细菌溶解产物联合乙酰半胱氨酸对支气管扩张症患者气道功能、炎症反应的影响

目的探究细菌溶解产物联合吸入用乙酰半胱氨酸对反复加重的支气管扩张症患者的临床疗效。方法将2018年2月至2020年12月收住我院呼吸危重症医学科的100例反复加重的支气管扩张症患者作为研究对象,使用随机法将其分为对照组和观察组。对照组给予抗感染、止咳化痰等常规治疗,观察组在常规治疗的基础上加用细菌溶解产物及吸入用乙酰半胱氨酸。两组观察时间为6个月,以评价两种治疗模式对患者气道功能及气道内炎症反应的影响。结果治疗前两组基线PaO₂、PaCO₂、SaO₂、肺功能指标、血清炎症因子指标,均无统计学差异。治疗后对照组PaO₂、SaO₂显著低于观察组(P<0.01),两组PaCO₂变化无统计学差异(P>0.05)。治疗后观察组FEV₁、FEV₁/FVC、FEV₁占预计值%均明显高于对照组(P<0.01)。治疗后观察组24h痰液体积、痰液细菌负荷≥10³cfu/mL的阳性率以及外周血中炎症因子包括IL-6、IL-8、TNF-α均较对照组显著降低(P<0.01)。观察组莱斯特咳嗽问卷(Leicester Cough Questionnaire,LCQ)总评分改善>1.3单位的患者比例为84%,对照组仅为56%,两组差异有显著统计学意义(P<0.01)。结论细菌溶解产物联合吸入用乙酰半胱氨酸,能够有效改善患者气道功能,抑制炎症反应,进而改善患者预后。

Effects of bacterial lysates combined with acetylcysteine on airway function and inflammatory response in patients with bronchiectasis

Objective To explore the clinical effects of the bacterial lysates combined with inhaled acetylcysteine on bronchiectasis patients with repeated exacerbation.Methods From January 2018 to December 2020,100 cases of bronchiectasis patients with repeated exacerbation at the Department of Respiratory Critical Medicine in the Jiangyin Clinical College of Xuzhou Medical University,were selected for the study.The patients were randomly assigned into the control and experimental group.The patients in the control group were given a set of conventional treatments including anti-infectives,relieving cough,and eliminating phlegm,while the patients in the experimental group were given the bacterial lysate and acetylcysteine inhalation on the basis of conventional treatments.The observation lasted for six months for the two groups in the study.The effects of the bacterial lysates combined with inhaled acetylcysteine on improving airway function and mitigating airway inflammation were evaluated.Results There were no significant differences in baseline PaO₂,PaCO₂,SaO₂,lung function,and serum inflammatory factors between the two groups before the treatment.After the treatment,PaO₂ and SaO₂ in the control group were significantly lower than those in the experimental group(P<0.01),but no significant difference was observed in PaCO₂ between the two groups(P>0.05).The predicted values(%)of FEV₁,FEV₁/FVC,and FEV₁in the experimental group were significantly higher than those in the control group(P<0.01).The 24-hour sputum volume,positive rate of sputum bacterial load≥10³ cfu/mL,and the peripheral blood levels of inflammatory cytokines including IL-6,IL-8,and TNF-αin patients of the experimental group were significantly lower than those in the control(P<0.01).84%of the patients in the experimental group and 56%in the control improved with the LCQ score>1.3 units,and the difference was statistically significant(P<0.01).Conclusion The bacterial lysates combined with inhaled acetylcysteine could effectively improve the airway function,inhibit the inflammatory response,and improve the prognosis of patients with bronchiectasis with repeated exacerbation.