N-乙酰半胱氨酸联合氨溴索对初治肺结核患者转归及血清IL-23、Nrf2水平的影响Impacts of N-acetylcysteine combined with ambroxol on the outcome and serum IL-23 and Nrf2 levels in newly diagnosed pulmonary tuberculosis patients
张焕,刘锐,王显雷,石璐,刘明,王勇
摘要(Abstract)：
目的 探究N-乙酰半胱氨酸（NAC）联合氨溴索对初治肺结核患者转归及血清白细胞介素-23(IL-23)、核因子E2相关因子2(Nrf2)水平的影响。方法 选取2021年1月至2022年1月收治的102例初治肺结核患者，随机分为单药组（n=51）和联合用药组（n=51）。单药组在常规治疗基础上采用氨溴索治疗，联合用药组在常规治疗的基础上采用NAC联合氨溴索治疗。比较2组肺结核患者治疗前后用力肺活量（FVC）、第1秒用力呼容积（FEV1）、FEV1/FVC、血清IL-23、Nrf2的水平，并比较2组治疗后痰菌转阴率、病灶吸收率及临床疗效。结果 与治疗前比较，治疗后2组肺结核患者FVC、FEV1、FEV1/FVC明显升高（P <0.05），且联合用药组均高于单药组（P <0.05）；治疗后2组肺结核患者血清IL-23、Nrf2水平明显降低（P <0.05），且联合用药组低于单药组（P <0.05）；治疗后，联合用药组痰菌转阴率、病灶吸收率及临床疗效均高于单药组（P <0.05）。结论 NAC联合氨溴索能够促进初治肺结核患者转归，改善患者肺功能、抑制氧化应激、减轻炎症反应，疗效较好。
关键词(KeyWords)： 肺结核;N-乙酰半胱氨酸;氨溴索;转归;白细胞介素-23;核因子E2相关因子2
基金项目(Foundation): 2022年度医学科学研究课题计划（编号20220944）
作者(Author): 张焕,刘锐,王显雷,石璐,刘明,王勇
DOI: 10.19577/j.1007-4406.2023.05.007
参考文献(References)：
- [1] NATARAJAN A, BEENA P M, DEVNIKAR A V, et al. A systemic review on tuberculosis[J]. Indian J Tuberc, 2020, 67(3):295.
- [2] SWAMINATHAN N, PERLOFF S R, ZUCKERMAN J M.Prevention of mycobacterium tuberculosis transmission in health care settings[J]. Infect Dis Clin North Am, 2021, 35(4):1013.
- [3] PASCUAL-PAREJA J F, CARRILLO-GóMEZ R, HONTA?óNANTO?ANA V, et al. Treatment of pulmonary and extrapulmonary tuberculosis[J]. Enferm Infecc Microbiol Clin(Engl Ed), 2018,36(8):507.
- [4] GODOY P. Guidelines on controlling latent tuberculosis infection to support tuberculosis elimination[J]. Rev Esp Sanid Penit,2021, 23(1):28.
- [5] SUáREZ I, FüNGER S M, KR?GER S, et al. The diagnosis and treatment of tuberculosis[J]. Dtsch Arztebl Int, 2019, 116(43):729.
- [6] FURIN J. Advances in the diagnosis, treatment, and prevention of tuberculosis in children[J]. Expert Rev Respir Med, 2019,13(3):301.
- [7] CALVERLEY P, ROGLIANI P, PAPI A. Safety of N-acetylcysteine at high doses in chronic respiratory diseases:a review[J]. Drug Saf, 2021, 44(3):273.
- [8] CAZAN D, KLIMEK L, SPERL A, et al. Safety of ambroxol in the treatment of airway diseases in adult patients[J]. Expert Opin Drug Saf, 2018, 17(12):1211.
- [9]中华医学会结核病学分会.肺结核诊断和治疗指南[J].中华结核和呼吸杂志, 2001, 24(2):70.
- [10]中华医学会结核病学分会.肺结核诊断和治疗指南[J].中国实用乡村医生杂志, 2013, 20(2):7.
- [11] DHEDA K, GUMBO T, MAARTENS G, et al. The Lancet Respiratory Medicine Commission:2019 update:epidemiology,p a t h o g e n e s i s, t r a n s m i s s i o n, d i a g n o s i s, a n d m a n a g e m e n t o f multidrug-resistant and incurable tuberculosis[J]. Lancet Respir Med, 2019, 7(9):820.
- [12] XU Z J, CHEN W W, LI X S. Effects of comprehensive nursing intervention combined with respiratory functional exercises on pulmonary function and self-care ability in patients with pulmonary tuberculosis:results of a randomized trial[J]. Ann Palliat Med, 2021, 10(7):7543.
- [13] DAGNINO S, BODINIER B, GRIGORYAN H, et al. Agnostic Cys34-albumin adductomics and DNA methylation:implication of N-acetylcysteine in lung carcinogenesis years before diagnosis[J]. Int J Cancer, 2020, 146(12):3294.
- [14]陶静,孙秋雁,周铭,等. N-乙酰半胱氨酸联合抗结核药治疗慢性阻塞性肺疾病合并肺结核患者的相关指标分析[J].中国医院药学杂志, 2021, 41(7):728.
- [15] BELLEZZA I, GIAMBANCO I, MINELLI A, et al. Nrf2-Keap1s i g n a l i n g i n o x i d a t i v e a n d r e d u c t i v e s t r e s s[J]. B i o c h i m Biophys Acta Mol Cell Res, 2018, 1865(5):721.
- [16]高健,赵春燕. miR-128和Nrf2在肺癌合并肺结核患者血清中的表达水平及其临床意义[J].热带医学杂志, 2021, 21(11):1449.
- [17]符婷,黄丽菊,杨进军,等.肺结核患者血清IL-18、IL-23、IFN-γ及MCP-1水平变化及其与病情严重程度的相关性[J].中国免疫学杂志, 2022, 38(7):859.
- [18] CHOI S M, LEE P H, AN M H, et al. N-acetylcysteine decreases lung inflammation and fibrosis by modulating ROS and Nrf2 in mice model exposed to particulate matter[J].Immunopharmacol Immunotoxicol, 2022, 44(6):832.
- [19]黄德珍,曾玉兰. N-乙酰半胱氨酸对老年慢性阻塞性肺疾病患者免疫功能及细胞因子的影响[J].实用医学杂志, 2015, 31(7):1186.