N-乙酰半胱氨酸联合氨茶碱治疗慢性肺源性心脏病患者的临床疗效及对血清BNP、CRP水平的影响

Clinical efficacy of N-acetylcysteine combined with aminophylline in the treatment of chronic pulmonary heart disease and its impact on serum BNP and CRP levels

目的探讨N-乙酰半胱氨酸联合氨茶碱治疗慢性肺源性心脏病患者的临床疗效及对血清B型钠尿肽(BNP)、C反应蛋白(CRP)水平的影响。方法前瞻性选取2020年8月至2022年8月湖北医药学院附属太和医院收治的152例慢性肺源性心脏病患者作为研究对象,按照随机数字表法将其分为氨茶碱组(n=76)和联合组(n=76)。氨茶碱组给予氨茶碱治疗,联合组给予N-乙酰半胱氨酸联合氨茶碱治疗,两组患者均连续治疗2周。比较两组患者临床疗效,治疗前后的肺功能指标[用力肺活量(FVC)、第一秒用力呼气容积(FEV1)、第一秒用力呼气容积占预计值百分比(FEV1%)、最大呼气流量(PEF)],心功能指标[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心房舒张末期内径(LAEDD)],血清BNP、CRP水平,血气指标[氧分压(PO_(2))、二氧化碳分压(PCO_(2))]以及不良反应发生情况。结果联合组的总有效率明显优于氨茶碱组,差异有统计学意义(P<0.05)。治疗2周后,两组患者FVC、FEV1、FEV1%、PEF、LVEF、PO_(2)水平均较治疗前升高,且联合组FVC、FEV1、FEV1%、PEF、LVEF、PO_(2)水平分别为(3.68±0.83)L、(2.87±0.51)L、(68.54±10.17)%、(80.56±13.21)L/min、(64.17±8.03)%、(78.45±13.16)mmHg,均高于氨茶碱组[(2.96±0.53)L、(2.32±0.46)L、(62.18±10.32)%、(74.17±11.27)L/min、(50.26±5.83)%、(70.27±12.43)mmHg],差异均有统计学意义(P<0.05)。治疗2周后,两组患者LVEDD、LAEDD、BNP、CRP、PCO_(2)水平均较治疗前降低,且联合组LVEDD、LAEDD、BNP、CRP、PCO_(2)水平分别为(43.16±5.61)mm、(29.16±3.27)mm、(215.37±32.33)pg/mL、(11.22±1.17)mg/L、(52.17±6.24)mmHg,均低于氨茶碱组[(54.14±6.18)mm、(35.17±3.96)mm、(289.16±44.89)pg/mL、(14.28±1.83)mg/L、(58.26±7.43)mmHg],差异均有统计学意义(P<0.05)。联合组不良反应发生率稍高于氨茶碱组,但两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论N-乙酰半胱氨酸联合氨茶碱治疗能够提高慢性肺源性心脏病患者肺功能及心功能、改善血气指标,降低BNP及CRP水平,具有较好的疗效。

Objective To investigate the clinical efficacy of N-acetylcysteine combined with aminophylline in the treatment of chronic pulmonary heart disease and its impact on serum B-type natriuretic peptide(BNP)and C-reactive protein(CRP)levels.Methods One hundred and fifty-two patients with chronic pulmonary heart disease admitted to Taihe Hospital Affiliated Hospital of Hubei University of Medicine from August 2020 to August 2022 were prospectively selected as the study subjects.They were randomly divided into aminophylline group(n=76)and combination group(n=76)according to random number table method.The aminophylline group was treated with aminophylline,and the combination group was treated with N-acetylcysteine and aminophylline.Both groups of patients were treated continuously for 2 weeks.The clinical efficacy,lung function indexes[forced vital capacity(FVC),forced expiratory volume in the first second(FEV1),the percentage of forced expiratory volume in the first second to predicted value(FEV1%),peak expiratory flow(PEF)],cardiac function indicators[left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD),left atrial end diastolic diameter(LAEDD)],serum BNP,CRP levels,blood gas indicators[oxygen partial pressure(PO_(2)),partial pressure of carbon dioxide(PCO_(2))]before and after treatment of patients in the two groups were compared.The occrence of adverse reaction was compared between the two groups.Results The total effective rate of the combination group were significantly better than those of aminophylline group,the differences were statistically significant(P<0.05).After 2 weeks of treatment,the levels of FVC,FEV1,FEV1%,PEF,LVEF and PO_(2)in the two groups were higher than those before treatment,and the levels of FVC,FEV1,FEV1%,PEF,LVEF,and PO_(2)in the combination group were(3.68±0.83)L,(2.87±0.51)L,(68.54±10.17)%,(80.56±13.21)L/min,(64.17±8.03)%,(78.45±13.16)mmHg,respectively,which were higher than those in the aminophylline group[(2.96±0.53)L,(2.32±0.46)L,(62.18±10.32)%,(74.17±11.27)L/min,(50.26±5.83)%,(70.27±12.43)mmHg],the differences were statistically significant(P<0.05).After 2 weeks of treatment,the levels of LVEDD,LAEDD,BNP,CRP and PCO_(2)in the two groups were lower than those before treatment,and the levels of LVEDD,LAEDD,BNP,CRP and PCO_(2)in the combination group were(43.16±5.61)mm,(29.16±3.27)mm,(215.37±32.33)pg/mL,(11.22±1.17)mg/L,(52.17±6.24)mmHg,respectively,which were lower than the aminophylline group[(54.14±6.18)mm,(35.17±3.96)mm,(289.16±44.89)pg/mL,(14.28±1.83)mg/L,(58.26±7.43)mmHg],the differences were statistically significant(P<0.05).The incidence of adverse reactions in combination group was higher than that in aminophylline group,and there was no statistical significance between the two groups(P>0.05).Conclusion N-acetylcysteine combined with aminophylline therapy can improve pulmonary function and heart function,improve blood gas indicators,and reduce BNP and CRP levels in patients with chronic pulmonary heart disease,with a good effect.