N-乙酰半胱氨酸治疗肺炎患儿全身炎症反应综合征的临床研究

目的探讨N-乙酰半胱氨酸（NAC）在小儿肺炎治疗及预防全身炎症反应综合征（SIRS）中的作用。方法将90例肺炎伴SIRS患儿随机分为治疗组和对照组,治疗组常规治疗结合富露施（乙酰半胱氨酸颗粒）口服或胃管注入,对照组常规治疗结合复方甘草合剂治疗。于治疗前和治疗后第6天查血清中白介素-1（IL-1）、白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、ALT、AST和CR的浓度,并观察肺炎相关症状和体征变化。结果治疗组治疗整体有效率为91.1%,对照组治疗整体有效率为75.6%,治疗组疗效高于对照组（P〈0.05）;住院天数较对照组少;临床分期Ⅰ期、Ⅱ期治疗组有效率与对照组相同,Ⅲ期、Ⅳ期治疗有效率高于对照组;Ⅴ期两组患儿均疗效欠佳,死亡率均为100%;两组治疗后血ALT、CR、IL-6、TNF水平较治疗前均明显下降,但治疗组较对照组下降更为明显（P〈0.01）。结论早期使用NAC可降低炎症反应对各器官的损伤,改善肝肾功能,缩短肺炎病程和提高治愈率;NAC可能通过调控IL-6和TNF-α等炎症因子水平,一定程度上干预肺炎患儿SIRS向多脏器功能不全综合征（MODS）进展,减少MODS的发生。

Clinical Research for Application of N-acetylcysteine in Children with Pneumonia and SIRS

Objective To investigate the role of N-acetylcysteine（NAC） in pneumonia therapy and prophylaxis of systemic inflammatory response syndrome（SIRS） in children.Methods Two groups were studied：control and NAC.Plasma levels of interleukin-1（IL-1）,interleukin-6（IL-6）,tumor necrosis factor-α（TNF-α）,alanine aminotransferase（ALT）,aspartate aminotransferase（AST） and creatinine（CR） were determined.Sings and symptoms were observed and recorded.Results Total effective rate was higher in the NAC group as compared with the control group（P0.05）.Hospitalization day（HOD） in the NAC group was less than the control group.Effectiveness was non-specific between the two groups at clinical stageⅠ,Ⅱand Ⅴ,but higher in the NAC group at clinical stage Ⅲ and Ⅳ.Plasma levels of IL-6,TNF-α,ALT and CR were decreased post-treatment in both NAC and control group,but decreased obviously in the NAC group（P0.01）.Conclusions Application of NAC early in children with pneumonia could lessen the organ damage caused by inflammatory reaction,and shorten the hospitalization day.Because of regulating the level of inflammatory factor such as IL-6,TNF-α etc.NAC might interfere the proceeding of multiorgan dysfunction syndrome（MODS）induced by SIRS,and reduce the incidence of MODS.