Ansari Sheeba F, Memon Mubeen, Brohi Naveed, Tahir Amber
Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK.
Pulmonology, Civil Hospital, Jamshoro, PAK.
Cureus. 2019 Nov 5;11(11):e6073. doi: 10.7759/cureus.6073.
Introduction Chronic obstructive pulmonary disease (COPD) is a preventable disease of the airways characterized by limited airflow. Acute exacerbations of COPD (AECOPD) may be precipitated by noxious stimuli. N-acetylcysteine (NAC) has mucolytic, antioxidant, and anti-inflammatory activity. We conducted this study to evaluate the effect of adding high-dose NAC to the protocol treatment of AECOPD. Methods In this single-center, prospective, interventional study, patients admitted with AECOPD, airflow obstruction on spirometry, and who were current smokers with 10 or more packs per year were included after attaining informed consent. NAC granules 600 mg twice daily orally (high dose) were included in the regimen of 25 randomly selected patients and the other 25 were managed without NAC. An improvement in clinical and biochemical markers was observed on day three and day seven. For statistical analysis, SPSS for Windows version 21.0 (IBM Corp., Armonk, NY) was utilized. Results The study was completed by 21 patients in the NAC group and 19 in the non-NAC group. In the NAC group, there was a significant improvement in the mean partial pressure of oxygen (PaO) both on day three (p=0.03) and day seven (p=0.01). The mean partial pressure of carbon dioxide (PaCO) was at the borderline in the two groups on day three; however, on day seven, the NAC group showed significantly improved PaCO as compared to the non-NAC group (p=0.007). There were significant improvements in oxygen saturation of the NAC group on day seven (p=0.02). There were significant improvements in clinical signs, including wheezing and dyspnea and the need for nasal oxygen support (p≤0.05). Conclusion The addition of 600 mg twice daily NAC (high dose) to the protocol treatment of patients with acute exacerbation of COPD may have beneficial outcomes. In the future, the role of high-dose NAC in AECOPD must be studied through multicenter, double-blinded, placebo-controlled trials with larger sample sizes in order to either establish or invalidate this association.
引言 慢性阻塞性肺疾病（COPD）是一种可预防的气道疾病，其特征为气流受限。COPD急性加重（AECOPD）可能由有害刺激引发。N-乙酰半胱氨酸（NAC）具有黏液溶解、抗氧化和抗炎活性。我们开展本研究以评估在AECOPD的方案治疗中添加高剂量NAC的效果。方法 在这项单中心、前瞻性、干预性研究中，纳入因AECOPD入院、肺功能检查存在气流阻塞且为当前吸烟者（每年吸烟10包或更多）并获得知情同意的患者。25例随机选择的患者的治疗方案中包括每日口服两次600 mg的NAC颗粒（高剂量），另外25例患者不使用NAC进行治疗。在第3天和第7天观察临床和生化指标的改善情况。进行统计分析时，使用Windows版SPSS 21.0（IBM公司，纽约州阿蒙克）。结果 NAC组的21例患者和非NAC组的19例患者完成了研究。在NAC组，第3天（p = 0.03）和第7天（p = 0.01）的平均氧分压（PaO）均有显著改善。第3天两组的平均二氧化碳分压（PaCO）处于临界值；然而，在第7天，与非NAC组相比，NAC组的PaCO有显著改善（p = 0.007）。NAC组在第7天的血氧饱和度有显著改善（p = 0.02）。包括喘息和呼吸困难以及对鼻导管吸氧支持的需求等临床体征有显著改善（p≤0.05）。结论 在COPD急性加重患者的方案治疗中每日两次添加600 mg NAC（高剂量）可能产生有益结果。未来，必须通过多中心、双盲、安慰剂对照试验以及更大样本量来研究高剂量NAC在AECOPD中的作用，以确定或否定这种关联。
