目的 探討羧甲司坦對(duì)老年慢性阻塞性肺疾病急性加重期（AECOPD）的療效及對(duì)血清白介素-8（IL-8）、腫瘤壞死因子-α（TNF-α）及免疫球蛋白E（IgE）水平的影響。方法 選取2018年8月—2019年8月商丘市中醫(yī)院肺病科收治的128例老年AECOPD患者，隨機(jī)分為對(duì)照組和治療組，每組各64例。對(duì)照組給予常規(guī)治療，治療組在對(duì)照組基礎(chǔ)上口服羧甲司坦口服溶液，10 mL/次，3次/d。兩組均治療1周。觀察兩組的臨床療效，比較兩組肺功能指標(biāo)、動(dòng)脈血?dú)庵笜?biāo)、呼吸困難程度、運(yùn)動(dòng)耐力和1年隨訪期間第一次急性癥狀發(fā)作時(shí)間、發(fā)作病例，記錄兩組治療前后的血清炎癥指標(biāo)水平和生活質(zhì)量。結(jié)果 治療后，治療組總有效率為92.19%，顯著高于對(duì)照組的79.69%，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組肺功能指標(biāo)中第一秒用力呼氣量（FEV₁）、FEV₁占用力肺活量百分比（FEV₁/FVC）、氧分壓（pO₂）均較治療前顯著升高，但二氧化碳分壓（pCO₂）較治療前顯著降低（P<0.05）；治療后，治療組肺功能指標(biāo)和動(dòng)脈血?dú)庵笜?biāo)均優(yōu)于對(duì)照組（P<0.05）。治療后，兩組患者CAT問卷評(píng)分較治療前顯著降低，而6分鐘步行距離（6MWT）顯著較治療前增加（P<0.05）；治療后，治療組以上指標(biāo)改善效果顯著優(yōu)于對(duì)照組（P<0.05）。治療組第一次發(fā)作時(shí)間較對(duì)照組顯著延后，急性發(fā)作病例顯著少于對(duì)照組（P<0.05）。治療后，兩組患者IL-8、TNF-α及IgE水平較治療前顯著降低（P<0.05）；治療后，治療組患者血清炎癥水平顯著低于對(duì)照組（P<0.05）。治療后，兩組SGRQ量表關(guān)于癥狀、活動(dòng)、疾病影響3個(gè)維度評(píng)分及總分較治療前顯著降低（P<0.05）；治療后，治療組SGRQ評(píng)分顯著低于對(duì)照組（P<0.05）。結(jié)論 羧甲司坦可明顯改善老年AECOPD患者的氧合能力、肺功能及運(yùn)動(dòng)耐力，延長(zhǎng)急性發(fā)作間期，下調(diào)炎癥因子水平，且用藥安全性良好。

Objective To investigate the curative effect of carbocisteine in treatment of elderly patients with acute exacerbation of chronic obstructive pulmonary disease and its impact on levels of serum IL-8, TNF-α and IgE. Methods Elderly patients (128 cases) with AECOPD admitted to Department of Lung Disease of Shangqiu Hospital of Traditional Chinese Medicine from August 2018 to August 2019 were randomly divided into control group and treatment group, with 64 patients in each group. Patients in the control group received conventional treatment. Patients in the treatment group were po administered with Carbocisteine Oral Solution on the basis of the control group, 10 mL/time, three times daily. Patients in two groups were treated for 7 d. After treatment, the clinical efficacy was evaluated, the indexes of pulmonary function, arterial blood gas, dyspnea degree, exercise endurance, the time and cases of the first onset of acute symptoms during 1-year follow-up were compared between two groups. Serum inflammatory indexes and life quality before and after treatment were recorded in two groups. Results After treatment, the total effective rate of the treatment group was 92.19%, which was significantly higher than that of the control group (79.69%), and the difference was statistically significant (P<0.05). After treatment, FEV₁, FEV₁/FVC and pO₂ in lung function indexes of 2 groups were significantly increased compared with before treatment, but pCO₂ was significantly decreased compared with before treatment (P<0.05). After treatment, pulmonary function indexes and arterial blood gas indexes in treatment group were better than those in control group (P<0.05). After treatment, CAT score in two groups was significantly lower than before treatment, while 6MWT was significantly increased (P<0.05); After treatment, the improvement effect of the above indexes in the treatment group was significantly better than that in the control group (P<0.05). The time of the first attack in the treatment group was significantly longer than that in the control group, and the cases of acute attack were significantly less than those in the control group (P<0.05). After treatment, the levels of serum IL-8, TNF-α, and IgE in two groups were significantly decreased compared with before treatment (P<0.05). After treatment, the serum inflammation level of treatment group was significantly lower than that of control group (P<0.05). After treatment, the scores of symptoms, activity and disease influence and the total scores of SGRQ in both groups were significantly lower than those before treatment (P<0.05). After treatment, the SGRQ score of treatment group was significantly lower than that of control group (P<0.05). Conclusion Carbocisteine can significantly improve oxygenation ability, lung function and exercise endurance in elderly patients with AECOPD, and can prolong the acute interattack period, and reduce the level of inflammatory factors, which has good drug safety.

R974

國(guó)家衛(wèi)生健康委科學(xué)研究基金資助項(xiàng)目（SB201901091）