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慢性阻塞性肺疾病(COPD)是全球范围内的公共卫生挑战,是目前全球第四大死亡原因[1]。COPD呈进行性发展趋势,慢性缺氧逐渐促使肺动脉压力升高[2],直至并发肺源性心脏病,导致心力衰竭,致残率及病死率极高,预后极差[3]。COPD引起肺心病发病的重要环节是肺动脉高压的形成,抑制肺动脉高压是防治COPD向肺心病发展的关键。目前COPD合并肺动脉高压的发病机制尚未完全阐明,涉及慢性炎症、内皮功能障碍、氧化应激、原位血栓形成等一系列机制,其中氧化应激在其病理生理过程中的重要作用越来越得到关注[4-6]。N-乙酰半胱氨酸(NAC)是一种巯基化合物,其巯基具有还原性及抗氧化性,是同时具有祛痰和抗氧化双重作用的药物[7],在临床已使用多年。本研究通过口服乙酰半胱氨酸辅助治疗老年COPD稳定期病人,观察其对肺动脉压力(PASP)、右心室射血分数(RVEF)和血清C反应蛋白(CRP)、过氧化物歧化酶(SOD)水平的影响, 探讨其临床应用价值。
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结果显示,随着治疗时间的延长,2组病人CRP均有下降趋势,观察组病人治疗后1个月和2个月CRP水平均显著低于治疗前水平(P < 0.01),而对照组不同时间CRP水平差异无统计学意义(P>0.05)。2组间比较,仅在治疗2个月后发现CRP的下降2组间差异有统计学意义(P < 0.01)。随着治疗时间的延长,2组病人SOD水平均有上升趋势,观察组病人治疗2个月后SOD水平显著高于治疗前及治疗1个月后水平(P < 0.01),而对照组不同时间SOD水平差异无统计学意义(P>0.05)。2组之间比较,治疗1个月、2个月后SOD的上升2组间差异有统计学意义(P < 0.05和P < 0.01)(见表 1)。
分组 治疗前 治疗后1个月 治疗后2个月 F P MS组内 CRP/(mg/L) 观察组 5.45±2.38 3.90±1.86** 3.10±1.71** 11.73 < 0.01 4.016 对照组 5.10±1.95 4.75±1.71 4.59±1.62 0.72 >0.05 3.117 t 0.65 1.93 3.63 — — — P >0.05 >0.05 < 0.01 — — — SOD/(U/mL) 观察组 120.33±22.21 126.64±15.53 136.06±18.00**# 5.86 < 0.01 352.822 对照组 115.03±17.23 118.15±14.49 120.12±13.62 0.94 >0.05 230.779 t 1.08 2.30 4.06 — — — P >0.05 < 0.05 < 0.01 — — — q检验:与治疗前比较*P < 0.05,**P < 0.01;与治疗后1个月比较#P < 0.05 表 1 2组病人治疗前后CRP与SOD的变化(ni=33)
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随着治疗时间的延长,2组病人PASP均有下降趋势,观察组病人治疗1个月和2个月后PASP水平显著低于治疗前水平(P < 0.05和P < 0.01),而对照组不同时间PASP水平差异无统计学意义(P>0.05)。2组之间比较,仅在治疗2个月后发现PASP的下降2组间差异有统计学意义(P < 0.05)。随着治疗时间的延长,2组病人RVEF均有上升趋势,但治疗后RVEF的上升在组内及组间比较差异均无统计学意义(P>0.05)(见表 2)。
分组 治疗前 治疗后1个月 治疗后2个月 F P MS组内 PASP/mmHg 观察组 43.27±11.21 37.73±9.98* 33.61±8.08** 8.01 < 0.01 96.850 对照组 39.76±11.87 39.09±11.07 38.30±10.67 0.14 >0.05 125.764 t 1.24 0.52 2.01 — — — P >0.05 >0.05 < 0.05 — — — RVEF/% 观察组 61.33±2.61 61.76±2.68 62.21±2.68 0.91 >0.05 7.059 对照组 60.67±2.39 60.82±2.40 61.21±2.41 0.45 >0.05 5.760 t 1.07 1.50 1.59 — — — P >0.05 >0.05 >0.05 — — — q检验:与治疗前比较*P < 0.05,**P < 0.01 表 2 2组病人治疗前后PASP与RVEF的变化(ni=33)
乙酰半胱氨酸辅助治疗对老年COPD稳定期病人肺动脉压力、右心室射血分数和血清CRP、SOD水平的影响
Effect of acetylcysteine adjuvant therapy on pulmonary artery pressure, right ventricular ejection fraction and serum levels of CRP and SOD in elderly patients with COPD at stable stage
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摘要:
目的观察乙酰半胱氨酸对老年慢性阻塞性肺疾病(COPD)稳定期病人肺动脉压力(PASP)、右心室射血分数(RVEF)和血清C反应蛋白(CRP)、过氧化物歧化酶(SOD)水平的影响,探讨其临床应用价值。 方法选择老年COPD稳定期病人共66例为研究对象。将病人随机分为对照组和观察组,每组33例。对照组病人给予常规治疗,观察组在常规治疗基础上加用乙酰半胱氨酸片口服,疗程2个月。分别于治疗前及治疗后1个月、2个月,运用心脏彩超测定2组病人的PASP、RVEF的变化,并检测其血清CRP、SOD水平的变化。 结果治疗后2组的PASP、CRP均较治疗前下降,但仅治疗2个月后PASP、CRP的下降观察组较对照组差异有统计学意义(P < 0.05和P < 0.01)。治疗后2组的SOD均较治疗前上升,且SOD的上升观察组较对照组差异有统计学意义(P < 0.05和P < 0.01)。治疗后RVEF的上升在2组内及组间差异均无统计学意义(P>0.05)。 结论联合使用乙酰半胱氨酸治疗老年COPD稳定期病人有利于肺动脉压力的控制,且可能通过抑制炎症反应、改善抗氧化能力而实现,对于此类病人具有临床应用价值。 Abstract:ObjectiveTo observe the effects of acetylcysteine adjuvant therapy on pulmonary artery pressure(PASP), right ventricular ejection fractions(RVEF) and serum levels of C-reactive protein(CRP) and superoxide dismutase(SOD) in elderly patients with chronic obstructive pulmonary disease(COPD) at stable stage, and investigate its clinical application value. MethodsSixty-six elderly patients with stable COPD were divided randomly into the control group and observation group(33 cases in each group).The control group was treated with conventional therapy, and observation group was treated with conventional therapy combined with oral acetylcysteine for 2 months.The levels of PASP and RVEF were detected using echocardiography, and the serum levels of CRP and SOD were measured in two groups before and after 1 and 2 months of treatment. ResultsAfetr treatment, the levels of PASP and CRP in two groups decreased compared with before treatment, and the differences of the decreasing degree of levels of PASP and CRP between two groups after 2 months of treatment were statistically significant(P < 0.05 and P < 0.01).Afetr treatment, the levels of SOD in two groups increased compared with before treatment, and the difference of the increasing degree of level of SOD between two groups was statistically significant(P < 0.05 and P < 0.01).The differences of the increasing degree of RVEF between and within two groups were not statistically significant(P>0.05). ConclusionsThe combined use of acetylcysteine in the treatment of elderly patients with COPD at stable stage is beneficial to the control of pulmonary artery pressure by inhibiting inflammatory response and improving antioxidant capacity, which has clinical application value. -
表 1 2组病人治疗前后CRP与SOD的变化(ni=33)
分组 治疗前 治疗后1个月 治疗后2个月 F P MS组内 CRP/(mg/L) 观察组 5.45±2.38 3.90±1.86** 3.10±1.71** 11.73 < 0.01 4.016 对照组 5.10±1.95 4.75±1.71 4.59±1.62 0.72 >0.05 3.117 t 0.65 1.93 3.63 — — — P >0.05 >0.05 < 0.01 — — — SOD/(U/mL) 观察组 120.33±22.21 126.64±15.53 136.06±18.00**# 5.86 < 0.01 352.822 对照组 115.03±17.23 118.15±14.49 120.12±13.62 0.94 >0.05 230.779 t 1.08 2.30 4.06 — — — P >0.05 < 0.05 < 0.01 — — — q检验:与治疗前比较*P < 0.05,**P < 0.01;与治疗后1个月比较#P < 0.05 表 2 2组病人治疗前后PASP与RVEF的变化(ni=33)
分组 治疗前 治疗后1个月 治疗后2个月 F P MS组内 PASP/mmHg 观察组 43.27±11.21 37.73±9.98* 33.61±8.08** 8.01 < 0.01 96.850 对照组 39.76±11.87 39.09±11.07 38.30±10.67 0.14 >0.05 125.764 t 1.24 0.52 2.01 — — — P >0.05 >0.05 < 0.05 — — — RVEF/% 观察组 61.33±2.61 61.76±2.68 62.21±2.68 0.91 >0.05 7.059 对照组 60.67±2.39 60.82±2.40 61.21±2.41 0.45 >0.05 5.760 t 1.07 1.50 1.59 — — — P >0.05 >0.05 >0.05 — — — q检验:与治疗前比较*P < 0.05,**P < 0.01 -
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