异丙托溴铵联合乙酰半胱氨酸治疗慢性阻塞性肺疾病稳定期患者的疗效观察

doi:10.3969/j.issn.2095-3755.2018.02.009

摘要/Abstract

摘要：

目的探究采用异丙托溴铵联合乙酰半胱氨酸对慢性阻塞性肺疾病(COPD)稳定期患者治疗的疗效,以及血清转化生长因子-β(TGF-β)和基质金属蛋白酶9(MMP-9)水平的影响。方法选取2015年1月至2017年6月辽宁省鞍山市第三医院收治的90例COPD患者作为研究对象。采用抽签法将研究对象分为观察组和对照组,每组45例。对照组予以异丙托溴铵治疗,观察组予以异丙托溴铵联合乙酰半胱氨酸治疗,比较两组患者的临床疗效、肺呼吸功能改善情况及TGF-β和MMP-9水平变化。结果观察组患者的总有效率为95.6%(43/45),高于对照组的71.1%(32/45),差异有统计学意义(χ ²=9.68,P=0.002)。观察组患者治疗后的1s用力呼气容积(FEV₁)为(1.87±0.51)L,用力肺活量(FVC)为(1.75±0.32)L,FEV₁/FVC为(63.94±5.20)%,均高于对照组[(1.62±0.42)L、(1.39±0.16)L、(55.86±6.42)%],差异均有统计学意义(t值分别为2.68、7.40、6.71,P值均<0.01)。观察组患者治疗后的血清TGF-β和MMP-9水平分别为(82.98±7.36)ng/L和(86.25±6.98)μg/L,均低于对照组[(93.03±7.91)ng/L和(96.75±8.73)μg/L],差异均有统计学意义(t值分别为5.89和6.13,P值均<0.01)。结论异丙托溴铵联合乙酰半胱氨酸治疗COPD稳定期患者的临床疗效显著,能有效降低血清TGF-β和MMP-9水平。

关键词: 肺疾病, 慢性阻塞性, 异丙托铵, 乙酰半胱氨酸, 转化生长因子β, 基质金属蛋白酶9, 疗效比较研究

Abstract:

Objective To study the efficacy of ipratropium bromide combined with N-acety-L-cysteine in patients with chronic obstructive pulmonary disease (COPD) in stable phase, and to analyze the effect of the treatment strategy on serum transforming growth factor beta (TGF-β) and matrix metalloproteinase 9 (MMP-9) levels.Methods A total of 90 COPD patients in Third Hospitals of Anshan from January 2015 to June 2017 were selected. The subjects were divided into the observation group (45 cases) and the control group (45 cases) by draw method. Patients in the control group were treated with ipratropium bromide, whereas patients in the observation group were treated with ipratropium bromide combined with N-acety-L-cysteine. The clinical efficacy, improvement in pulmonary respiratory function, and serum MMP-9 and TGF-β levels were compared between the two groups.Results The effective rate of the observation group (95.6%, 43/45) was higher than that of the control group (71.1%, 32/45), and the difference was statistically significant (χ ²=9.68, P=0.002). After treatment, the forced expiratory volume in one second (FEV₁; (1.87± 0.51)L), forced vital capacity (FVC; (1.75±0.32)L) and FEV₁/FVC ((63.94±5.20)%) of the observation group were better than the control group ((1.62±0.42)L, (1.39±0.16)L, (55.86±6.42)%). The differences were statistically significant (t=2.68, 7.40, 6.71, all P<0.01). After treatment, the serum TGF-β ((82.98±7.36) ng/L) and MMP-9 ((86.25±6.98)μg/L) levels in the observation group were higher than those of the control group ((93.03±7.91) ng/L, (96.75±8.73)μg/L). The difference were statistically significant (t=5.89, 6.13, all P<0.01). Conclusion Ipratropium bromide combined with N-acety-L-cysteine has significant efficacy in the treatment of COPD in stable phase. It can reduce the levels of TGF-β and MMP-9.

Key words: Pulmonary disease, chronic obstructive, Ipratropium, Acetylcysteine, Transforming growth factor beta, Matrix metalloproteinase 9, Comparative effectiveness research

李树贵. 异丙托溴铵联合乙酰半胱氨酸治疗慢性阻塞性肺疾病稳定期患者的疗效观察[J]. 结核病与肺部健康杂志, 2018, 7(2): 120-122. doi: 10.3969/j.issn.2095-3755.2018.02.009

Shu-gui. LI. Influence of ipratropium bromide combined with N-acety-L-cysteine in patients with chronic obstructive pulmonary disease in stable phase[J]. Journal of Tuberculosis and Lung Health, 2018, 7(2): 120-122. doi: 10.3969/j.issn.2095-3755.2018.02.009

图/表 2

表1

表2

对照组与观察组治疗前后血清中转化生长因子-β和基质金属蛋白酶9水平

组别	TGF-β(ng/L, $x ˉ$ ±s)	MMP-9(μg/L, $x ˉ$ ±s)
对照组
治疗前	114.05±8.20	119.87±10.02
治疗后	93.03±7.91	96.75±8.73
t值	5.26	6.14
P值	<0.01	<0.01
观察组
治疗前	113.97±8.14	120.01±10.23
治疗后	82.98±7.36	86.25±6.98
t值	9.58	8.79
P值	<0.01	<0.01

表2

参考文献 5

[1]	中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南(2007年修订版). 中华内科杂志, 2007,46(3):254-261. doi: 10.3760/cma.j.issn.1001-0939.2013.04.007 URL
[2]	路恩丽, 于振香 . 异丙托溴铵和乙酰半胱氨酸对稳定期COPD患者气道重塑的影响. 中国老年学杂志, 2016,36(22):5645-5647. doi: 10.3969/j.issn.1005-9202.2016.22.069 URL
[3]	彭先祝, 李竹英, 王雪慧 . 通腑化痰中药汤剂联合西药综合治疗慢性阻塞性肺疾病急性加重期的临床观察. 蚌埠医学院学报, 2017,42(4):434-436.
[4]	Biswas S, Hwang JW, Kirkham PA , et al. Pharmacological and dietary antioxidant therapies for chronic obstructive pulmonary disease. Curr Med Chem, 2013,20(12):1496-1530. doi: 10.2174/0929867311320120004 URL
[5]	韩晶, 毛锦娟 . N-乙酰半胱氨酸对老年慢性阻塞性肺疾病患者肺功能及细胞因子的影响. 临床肺科杂志, 2016,21(6):1139-1141. doi: 10.3969/j.issn.1009-6663.2016.06.051 URL

[1]	王颖, 蔡春葵, 许岩, 孙诗学, 李刚, 顾晓峰, 于洋. 利奈唑胺治疗广泛耐药肺结核疗效分析[J]. 结核与肺部疾病杂志, 2020, 1(2): 136-139.
[2]	吴竞, 许岩, 方咏梅, 张晶晶, 章燕, 钟峰. 荧光染色联合1,3-β-D葡聚糖检测对慢性阻塞性肺疾病并发真菌感染的诊断价值[J]. 结核与肺部疾病杂志, 2020, 1(2): 140-143.
[3]	肖阳宝, 罗林紫, 卢志斌, 冯丹, 白丽琼, 罗莉. 超声引导下淋巴结穿刺注射给药联合冷冻治疗破溃期淋巴结瘘型气管支气管结核的价值[J]. 结核与肺部疾病杂志, 2020, 1(2): 149-153.
[4]	蒋玲, 罗廷茹, 周小琦, 唐娜, 蒙昌平, 钱春芳. 含利奈唑胺化疗方案治疗重症结核性脑膜炎的效果评价[J]. 结核病与肺部健康杂志, 2020, 9(1): 44-48.
[5]	刘思梅, 奚修凤, 李冰. 呼吸训练干预对慢性阻塞性肺疾病患者呼吸功能和生活质量的影响[J]. 结核与肺部疾病杂志, 2020, 1(1): 34-38.
[6]	周正华,温保江,龚声宏,梁志勇. 血清降钙素原、超敏C反应蛋白及D-二聚体联合检测在慢性阻塞性肺疾病急性加重期患者预后预测中的价值[J]. 结核病与肺部健康杂志, 2019, 8(4): 289-293.
[7]	常丽,林红,孙素芹,庞有铨,边楠楠,甄春英,关雪晴,杨浩,刘雪梅. 核苷酸切除修复交叉互补组1和肺耐药蛋白不同表达水平对顺铂治疗恶性胸腔积液的影响[J]. 结核病与肺部健康杂志, 2019, 8(3): 178-182.
[8]	梁爽,韩东伟,钟威,毛宁,刘毅,蒋轶文. 抗结核固定剂量复合制剂联合左氧氟沙星治疗复治涂阳肺结核患者的效果分析[J]. 结核病与肺部健康杂志, 2019, 8(2): 149-152.
[9]	柳杞,李冰. 同伴支持的护理干预对慢性阻塞性肺疾病患者呼吸功能与生活质量的影响[J]. 结核病与肺部健康杂志, 2019, 8(1): 69-72.
[10]	付伟,黄友玲,李冰. 感恩干预对改善慢性阻塞性肺疾病患者负性情绪和生活质量的研究[J]. 结核病与肺部健康杂志, 2018, 7(2): 142-145.
[11]	李树贵. 常规治疗加复合乳酸菌口服对中老年慢性阻塞性肺疾病急性加重期的疗效[J]. 结核病与肺部健康杂志, 2018, 7(1): 64-67.
[12]	马艳,黄麦玲,杜建,舒薇,谢仕恒,王红红,谭守勇,李向群,傅衍勇,马丽萍,张联英,刘飞鹰,胡代玉,张艳玲,刘宇红,李亮. ≥65岁与<65岁肺结核患者治疗效果的对比分析[J]. 结核病与肺部健康杂志, 2018, 7(1): 54-59.
[13]	徐伟,武丽娟,沈宁,曹文利. 结核相关阻塞性肺疾病稳定期的诊治研究[J]. 结核病与肺部健康杂志, 2017, 6(3): 270-274.
[14]	薛声波，吴桂辉，何畏，等. 艾滋病并发肺结核患者行抗结核药物治疗的效果观察[J]. 结核病与肺部健康杂志, 2017, 6(1): 32-35.
[15]	吴重重,赵绍宏,聂永康,蔡祖龙,杨立,金鑫. 免疫正常与抑制患者原发性肺隐球菌病的CT征象分析[J]. 结核病与肺部健康杂志, 2015, 4(3): 162-168.