Objective:To study the influence of ipratropium bromide combined with N-acety-L-cysteine (NAC) in the serum MMP-9 and TGF-βlevels of the patients with chronic obstructive pulmonary disease (COPD)in stable phase,and to discuss the role in airway remodeling of the COPD patients.Methods:Eighty patients with COPD in stable phase were randomly divided into NAC group (n = 27 ), ipratropium bromide group (n = 27 ), and combination group (n=26).26 cases of healthy volunteers were selected as control group.The clinical symptom and physical sign scores and the lung function indexes (FVC,FEV1 ,FEV1 %,and FEV1/FVC)were monitored and the serum TGF-βand MMP-9 levels of the patients in various groups were detected before and after treatment. The relationships between the value of FEV1 and the serum TGF-β and MMP-9 were analyzed with Spearman analysis.Results:Compared with before treatment,the symptom and physical sign scores of the patients in various treatment groups after treatment were significantly decreased (P < 0.05 ); compared with NAC group and ipratropium bromide group, the symptom and physical sign scores of the patients in combination group after treatment were significantly decreased (P <0.05).Compared with before treatment,the lung function indexes of the patients in various treatment groups after treatment were improved (P <0.05);compared with NAC group and ipratropium bromide group,the lung function indexes of the patients in combination group after treatment were significantly improved (P < 0.05).Compared with control group,the serum TGF-β and MMP-9 levels of the patients in various treatment groups before and after treatment were significantly decreased (P <0.05);compared with NAC group and ipratropium bromide group,the serum TGF-βand MMP-9 levels of the patients in combintion group were significantly decreased (P <0.05).The FEV1 values of the patients in combination group had negative correlations with the serum TGF-βand MMP-9 levels before and after treatment (before:r =-0.554,-0.477, P <0.05;after:r = - 0.415,- 0.654,P < 0.05).Conclusion:Ipratropium bromide combined with NAC can significantly improve the clinical symptoms,signs and lung function,and decrease the serum MMP-9 and TGF-βlevels.Therefore,it can inhibit the airway remodeling in the treatment of the COPD patients in stable phase.%目的：研究异丙托溴铵联合乙酰半胱氨酸（NAC）对慢性阻塞性肺疾病（COPD）稳定期患者血清中转化生长因子（TGF-β）和基质金属蛋白酶9（MMP-9）水平的影响，探讨其对 COPD 患者气道重塑的作用。方法：COPD 稳定期患者80例，随机分为 NAC 组（27例）、异丙托溴铵组（27例）和 NAC 与异丙托溴铵联合用药组（26例），同时选取健康志愿者26人做为对照组。监测各组患者治疗前后症状和体征评分及肺功能指标[用力肺活量（FVC）、第1秒钟用力呼气容积（FEV1）、第1秒钟用力呼气容积占预计值的百分比（FEV1％）及第1秒钟用力呼气容积占用力肺活量的百分比（FEV1／FVC）]，检测各组患者血清中 TGF-β和 MMP-9水平， FEV1值与血清中 TGF-β和 MMP-9水平的相关性采用 Spearman 相关分析。结果：与治疗前比较，治疗后各用药组患者症状和体征评分均明显降低（P ＜0.05）；与 NAC 组和异丙托溴铵组比较，联合用药组患者治疗后症状和体征评分降低更明显（P ＜0.05）。与治疗前比较，治疗后各用药组患者肺功能指标明显改善（P ＜0.05）；与NAC 组和异丙托溴铵组比较，联合用药组患者肺功能指标改善更明显（P ＜0.05）。与对照组比较，治疗前后各用药组患者血清中 TGF-β和 MMP-9水平均明显升高（P ＜0.05）；与治疗前比较，治疗后各用药组患者血清中TGF-β和 MMP-9水平均明显降低（P ＜0.05）；与 NAC 组和异丙托溴铵组比较，联合用药组患者血清中 TGF-β和 MMP-9水平降低更明显（P ＜0.05）。联合用药组患者治疗前后 FEV1值与血清中 TGF-β和 MMP-9水平呈负相关关系（治疗前：r＝－0.554，r＝－0.477，均 P ＜0.05；治疗后：r＝－0.415，r＝－0.654，均 P ＜0.05）。结论：异丙托溴铵联合 NAC 治疗可明显改善 COPD 患者症状、体征及肺功能，降低血清中 TGF-β和 MMP-9水平，在一定程度上抑制气道重塑。
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