N-乙酰半胱氨酸泡腾片辅助治疗急性加重期哮喘-慢性阻塞性肺疾病重叠的临床疗效观察

摘要

目的 探讨N-乙酰半胱氨酸(NAC)辅助治疗急性加重期哮喘-慢性阻塞性肺疾病重叠(ACO)的临床疗效.方法 将2016年3月至2018年8月在河南省人民医院呼吸与危重症学科收治的146例急性加重期ACO患者,以随机数字表法分为对照组和观察组各73例.对照组住院期间给予支气管扩张剂、吸入性糖皮质激素及低流量吸氧等临床治疗,出院后继续使用布地奈德福莫特罗粉吸入剂联合噻托溴铵粉雾剂治疗至4周;观察组在对照组的基础上加用NAC 600 mg冲服,2次/d,用至4周.收集患者的基线资料及住院时间,记录两组患者治疗前后血常规、C-反应蛋白(CRP)、第一秒用力呼气容积占用力肺活量的比值(FEV1/FVC)、第1秒用力呼气容积占预计值的百分比(FEV1%pred)等指标,比较两组患者的临床疗效及药物不良反应.结果 两组治疗后白细胞计数、嗜酸性粒细胞计数、中性粒细胞计数、CRP 、FEV1/FVC、FEV1%pred均较治疗前明显改善,差异有统计学意义(P＜0.05);观察组治疗后白细胞计数、嗜酸性粒细胞计数、中性粒细胞计数、CRP 明显低于对照组[(7.40 ± 1.12)× 109/L 比(8.34 ± 1.56)× 109/L、(0.30 ± 0.15)× 109/L 比(0.42 ± 0.18)× 109/L、(3.76 ± 1.49)× 109/L 比(4.58 ± 1.72)× 109/L、(5.33 ± 1.65) mg/L 比(5.95 ± 1.74)mg/L],差异有统计学意义(P＜0.05);观察组治疗后FEV1/FVC、FEV1%pred与对照组比较差异无统计学意义(P>0.05).观察组治疗后总有效率明显高于对照组[94.52%(69/73)比82.19%(60/73)],差异有统计学意义(P＜0.05);治疗过程中,观察组住院时间较对照组缩短[(5.82 ± 2.29)d比(7.25 ± 3.05)d],差异有统计学意义(P＜0.05),观察组不良反应发生率与对照组比较差异无统计学意义(P>0.05).结论 NAC辅助治疗急性加重期ACO可以明显抑制患者的炎性反应水平,缩短患者的住院时间.%Objective To investigate clinical efficacy of N-acetylcysteine (NAC) in the adjuvant treatment of patients with acute exacerbation of asthma-chronic obstructive pulmonary disease overlap (ACO). Methods One hundred and forty-six patients with acute exacerbation of ACO admitted to department of respiratory and critical care medicine of Henan provincial people′s hospital from March 2016 to August 2018 were divided into control group and observation group according to random number table, with 73 patients in each group. The control group was given clinical treatment such as bronchodilator, inhaled glucocorticoid and low- flow oxygen inhalation during hospitalization, and inhalation of budesonide/formoterol fumarate powder combined with tiotropium was continued after discharge. The treatment lasted for 4 weeks. The observation group was added with NAC 600 mg, twice daily, totally for 4 weeks on the basis of the control group. Baseline data and duration of hospital stay were collected. Before and after treatment, blood routine, c-reactive protein (CRP), forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) and FEV1% pred were recorded. Clinical efficacy and adverse drug reaction were compared between the two groups. Results The white blood cell count, eosinophil count, neutrophil count, CRP, FEV1/FVC and FEV1% pred of two groups were significantly ameliorative after treatment compared with those before treatment, and the difference was statistically significant (P < 0.05). The white blood cell count, eosinophil count, neutrophil count and CRP after treatment in observation group were significantly lower than those in control group: (7.40 ± 1.12)×109/L vs. (8.34 ± 1.56) ×109/L, (0.30 ± 0.15) ×109/L vs. (0.42 ± 0.18) ×109/L, (3.76 ± 1.49) ×109/L vs. (4.58 ± 1.72) × 109/L, (5.33 ± 1.65) mg/L vs. (5.95 ± 1.74) mg/L, and the differences were statistically significant (P<0.05). There were no statistical differences in FEV1/FVC and FEV1%pred after treatment between observation group and control group (P > 0.05). The total effective rate after treatment in observation group was significantly higher than that in control group: 94.52% (69/73) vs. 82.19% (60/73), and the difference was statistically significant (P<0.05). During the treatment, duration of hospital stay in observation group was shorter than that in control group: (5.82 ± 2.29) d vs. (7.25 ± 3.05) d, and the difference was statistically significant (P<0.05). The incidence of adverse reactions in observation group was compared with control group: 10.96% (8/73) vs.5.48% (4/73), and the difference was not statistically significant (P > 0.05). Conclusions NAC has a significant effect in adjuvant treatment of acute exacerbation of ACO, which can significantly inhibit the level of inflammation and shorten the length of hospital stay.