不同剂量N—乙酰半胱氨酸对不同病期慢性阻塞性肺疾病患者氧化应激及炎性反应介质和免疫功能的影响

肖伟峰+苗虎+范元

[摘要] 目的 探討不同剂量N-乙酰半胱氨酸对不同病期慢性阻塞性肺疾病患者氧化应激及炎性反应介质和免疫功能的影响。方法 根据入选及排除标准分为急性加重期组与稳定期组，再依据住院尾号单双数分为大剂量组或常规治疗组。各组患者均不限制常规药物治疗。大剂量组（观察组）予NAC 600mg，3次/d，常规治疗组予NAC 600mg，2次/d，疗程8周。观察各组在应用N-乙酰半胱氨酸8周后氧化应激指标（MDA、SOD）和炎性介质（CRP、IL-6、IL-8）水平及T淋巴细胞亚群 CD3+、CD4+、CD8+和CD4+/CD8+的变化。结果 在急性加重期与稳定期两组治疗后数据显示，SOD均较同组治疗前明显升高，与治疗前相比，MDA及各项血清炎性因子水平均明显降低，差异有统计学意义，且与对照组相比，观察组治疗后SOD水平显著增高，MDA与各项血清炎性因子水平均显著低于对照组治疗后（P<0.05）。与治疗前相比，CD3+、CD4+、CD4+/CD8+均明显升高，CD8+明显降低，差异有统计学意义；且与对照组相比，观察组治疗后的 CD3+、CD4+、CD4+/CD8+水平明显增高，CD8+亦明显降低。结论 大剂量N-乙酰半胱氨酸在治疗COPD患者时增加机体抗氧化应激能力，减少炎性细胞因子及调节T淋巴细胞亚群水平，增强细胞免疫功能方面优于常规量治疗，且临床应用安全可靠。

[关键词] N-乙酰半胱氨酸；慢性阻塞性肺病；氧化应激；炎性介质；免疫功能

[中图分类号] R563 [文献标识码] A [文章编号] 2095-0616（2017）13-17-05

[Abstract] Objective To explore the influence of different doses of N- acetyl cysteine to oxidative stress and inflammatory response mediators and immune function of patients with chronic obstructive pulmonary disease at different stages of disease. Methods According to the inclusion and exclusion criteria， they were divided into two groups： acute exacerbation group and stable stage group. According to length of single and double tail number， they were divided into large dose group and conventional treatment group. Patients in each group were not restricted to conventional medication. Patients in large dose group（observation group） were treated with NAC600mg， 3 times per day， and the routine treatment group was given NAC600mg， 2 times per day， course of treatment 8W. The levels of oxidative stress（MDA， SOD） and inflammatory mediators （CRP， IL-6， IL-8） were measured after the application of N- N-acetylcysteine 8W and change of T lymphocyte subsets CD3+， CD4+， CD8+ and CD4+/CD8+ of each group were observed. Results In the acute exacerbation phase and the stable stage after treatment， the data showed that SOD was significantly higher than that of the same group before treatment， compared with before treatment， MDA and serum inflammatory factors were significantly lower， the difference was statistically significant， compared with the control group， the level of SOD in the observation group was significantly increased， the levels of MDA and serum inflammatory factors were significantly lower than those of the control group（P<0.05）. Compared with before treatment， CD3+， CD4+， CD4+/CD8+ after treatment were significantly increased， CD8+ were significantly decreased， the difference was statistically significant. And compared with the control group， CD3+， CD4+， CD4+/CD8+ of observation group were significantly increased， CD8+ were significantly decreased， the difference was statistically significant. Conclusion Large doses of N-acetylcysteine can increase antioxidant stress in patients with COPD， reduce inflammatory cytokines and regulate the level of T lymphocyte subsets. Enhancing cellular immune function is superior to routine dose therapy. And the clinical application is safe and reliable.

[Key words] N-acetyl cysteine； Chronic obstructive pulmonary disease； Oxidative stress； Inflammatory mediators； Immune function

慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）是具有气道阻塞特征的慢性支气管炎和（或）肺气肿。其患病数多，而且，病程长、迁延不愈，嚴重降低患者的生活质量，给患者的工作和生活带来较大影响[1-2]。本项目拟探讨不同剂量N-乙酰半胱氨酸（N-acetylcysteine，NAC）对不同病期慢性阻塞性肺疾病患者的氧化应激及炎性反应介质，以及免疫功能的影响，并对其对比分析。

1 资料与方法

1.1 一般资料

选取2015年8月～2016年12月期间我院呼吸内科及老年病科收治的207例COPD患者，均符合2013 年《慢性阻塞性肺疾病诊治指南（修订……