噻托溴铵联合N-乙酰半胱氨酸对慢性阻塞性肺疾病缓解期临床疗效观察

目的 观察噻托溴铵联合N-乙酰半胱氨酸(NAC)对慢性阻塞性肺疾病(COPD)缓解期的疗效.方法 将60例患者随机分为两组,对照组30例给予沙美特罗替卡松粉吸入剂(舒利迭)治疗,治疗组30例在时照组的基础上加用噻托溴铵和NAC.分别在治疗前、治疗后半年及1年测定Borg呼吸困难评分、6分钟步行距离(6MWD)、1秒钟用力呼气容积(FEV,)、用力肺活量(FVC)及发作频率等指标.结果 两组Borg呼吸困难评分呈逐渐下降趋势,6MWD及FEV1、FVC均呈逐渐增加趋势;在6MWD测定,治疗组治疗前(387.53±67.51)m,治疗半年(429.53±66.58)m,治疗1年(480.73±55.46)m,对照组治疗前(388.53±61.65)m,治疗半年(413.83±61.52)m,治疗1年(446.23±61.98)m,两组在不同时点以及组间和不同时点的交互作用差异均有统计学意义(P<0.01),但是在组间的比较差异无统计学意义(P>0.05).在Borg呼吸困难评分,治疗组治疗前(4.03±2.03)分,治疗半年(3.07±1.64)分,治疗1年(1.77±1.19)分,对照组治疗前(4.37±2.01)分,治疗半年(3.53±1.85)分,治疗1年(2.67±1.95)分,两组在组间、不同时点以及组间和不同时点的交互作用差异均无统计学意义(P>0.05);在肺功能,FEV1治疗组治疗前(0.85±0.18)L,治疗半年(1.09±0.18)L,治疗1年(1.33±0.20)L,对照组治疗前(0.84±0.16)L,治疗半年(0.91±0.17)L,治疗1年(1.01±0.09)L,FVC治疗组治疗前(1.52±0.26)L,治疗半年(1.93±0.24)L,治疗1年(2.38±0.39)L,对照组治疗前(1.53±0.22)L,治疗半年(1.66±0.23)L,治疗1年(1.87±0.27)L,两组在组间、不同时点以及组间和不同时点的交互作用差异均有统计学意义(P<0.01).在发作次数,治疗组的发作次数较对照组明显减少(1.73±0.87)次vs(2.30±0.99)次(P<0.05).结论 噻托溴铵联合N-乙酰半胱氨酸对减少COPD的发作频率及增加运动耐量、改善呼吸困难、减缓病情恶化有显著疗效.

Therapeutic effect of tiotropium bromide combined with N-acetylcysteine therapy for patients with COPD

Objective To investigate the effect on tiotropium bromide combined with N-acetylcysteine（NAC） therapy for patients with chronic obstructive pulmonary disease（COPD）.Methods Sixty patients were randomly divided into two groups,30 patients in the treatment group treated by tiotropium bromide and NAC,and another 30 patients in controlled group given seretide.Borg dyspnea score,seizure frequency,forced expiratory volume in one second（FEV1）,forced vital capacity（FVC） and 6 min walk distance（6MWD） were measured before and after treatment for 6 months,12 months.Results Borg dyspnea score appeared to have a gradual decline tendency,and FEV1,FVC and 6MWD appeared to have a gradually ascendant trend between the two groups.About 6MWD,treatment group before therapy（387.53±67.51） m,six months after therapy（429.53±66.58） m,1 year after therapy（480.73±55.46） m;control group before therapy（388.53±61.65） m,six months after therapy（413.83±61.52） m,1 year after therapy（446.23±61.98） m.The differences of time dissimilarity and interaction of interblock with time dissimilarity had statistical significance（all P〈0.01）,but between groups this result did not show（P〉0.05）.As to Borg dyspnea score,treatment group before therapy（4.03±2.03） scores,six months after therapy（3.07±1.64） scores,1 year after therapy（1.77±1.19） scores;control group before therapy（4.37±2.01） scores,six months after therapy（3.53±1.85） scores,1 year after therapy（2.67±1.95） scores.The differences of interblock,time dissimilarity and interaction of interblock with time dissimilarity had no significant difference in statistics（all P〉0.05）.About FEV1,treatment group before therapy（0.85±0.18） L,six months after therapy（1.09±0.18） L,1 year after therapy（1.33±0.20） L;control group before therapy（0.84±0.16） L,Six months after therapy（0.91±0.17） L,1 year after therapy（1.01±0.09）L.And FVC,treatment group before therapy（1.52±0.26） L,six months after therapy（1.93±0.24） L,1 year after therapy（2.38±0.39） L;control group before therapy（1.53±0.22） L,six months after therapy（1.66±0.23）L,1 year after therapy （1.87±0.27） L.The differences of interblock,time dissimilarity and interaction of interblock with time dissimilarity between the two groups had statistical significance（all P〈0.01）.Seizure frequency was reduced in group of tiotropium＋NAC（1.73±0.87） times vs（2.30±0.99） times（P〈0.05）.Conclusion The present study confirms that tiotropium bromide combined with NAC can reduce seizure frequency,improve symptom-limited exercise tolerance,ease exertional dyspnea and slow disease progression in COPD patients.