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目的:探讨雾化吸入碳酸氢钠液对慢性阻塞性肺疾病急性加重(AECOPD)患者呼出气冷凝液(EBC)白三烯B4(LTB4)和肿瘤坏死因子-α(TNF-α)的影响。方法:以2009年3月-2010年5月在郑州大学第五附属医院呼吸科住院的78例AECOPD患者为研究对象,随机分成临床组和对照组。对照组用抗感染、祛痰、常规雾化等治疗,临床组在对照组的基础上加雾化吸入碳酸氢钠液治疗,疗程均为1周,观察治疗前后EBC中pH值和LTB4及TNF-α的浓度变化以及肺功能的情况。结果:临床组治疗后pH(7.45±0.29)比治疗前明显升高(7.10±0.38,P<0.05),而对照组治疗后与治疗前差异无统计学意义(P>0.05);临床组和对照组患者治疗后的TNF-α分别为(15.3±10.2)ng.L-1和(26.4±14.4)ng.L-1,与治疗前(35.6±14.8)ng.L-1和(35.5±14.4)ng.L-1比较差异均有统计学意义(P均<0.05);临床组和对照组患者治疗后的LTB4分别为(14.6±11.2)ng.L-1和(20.2±12.2)ng.L-1,与治疗前(25.3±10.2)ng.L-1和(25.4±10.2)ng.L-1比较差异均有统计学意义(P均<0.05);但2组治疗前后差值的统计学比较,临床组差异更显著。临床组和对照组患者的1 s用力呼气量/用力肺活量、1 s用力呼气量%预计值在治疗前后的变化均有统计学意义(P均<0.05),相关分析显示,LTB4和TNF-α与肺功能等指标无相关性。结论:雾化吸入碳酸氢钠溶液可明显减轻AECOPD患者气道酸化的程度,降低其EBC中LTB4、TNF-α的浓度,提示雾化吸入碳酸氢钠溶液能有效缓解AECOPD患者炎症的严重程度。
Objective: To investigate the effects of inhaled sodium bicarbonate solution on leukotriene B4 (LTB4) and tumor necrosis factor-α (TNF-α) in patients with exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods: From March 2009 to May 2010, 78 AECOPD patients admitted to Respiratory Department of the Fifth Affiliated Hospital of Zhengzhou University were randomly divided into clinical group and control group. The control group was treated with anti-infective, expectorant and conventional nebulization. The clinical group was treated with nebulized sodium bicarbonate solution on the basis of the control group for one week. Before and after treatment, the pH, LTB4 and TNF -α concentration changes and lung function. Results: After treatment, the pH value in the clinical group was significantly higher than that before treatment (7.10 ± 0.38, P <0.05), while there was no significant difference between the control group and before treatment (P> 0.05) The levels of TNF-α in the control group were (15.3 ± 10.2) ng.L-1 and (26.4 ± 14.4) ng.L-1, respectively, which were significantly lower than those before treatment (35.6 ± 14.8) ng.L- (14.4 ± 11.2) ng.L-1 and (20.2 ± 12.2) ng · L-1 in the clinical and control groups, respectively (all P <0.05) (P <0.05). However, the difference between the two groups before and after treatment (25.3 ± 10.2) ng.L-1 and (25.4 ± 10.2) ng.L-1 was statistically significant The statistical difference between the clinical group more significant. The changes of 1 h forced expiratory volume / forced vital capacity and 1% forced expiratory volume of 1 h before and after treatment in both clinical and control groups were statistically significant (all P <0.05). Correlation analysis showed that LTB4 and TNF -α and pulmonary function and other indicators no correlation. CONCLUSION: Inhalation of sodium bicarbonate solution can significantly reduce the degree of airway acidification in AECOPD patients and decrease the concentration of LTB4 and TNF-α in EBC, suggesting that nebulized sodium bicarbonate solution can effectively relieve the severity of inflammation in AECOPD patients.