标题：N-乙酰半胱氨酸联合孟鲁司特钠治疗特发性肺纤维化临床疗效观察

      作者：王传海，李承红
    (江汉大学附属医院呼吸内科，湖北 武汉 430015)

      卷次： 2016年27卷1期

      【摘要】 目的 探讨 N-乙酰半胱氨酸 (NAC)联合孟鲁司特钠治疗特发性肺纤维化 (IPF)的临床疗效。
方法 选择我院 2008年 1月至 2014年 6月经临床-影像证实的 IPF患者 64例，按随机数字表法分为观察组和
对照组，每组 32例，观察组在口服常规激素治疗基础上加用NAC联合孟鲁司特钠，对照组口服常规糖皮质激素治
疗，疗程3个月。比较两组患者的临床疗效、肺活量(VC)、一氧化碳弥散量(DLco)、pH值、氧分压(PaO2)、血氧饱和度
(SaO2)、二氧化碳分压(PaCO2)变化和用药安全性。结果 两组疗效比较，观察组总有效率为 81.25%，明显高于对
照组的 57.60%，差异有统计学意义(P<0.05)；治疗前观察组和对照组的VC值、DLco值分别为(2.15±0.29) L和
(2.13±0.18) L、(3.72±0.58) mmol/(min·kPa)和(3.70±0.16) mmol/(min·kPa)，治疗后分别为(2.14±0.13) L和(2.06±0.11) L、
(3.60±0.24) mmol/(min·kPa)和(3.50±0.17) mmol/(min·kPa)，与治疗前比较，治疗后对照组患者VC、DLco均明显降
低(P<0.05)，观察组略有降低(P>0.05)，治疗后两组VC值、DLco值比较差异均有统计学意义(P<0.05)；治疗前观察组
和对照组的PaO2值、SaO2值分别为(69.1±7.7) mmHg和(68.2±6.9) mmHg、(92.7±2.5)%和(92.2±2.3)%，治疗后分别为
(68.5±5.6) mmHg和(66.1±1.6) mmHg、(92.3±2.1)%和(91.3±1.5)%，与治疗前比较，治疗后对照组患者PaO2、SaO2均明
显降低(P<0.05)，观察组略有降低(P>0.05)，治疗后两组的VC值、DLco值比较差异均有统计学意义(P<0.05)；两组治疗
后pH、PaO2比较差异均无统计学意义(P>0.05)；两组均未发生严重不良反应。结论 在常规激素治疗基础上加用NAC
联合孟鲁司特治疗IPF患者能有效改善患者的症状，减缓VC、DLco、PaO2、SaO2的下降。

      【关键词】 特发性肺纤维化；N-乙酰半胱氨酸；孟鲁司特钠；疗效

      【中图分类号】 R563 【文献标识码】 A 【文章编号】 1003—6350（2016）01—0037—03


Therapeutic effect of N-acetylcysteine and montelukast sodium in patients with idiopathic pulmonary fibrosis.
WANG Chuan-hai, LI Cheng-hong.
Department of Respiratory Medicine, the Affiliated Hospital of Jianghan University,
Wuhan 430015, Hubei, CHINA

【Abstract】 Objective To investigate the effect of N-acetylcysteine (NAC) and montelukast sodium in pa-
tients with idiopathic pulmonary fibrosis (IPF). Methods A total of 64 patients with IPF confirmed by clinical data
and imaging examination from January 2008 to June 2014 were selected in our hospital. According to random number
table, the patients were randomly divided into the observation group and the control group with 32 patients in each
group. The control group applied conventional glucocorticoids treatment, while the observation group used NAC and
montelukast sodium based on glucocorticoids treatment. All patients were treated for 3 months. The therapeutic effect,
vital capacity (VC), diffusion capacity for carbon monoxide (DLco), pH value, oxygen partial pressure (PaO2), oxygen
saturation (SaO2), partial pressure of carbon dioxide (PaCO2) and medication safety were compared between the two
groups. Results In the observation group, the total effective rate was 81.25%, which was significantly higher than
57.60% in the control group (P<0.05). The VC, DLco of the observation group and the control group were (2.15±0.29) L
and (2.13±0.18) L, (3.72±0.58) mmol/(min·kPa) and (3.70±0.16) mmol/(min·kPa) before treatment, (2.14±0.13) L and
(2.06±0.11) L, (3.60±0.24) mmol/(min·kPa) and (3.50±0.17) mmol/(min·kPa) after treatment, respectively. Compared
with before treatment, the VC, DLco were significantly decreased in the control group (P<0.05), but slightly decreased
in the observation group (P>0.05). After treatment, the differences in VC, DLco between the two groups were statistical-
ly significant (P<0.05). The PaO2, SaO2 of the observation group and the control group were (69.1 ± 7.7) mmHg and
(68.2±6.9) mmHg, (92.7±2.5)% and (92.2±2.3)% before treatment, (68.5±5.6) mmHg and (66.1±1.6) mmHg, (92.3±2.1)%
and (91.3±1.5)% after treatment, respectively. Compared with before treatment, the PaO2, SaO2 were significantly de-
creased in the control group (P<0.05), but slightly decreased in the observation group (P>0.05). After treatment, the dif-
ferences in PaO2, SaO2 between the two groups were statistically significant (P<0.05). After treatment, there was no sig-
nificant difference in pH and PaCO2 between the two groups (P>0.05). No serious adverse reaction was found in the two
groups. Conclusion The conventional glucocorticoids therapy added with NAC and montelukast sodium in the treatment of
IPF can effectively improve the symptoms of patients, and slow down the decrease of VC, DLco, PaO2, SaO2.

      【Key words】 Idiopa