目的:探讨口服N-乙酰半胱氨酸对稳定期慢性阻塞性肺疾病患者 T h1/T h2平衡的影响.方法:80例C、D型慢性阻塞性肺疾病稳定期患者分为2组,治疗组患者给予口服N-乙酰半胱氨酸片6个月(每次0.6 g,2次/d),对照组患者给予安慰剂治疗.比较6个月期间两组患者急性加重发生的次数、急性加重的天数、急性加重事件严重程度.采用ELISA法测定两组患者治疗前后血清中 IL-4、IFN-γ的浓度,流式细胞术测定两组患者治疗前后外周血 T h1、T h2占CD4+T 细胞的比值.结果:治疗组平均急性加重次数、平均急性加重天数、Ⅱ ~ Ⅲ级急性加重次数少于对照组,差异有统计学意义(P<0.05);治疗组患者治疗后血清IL-4水平、T h2/CD4+T细胞比值较治疗前及对照组升高,IFN-γ水平、T h1/CD4+T细胞比值较治疗前及对照组降低,T h1/T h2比值较治疗前及对照组下降,差异有统计学意义(P<0.05).对照组治疗前后血清IL-4、IFN-γ水平、T h1/CD4+T细胞、T h2/CD4+T细胞、T h1/T h2比值比较差异无统计学意义.结论:长期每日口服1200 mg的N-乙酰半胱氨酸对C、D型稳定期COPD患者具有一定的疗效,用药期间能使 Th1/Th2趋于平衡,降低患者急性加重次数,缩短其急性加重的天数,减少中重度急性加重事件发生.%Objective: To assess the efficacy of N-acetylcysteine on Th1/Th2 balance in patients with chronic obstructive pulmonary disease(COPD).Methods:In our study,we enrolled 80 COPD patients aged 60-85 years old with type C and D.The patients were randomly allocated to receive N-acetylcysteine(one 600 mg tablet,twice daily)or placebo for 6 months.ELISA was used to detect the expression of interferon-γ(IFN-γ)and interleukin-4(IL-4).Flow cytometry was used to compare the rate of Th1/Th2.The rate,duration and the severity of the exacerbation were compared between the two groups throughout the course of treatment.Results:Compared with the placebo group,patients treated with N-acetylcysteine had less acute exacerbation rate,duration time and the Ⅱ or Ⅲ grade severity acute exacerbation,the difference was statistically significant(P<0.05).The levels of IL-4 and Th2/CD4+T cell were significantly higher while the levels of IFN-γ and the Th1/CD4+T cell and Th1/Th2 were significantly lower in N-acetylcysteine group than those in the placebo group after 6 months treatment,the same results were observed compared with that before the treatment(P<0.05).There was no difference of the IL-4,IFN-γ,Th1/CD4+T cell,Th2/CD4+T cell and Th1/Th2 level in placebo group before and after the treatment. Conclusions:Our study shows that in elderly COPD patients with group C and D,long-term use of 1 200 mg N-acetylcysteine can balance the rate of Th1/Th2 and prevent exacerbation,shorten the duration,and decrease the severity of exacerbation.
展开▼
