血清高迁移率族蛋白B1在老年慢性阻塞性肺疾病急性加重病人中的表达及N-乙酰半胱氨酸泡腾片干预效果研究

目的探讨血清高迁移率族蛋白B1(HMGB1)在老年COPD急性加重(AECOPD)病人中的表达及N-乙酰半胱氨酸泡腾片的干预效果。方法选择2018年1月至2019年10月老年AECOPD病人82例为AECOPD组,另选择同期治疗的老年COPD稳定期病人71例为COPD组以及健康体检者51例为对照组。采用ELISA法测定3组HMGB1、TNF-α水平。AECOPD组病人根据是否使用N-乙酰半胱氨酸泡腾片治疗分为使用组(n=41例)和未使用组(n=41例),比较2组治疗前后HMGB1、TNF-α、肺功能水平以及COPD评估测试评分(CAT)。结果AECOPD组HMGB1、TNF-α水平均高于COPD组和对照组(P<0.05);COPD组HMGB1及TNF-α水平高于对照组(P<0.05);AECOPD组重度病人HMGB1及TNF-α水平高于轻度、中度病人(P<0.05)。AECOPD病人治疗后HMGB1、TNF-α水平、CAT评分均低于治疗前(P<0.05);使用组治疗后HMGB1、TNF-α水平、CAT评分均低于未使用组(P<0.05)。AECOPD病人干预1个月后肺功能均得到改善,使用组病人治疗1个月后FEV1、FVC及FEV1/FVC水平均高于未使用组(P<0.05)。使用组与未使用组组治疗过程中恶心呕吐、腹泻便秘、血压波动、肝肾功能异常等不良反应发生率差异无统计学意义(P>0.05)。结论HMGB1在老年AECOPD病人中呈高表达,在常规治疗基础上联合N-乙酰半胱氨酸泡腾片治疗能降低病人HMGB1、TNF-α水平,提高肺功能水平,值得推广应用。

Expression of serum high mobility group protein B1 and effect of N-acetylcysteine effervescent tablets in elderly patients with acute exacerbation of chronic obstructive pulmonary disease

Objective To investigate the expression of serum high mobility group protein B1(HMGB1)in the elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and the intervention effect of N-acetylcysteine effervescent tablets.Methods From January 2018 to October 2019,82 elderly patients with AECOPD were selected as AECOPD group;71 elderly patients with stable COPD treated at the same time were selected as COPD group,and 51 cases of healthy physical examination were selected as control group.Enzyme-linked immunosorbent assay was used to detect the levels of HMGB1 and tumor necrosis factor-α(TNF-α)in the three groups.According to whether they were treated with N-acetylcysteine effervescent tablets,the AECOPD patients were divided into used group and non-used group,with 41 cases in each group.The levels of HMGB1,TNF-α,lung function and COPD assessment test(CAT)score between the two groups before and after treatment were compared.Results The levels of HMGB1 and TNF-αin the AECOPD group were higher than those in the COPD group and the control group(P<0.05).The levels of HMGB1 and TNF-αin the COPD group were higher than those in the control group(P<0.05).In the AECOPD group,the levels of HMGB1 and TNF-αin severe patients were higher than those in mild and moderate patients(P<0.05).After treatment,the levels of HMGB1,TNF-αand CAT scores in AECOPD patients were lower than before treatment(P<0.05).The levels of HMGB1,TNF-αand CAT scores after treatment in the used group were lower than those in the non-used group(P<0.05).The pulmonary function of AECOPD patients were improved after 1 month of intervention,and the levels of forced vital capacity rate of one second(FEV1),forced vital capacity(FVC)and FEV1/FVC in the used group were higher than those of the non-used group(P<0.05).The incidence rate of nausea and vomiting,diarrhea,constipation,blood pressure fluctuation,liver and kidney abnormalities during the treatment between the AECOPD subgroups showed no statistically significant difference(P>0.05).Conclusions HMGB1 is highly expressed in the elderly patients with AECOPD.On the basis of conventional treatment,N-acetylcysteine effervescent tablets can reduce the levels of HMGB1 and TNF-αand improve patients’lung function,which is worthy of promotion and application.