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目的探讨大剂量乙酰半胱氨酸(NAC)对矽肺患者血清中纤维化指标和T淋巴细胞亚群的影响及其意义。方法矽肺患者43例,随机分成2组,其中常规治疗为对照组18例;NAC治疗组25例,在常规治疗的基础上加用NAC口服,每次600 mg,每日3次,疗程3个月。治疗前后用化学发光法测定血清中纤维化指标和T淋巴细胞亚群。结果 NAC组治疗后,血清中铜蓝蛋白(CP)、透明质酸(HA)水平降低,与治疗前及对照组治疗后比较,差异均有统计学意义(P<0.05);血清中层黏蛋白(LN)水平降低,与治疗前比较,差异有统计学意义(P<0.05);血清中Ⅳ型胶原(Ⅳ-C)、Ⅲ型前胶原(PC-Ⅲ)与治疗前及对照组治疗后比较,差异均无统计学意义(P>0.05);NAC组治疗后血清中CD3+、CD4+水平明显增加,与治疗前及对照组治疗后比较,差异均有统计学意义(P<0.05);血清中CD4+/CD8+明显增加,与治疗前比较,差异有统计学意义(P<0.05);血清中CD8+与治疗前及对照组治疗后比较,差异均无统计学意义(P>0.05)。结论大剂量NAC治疗矽肺,能抑制肺纤维化进程,并改善患者的免疫状态。
Objective To investigate the effect and significance of high dose acetylcysteine (NAC) on serum fibrotic index and T lymphocyte subsets in patients with silicosis. Methods Forty-three patients with silicosis were randomly divided into two groups, of which 18 cases were routinely treated as control group and 25 cases were treated with NAC. On the basis of routine treatment, NAC was given orally 600 mg once daily for 3 times month. Serum fibrotic index and T lymphocyte subsets were determined by chemiluminescence before and after treatment. Results The serum levels of ceruloplasmin (CP) and hyaluronic acid (HA) in NAC group were significantly lower than those in the control group before and after treatment (P <0.05) (P <0.05). The levels of type Ⅳ collagen (Ⅳ-C) and type Ⅲ procollagen (PC-Ⅲ) in serum were significantly lower than those before treatment and before treatment (P> 0.05). The levels of CD3 + and CD4 + in serum of NAC group were significantly increased after treatment compared with that before treatment and control group (P <0.05), and the difference was not statistically significant (P <0.05). There was no significant difference in the levels of CD8 + in serum between the two groups before and after treatment (P> 0.05). Conclusion High-dose NAC treatment of silicosis can inhibit the progress of pulmonary fibrosis, and improve the patient’s immune status.