布地奈德聯(lián)合乙酰半胱氨酸泡騰片對支氣管哮喘的療效及對NO/NOS、ROS水平的影響

魏健平　許碩　徐玉輝

【摘要】 目的：探討布地奈德聯(lián)合乙酰半胱氨酸泡騰片對支氣管哮喘的療效及對NO/NOS、ROS水平的影響。方法：選取2014年10月-2017年9月在本院治療的支氣管哮喘患者120例，根據(jù)治療方案分為：A組（n=61）和B組（n=59），其中A組給予布地奈德治療，B組給予布地奈德和乙酰半胱氨酸泡騰片治療，觀察各組治療前后肺功能、NO、NOS、ROS及炎癥因子水平。結(jié)果：B組治療后FVC、FEV1%和PEF分別為（2.78±0.39）L、（73.10±10.21）%和（2.52±0.30）L/s，均明顯高于A組（P<0.05）；B組治療后NO、NOS和ROS分別為（60.10±7.84）μmol/L、（30.02±5.20）U/mL和（9.84±2.33）ng/mL，

均明顯低于A組（P<0.05）；B組治療后IL-4、IL-13和CRP分別為（4.23±0.95）pg/mL、（29.38±7.06）pg/mL

和（9.10±2.01）mg/L，均明顯低于A組（P<0.05）；NO與FVC、FEV1%和PEF呈負(fù)相關(guān)（r=-0.492、

-0.503和-0.477，P<0.05）；NOS與FVC、FEV1%和PEF呈負(fù)相關(guān)（r=-0.503、-0.446和-0.412，P<0.05）；ROS與FVC、FEV1%和PEF呈負(fù)相關(guān)（r=-0.499、-0.489和-0.412，P<0.05）；NO、NOS及ROS與IL-4、IL-13及CRP均無明顯相關(guān)（P>0.05）。結(jié)論：布地奈德聯(lián)合乙酰半胱氨酸泡騰片治療支氣管哮喘患者有較好的效果，能明顯改善患者肺功能，降低患者NO、NOS、ROS及炎癥因水平。

【關(guān)鍵詞】 支氣管哮喘； 一氧化氮； 一氧化氮合酶； 活性氧； 肺功能

Detection and Clinical Significance of Nitric Oxide/Nitric Oxide Synthase and Reactive Oxygen Species in Peripheral Blood of Patients with Bronchial Asthma/WEI Jianping，XU Shuo，XU Yuhui.//Medical Innovation of China，2017，14（32）：029-032

【Abstract】 Objective：To investigate the levels of nitric oxide/nitric oxide synthase（NO/NOS） and reactive oxygen species（ROS） in peripheral blood of patients with bronchial asthma before and after treatment.Method：120 patients with bronchial asthma treated in our hospital from October 2014 to September 2017 were divided into two groups according to the treatment plan：group A（n=61） and group B（n=59），group A was treated with Budesonide，group B was received Budesonide and Acetylcysteine Effervescent Tablets treatment，the lung function，NO，NOS，ROS and inflammatory factors of two group were observed before and after treatment.Result：FVC，F(xiàn)EV1% and PEF in group B after treatment were （2.78±0.39）L，（73.10±10.21）%和（2.52±0.30）L/s，significantly higher than those in group A（P<0.05）.NO，NOS and ROS in group B after treatment were （60.10±7.84）μmol/L，（30.02±5.20）U/mL and （9.84±2.33）ng/mL，were significantly lower than those of group A（P<0.05）.IL-4，IL-13 and CRP of group B after treatment were （4.23±0.95）pg/mL，

（29.38±7.06）pg/mL and （9.10±2.01）mg/L，significantly lower than those of group A（P<0.05）.NO was negatively correlated with FVC，F(xiàn)EV1 % and PEF（r=-0.492，-0.503 and -0.477，P<0.05）.NOS was negatively correlated with FVC，F(xiàn)EV1% and PEF（r=-0.503，-0.446 and -0.412，P<0.05）.ROS was negatively correlated with FVC，F(xiàn)EV1% and PEF（r=-0.499，-0.489 and -0.412，P<0.05）.NO，NOS and ROS were not significantly related to IL-4，IL-13 and CRP（P>0.05）.Conclusion：Budesonide combined with Acetylcysteine Effervescent Tablets in the treatment of bronchial asthma patients has a better effect，can significantly improve the patients lung function，reduce patients NO，NOS，ROS and inflammatory levels.endprint

【Key words】 Bronchial asthma； Nitric oxide； Nitric oxide synthase； Reactive oxygen species； Pulmonary function

First-authors address：Ganzhou Peoples Hospital，Ganzhou 341000，China

doi：10.3969/j.issn.1674-4985.2017.32.007

支氣管哮喘是臨床常見的慢性氣道炎癥性疾病，其發(fā)病機(jī)制比較復(fù)雜。目前已有的臨床研究發(fā)現(xiàn)，Th1/Th2細(xì)胞因子失衡及氧化應(yīng)激在支氣管哮喘的發(fā)生、發(fā)展中具有重要作用。Th1細(xì)胞分泌γ-干擾素減少及Th2細(xì)胞分泌炎性因子IL-4增多可誘發(fā)支氣管上皮細(xì)胞iNOS的表達(dá)，使肺組織中NO含量明顯升高，從而加重氣道炎癥反應(yīng)，促發(fā)支氣管哮喘[1]。有研究發(fā)現(xiàn)，哮喘患者體內(nèi)氧化水平升高，抗氧化機(jī)制下降，使得ROS蓄積造成細(xì)胞的多重?fù)p傷，瀑布式誘發(fā)氣道炎癥反應(yīng)[2]。乙酰半胱氨酸是一種黏痰溶解劑，可促進(jìn)痰液化而易于咳出，改善哮喘患者的氣道阻塞狀況。本研究探討了支氣管哮喘患者采用不同治療方案治療的效果及治療后外周血NO/iNOS、ROS的變化，現(xiàn)報道如下。

1 資料與方法

1.1 一般資料 選取2014年10月-2017年9月在本院治療的支氣管哮喘患者120例，納入標(biāo)準(zhǔn)：（1）診斷符合中華醫(yī)學(xué)會哮喘學(xué)組制定的支氣管哮喘防治指南中的標(biāo)準(zhǔn)[3]；……