0.05). After treatment, serological indexes in the treatment group were better than those in the control group(P < 0.05).Conclusion Acetylcysteine solution combined with terbutaline has overall definite effect in treatment of acute exacerbation of chronic obstructive pulmonary disease, and can safely, effectively and rapidly relieve the respiratory symptoms of patients, improve the lung function and life quality of the patients, which may be significantly related to inflammation and oxidative stress.