Abstract:

Objective　To study the effects of acetylcysteine combined with budesonide atomization on lung function and airway inflammation in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods　A total of 89 patients with AECOPD admitted to Liaocheng Third People's Hospital from February 2020 to February 2023 were selected and divided into an observation group (45 cases) and a control group (44 cases) by the envelope method. There were 24 males and 20 females in the control group; they were (58.69±3.64) years old. There were 25 males and 20 females in the observation group; they were (58.74±3.62) years old. The control group received conventional treatment; in addition, the observation group took acetylcysteine and budesonide atomization. The therapeutic effects, lung function [the forced expiratory volume in first second (FEV1), peak rate of expiration flow (PEF), forced vital capacity (FVC), and FEV1/FVC], blood gas indicators [oxygen partial pressure (PaO₂), blood oxygen saturation (SpO₂), and CO₂ partial pressure (PaCO₂)], serum levels of fetuin-A, retinol binding protein 4 (RBP4), and adiponection (APN), and incidences of adverse reactions were compared between the two groups. t and χ² tests were applied. Results　After the treatment, the total effective rate of the observation group was higher than that of the control group [97.78% (44/45) vs. 81.82% (36/44)], with a statistical difference (P<0.05). After the treatment, the FEV1, PEF, FVC, FEV1/FVC increased in both groups; those in the observation group were higher than those in the control group [(1.42±0.15)L vs. (1.26±0.13)L, (3.06±0.75)L/s vs. (2.60±0.78)L/s, (1.43±0.21)L vs. (1.26±0.19)L, and (64.52±3.64)% vs.(62.37±3.67)%; all P<0.05]. After the treatment, the PaO₂ and SpO₂ increased and PaCO₂ decreased in both group, and those in the observation group were better than those in the control group (all P<0.05). After the treatment, the level of fetuin-A increased in both groups; the level in the observation group was higher than that in the control group [(408.54±40.83) mg/L vs. (390.44±37.39) mg/L; P<0.05]. After the treatment, the levels of RBP4 and APN of the two groups decreased; the levels in the observation group were lower than those in the control group [(54.63±14.24) mg/L vs. (61.43±14.63) mg/L and (8.44±2.07) μg/L vs. (9.45±2.16) μg/L; both P<0.05]. There was no statistical difference in the total incidence of rash, laryngeal irritation, nausea and vomiting, and headache between the two groups (P>0.05). Conclusion　The combination of acetylcysteine and budesonide atomization for patients with AECOPD is effective, and can significantly improve their pulmonary function and blood gas indicators, and better control their airway inflammation.

Key words:

Acute exacerbation of chronic obstructive pulmonary disease, Acetylcysteine, Budesonide, Fetoglobulin A, Retinol-binding protein 4,  , Adiponectin, Lung function, Airway inflammatory response

摘要：

目的　研究乙酰半胱氨酸与布地奈德联合雾化给药对慢性阻塞性肺疾病急性加重期（AECOPD）患者肺功能及气道炎症反应的影响。方法　选取2020年2月至2023年2月聊城市第三人民医院收治的89例AECOPD患者，采用信封法随机分为观察组与对照组。对照组44例，男24例，女20例，年龄（58.69±3.64）岁，给予常规治疗。观察组45例，男25例，女20例，年龄（58.74±3.62）岁，在对照组基础上给予乙酰半胱氨酸联合布地奈德雾化。比较两组治疗效果、肺功能［第1秒用力呼气流量（FEV1）、呼气流量峰值（PEF）、用力肺活量（FVC）、第1秒用力呼气流量与用力肺活量的比值（FEV1/FVC）］、血气指标［氧分压（PaO₂）、血氧饱和度（SpO₂）、二氧化碳分压（PaCO₂）］、血清胎球蛋白A、视黄醇结合蛋白4（retinol binding protein 4，RBP4）及脂联素水平，统计两组不良反应发生情况。采用t、χ²检验进行统计比较。结果　治疗后，观察组总有效率为97.78%（44/45），高于对照组的81.82%（36/44），差异有统计学意义（P<0.05）。治疗后两组FEV1、PEF、FVC、FEV1/FVC升高，且观察组［FEV1（1.42±0.15）L，FEV1/FVC（64.52±3.64）%，PEF（3.06±0.75）L/s，FVC（1.43±0.21）L］均高于对照组［FEV1（1.26±0.13）L，FEV1/FVC（62.37±3.67）%，PEF（2.60±0.78）L/s，FVC（1.26±0.19）L］（均P<0.05）。治疗后，两组PaO₂、SpO₂升高，且观察组高于对照组（均P<0.05）；治疗后，两组PaCO₂降低，且观察组低于对照组（P<0.05）。治疗后，两组血清胎球蛋白A升高，且观察组［（408.54±40.83）mg/L］高于对照组［（390.44±37.39）mg/L］（P<0.05）；治疗后，两组RBP4、脂联素下降，且观察组［RBP4（54.63±14.24）mg/L，脂联素（8.44±2.07）μg/L］低于对照组［RBP4（61.43±14.63）mg/L，脂联素（9.45±2.16）μg/L］（均P<0.05）。两组皮疹、喉部刺激、恶心呕吐及头疼并发症总发生率比较，差异无统计学意义（P>0.05）。结论　乙酰半胱氨酸联合布地奈德雾化治疗AECOPD，其效果较好，可明显改善患者的肺功能及血气指标，更好地控制患者气道炎症反应。

关键词:

慢性阻塞性肺疾病急性加重期, 乙酰半胱氨酸, 布地奈德, 胎球蛋白A, 视黄醇结合蛋白4, 脂联素, 肺功能, 气道炎症反应