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目的观察雾化吸入碳酸氢钠溶液对慢性阻塞性肺疾病急性加重(AECOPD)患者呼出气冷凝液(EBC)中肿瘤坏死因子(TNF)-α的影响。方法以2008年10月至2009年5月在昆明总医院呼吸科住院的64例重度AECOPD患者为实验对象,随机分成实验组和对照组。对照组用抗感染、祛痰、常规雾化等治疗;实验组在对照组的基础上加用雾化吸入碳酸氢钠溶液治疗,疗程均为1周。以治疗前后EBC中pH、TNF-α的浓度及肺功能为观察指标。结果 (1)实验组治疗后pH(7.45±0.29)比治疗前明显升高(7.10±0.50,P=0.005),而对照组在治疗后pH也有所升高,但与治疗前比较差异无统计学意义(P=0.06);(2)两组患者治疗后TNF-α的浓度均降低,且与治疗前比较均有统计学差异(对照组:36.87±3.78对29.16±6.17;实验组:37.46±4.28对24.30±2.79,P<0.01),但两组治疗前后差值的统计比较,实验组差异更显著。(3)两组患者的一秒用力呼气量/用力肺活量(FEV1/FVC)、一秒用力呼气量(FEV1)%预计值在治疗后的变化均无统计学意义(P>0.05)。结论雾化碳酸氢钠溶液可明显减轻AECOPD患者气道酸化的程度,降低其EBC中TNF-α的浓度。
Objective To observe the effect of inhaled sodium bicarbonate solution on tumor necrosis factor (TNF) -α in exhaled breath condensate (EBC) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Sixty-four patients with severe AECOPD hospitalized in Department of Respiratory Medicine, Kunming General Hospital from October 2008 to May 2009 were randomly divided into experimental group and control group. The control group was treated with anti-infective, expectorant and conventional aerosolization. The experimental group was treated with nebulized sodium bicarbonate solution on the basis of the control group for one week. Before and after treatment in the EBC pH, TNF-α concentration and lung function as an index. Results (1) After treatment, the pH value in the experimental group was significantly higher than that before treatment (7.10 ± 0.50, P = 0.005), while the pH value of the control group increased after treatment, but there was no statistical difference (P = 0.06). (2) After treatment, the concentration of TNF-α in both groups decreased, and the difference was statistically significant compared with that before treatment (control group: 36.87 ± 3.78 vs 29.16 ± 6.17; experimental group: 37.46 ± 4.28 vs. 24.30 ± 2.79, P <0.01). However, the statistical difference between the two groups before and after treatment showed that the differences between the experimental groups were more significant. (3) FEV1 / FVC and FEV1% predicted no change after treatment in both groups (P> 0.05). Conclusion Atomized sodium bicarbonate solution can significantly reduce the degree of airway acidification in AECOPD patients and decrease the concentration of TNF-α in EBC.