N-乙酰半胱氨酸治疗社区获得性肺炎的效果

Effect Observation of N-acetylcysteine in Treatment of Community Acquired Pneumonia

目的探讨N-乙酰半胱氨酸治疗社区获得性肺炎的临床疗效。方法选取2012年11月至2014年11月唐山市人民医院诊治的156例社区获得性肺炎患者,采用随机数字法分为常规治疗组(78例)和N-乙酰半胱氨酸组(78例)。常规治疗组给予常规治疗,N-乙酰半胱氨酸组患者在常规治疗的基础上给予N-乙酰半胱氨酸(每次100 mg,每日3次)治疗,比较两组患者的的退热时间、抗生素使用时间、住院时间,治疗前后炎性因子、免疫指标水平以及血清降钙素原、动脉血氧分压、动脉血二氧化碳分压的变化。结果 N-乙酰半胱氨酸组患者的退热时间、抗生素使用时间、住院时间均明显短于常规治疗组[(3.8±0.7)d比(4.6±1.0)d、(12.5±2.4)d比(16.1±3.6)d、(17.2±3.5)d比(21.4±2.8)d](P<0.01),高敏C反应蛋白、白细胞介素6、肿瘤坏死因子α、白细胞计数、中性粒细胞计数、降钙素原、动脉血二氧化碳分压均明显低于常规治疗组[(7.8±1.1)mg/L比(16.2±3.0)mg/L、(71.3±15.2)ng/L比(102.4±17.8)ng/L、(2.6±0.3)μg/L比(3.1±0.4)μg/L、(6.1±0.7)×10~9/L比(7.6±0.9)×10~9/L、(2.0±0.5)×10~9/L比(2.8±0.6)×10~9/L、(1.2±0.3)μg/L比(2.0±0.4)μg/L、(40.2±4.1)mmHg(1 mmHg=0.133 k Pa)比(48.3±3.6)mmHg](P<0.01),B细胞、自然杀伤细胞、动脉血氧分压均明显高于常规治疗组[(36.7±2.8)%比(32.9±2.5)%、(58.3±7.6)%比(48.9±5.1)%、(72.8±6.2)mmHg比(66.5±7.1)mmHg](P<0.01)。结论 N-乙酰半胱氨酸是治疗社区获得性肺炎的有效药物,其可明显改善患者的免疫功能和炎性因子水平,显著缩短患者的治疗时间。

Objective To investigate the clinical effect of N-acetylcysteine in treatment of community acquired pneumonia. Methods Total of 156 patients with community acquired pneumonia were selected in Tangshan People's Hospital from Nov.2012 to Nov.2014,and then divided into a conventional group(78 cases) and N-acetylcysteine group( 78 cases) by random number method. The conventional group received conventional treatment. N-acetylcysteine group received N-acetylcysteine(100 mg every time,thrice a day)on the basis of conventional treatment. The pyretolysis time,antibiotics use time,hospitalization time,inflammatory factors before and after treatment,levels of immune indexes,changes of serum calcitonin,partial pressure of oxygen(PaO_2),partial pressure of carbon dioxide( PaCO_2) of the two groups were compared. Results Pyretolysis time,antibiotics use time,hospitalization time of the N-acetylcysteine group was significantly less than the conventional group[(3. 8 ± 0. 7) d vs( 4. 6 ± 1. 0) d,( 12. 5 ± 2. 4) d vs(16. 1 ± 3. 6) d,( 17. 2 ± 3. 5) d vs( 21. 4 ± 2. 8) d,P < 0. 01],while the levels of high-sensitivity C-reactive protein( hs-CRP),interleukin-6( IL-6),tumor necrosis factor-α( TNF-α),white blood cell count( WBC),neutrophil,procalcitonin,PaCO_2 were significantly lower than the conventional group[( 7. 8 ± 1. 1) mg / L vs( 16. 2 ±3. 0) mg / L,( 71. 3 ± 15. 2) ng / L vs( 102. 4 ± 17. 8) ng / L,( 2. 6 ± 0. 3) μg / L vs( 3. 1 ± 0. 4) μg / L,( 6. 1 ±0. 7) × 10~9/ L vs( 7. 6 ± 0. 9) × 10~9/ L,( 2. 0 ± 0. 5) × 10~9/ L vs( 2. 8 ± 0. 6) × 10~9/ L,( 1. 2 ±0. 3) μg / L vs( 2. 0 ± 0. 4) μg / L,( 40. 2 ± 4. 1) mmHg vs( 48. 3 ± 3. 6) mmHg,P < 0. 01],while B cells,NK cells,PaO_2 were significantly higher than the conventional group[( 36. 7 ± 2. 8) % vs( 32. 9 ± 2. 5) %,( 58. 3 ±7. 6) % vs( 48. 9 ±5. 1) %,( 72. 8 ±6. 2) mmHg vs( 66. 5 ±7. 1) mmHg,P <0. 01]. Conclusion N- acetylcysteine is an effective drug in treatment of community acquired pneumonia,which can significantly improve immune function and levels of inflammatory cytokines,which can also significantly shorten the treatment time.