N-乙酰半胱氨酸对胸外科肺叶切除术后肺保护的临床研究
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摘要
目的观察N-乙酰半胱氨酸注射液(NAC)对胸外科肺叶切除术后患者的肺保护作用及可能机制。方法选取40例胸腔镜肺叶切除术的患者,随机分为实验(N-乙酰半胱氨酸,A组,下同)和对照(生理盐水,B组,下同)组,每组各20例。A组术后静脉滴注N-乙酰半胱氨酸(8g/次,qd),B组术后静脉滴注生理盐水(250mL/d);采集患者麻醉诱导前(T0),术后8h(T1),术后24h(T2),术后48h(T3)静脉血标本,采用酶联免疫吸附法(Elisa)测定血浆肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、超氧化物歧化酶(SOD)水平。结果 T0时间点,两组血浆TNF-α、IL-6、SOD浓度之间无显著差异(P> 0. 05);与T0比较,两组血浆TNF-α、IL-6浓度在T1-3明显上升,SOD浓度明显下降(P <0. 05),A组T1～3血浆TNF-α、IL-6浓度均明显低于B组(P <0. 05),SOD明显高于B组(P <0. 05)。结论 NAC在肺叶切除术后对肺脏具有一定的保护作用,其机制可能与NAC抑制炎症因子的表达和减轻氧化应激有关。
Objective To observe the protective effect of N-acetylcysteine injection( NAC) on lung in patients after thoracic lobectomy and to explore its possible mechanism. Methods 40 patients after thoracoscopic lobectomy were randomly divided into the experimental group( N-acetylcysteine,the group A) and the control group( normal saline,the group B). The group A received intravenous infusion of N-acetylcysteine( 8 g/times,qd),and the group B received intravenous infusion of normal saline( 250 mL/d). Their blood sample were collected at the time of before anesthesia induction( T0),8 h( T1),24 h( T2),and 48 h( T3) after operation. Plasma levels of tumor necrosis factor-α( TNF-α),interleukin-6( IL-6) and superoxide dismutase( SOD) were measured by enzyme-linked immunosorbent assay( Elisa). Results There was no significant difference in plasma TNF-α and IL-6 and SOD concentrations between the two groups at T0( P > 0. 05). Compared with T0,the concentrations of TNF-α and IL-6 at T1-3 and SOD decreased significantly in both groups( P < 0. 05). The concentrations of TNF-α and IL-6 at T1-3 were significantly lower than those in the group B( P < 0. 05). SOD was significantly higher than that in the group B( P < 0. 05). Conclusion NAC has a protective effect on lung after lobectomy,and its mechanism may be related to the inhibition of inflammatory factor expression by NAC and the reduction of oxidative stress.
Objective To observe the protective effect of N-acetylcysteine injection( NAC) on lung in patients after thoracic lobectomy and to explore its possible mechanism. Methods 40 patients after thoracoscopic lobectomy were randomly divided into the experimental group( N-acetylcysteine,the group A) and the control group( normal saline,the group B). The group A received intravenous infusion of N-acetylcysteine( 8 g/times,qd),and the group B received intravenous infusion of normal saline( 250 mL/d). Their blood sample were collected at the time of before anesthesia induction( T0),8 h( T1),24 h( T2),and 48 h( T3) after operation. Plasma levels of tumor necrosis factor-α( TNF-α),interleukin-6( IL-6) and superoxide dismutase( SOD) were measured by enzyme-linked immunosorbent assay( Elisa). Results There was no significant difference in plasma TNF-α and IL-6 and SOD concentrations between the two groups at T0( P > 0. 05). Compared with T0,the concentrations of TNF-α and IL-6 at T1-3 and SOD decreased significantly in both groups( P < 0. 05). The concentrations of TNF-α and IL-6 at T1-3 were significantly lower than those in the group B( P < 0. 05). SOD was significantly higher than that in the group B( P < 0. 05). Conclusion NAC has a protective effect on lung after lobectomy,and its mechanism may be related to the inhibition of inflammatory factor expression by NAC and the reduction of oxidative stress.
引文
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[3]张笑天,郑晓瑛.氧化自由基清除剂超氧化物歧化酶与疾病[J].中国公共卫生,2014,30(10):1349-1352.
[4] PATRIARCA S,FURFARO A L,DOMENICOTTI C,et al. Supplementation with N-acetylcysteine and taurine failed to restore glutathione content in liver of streptozotocin-induced diabetics rats but protected from oxidative stress[J]. Biochim Biophys Acta,2005,1741(1/2):48-54.
[5] DUBE K M,DITCH K L,HILLS L. Use of Nebulized Heparin,Nebulized N-Acetylcysteine,and Nebulized Epoprostenol in a Patient With Smoke Inhalational Injury and Acute Respiratory Distress Syndrome[J]. J Pharm Pract,2017,30(6):663-667.
[6] BHAT P V,PANDAREESH M D,KHANUM F,et al. Cytotoxic effects of Ochratoxin A in Neuro-2a Cells:role of oxidative stress evidenced by N-acetylcysteine[J]. Front Microbiol,2016,7:1142-1153.
[7]江继鹏,程远驰,刘宝虎,等. N-乙酰半胱氨酸抑制急性脊髓损伤后炎症因子的作用研究[J].天津医药,2017,45(8):817-821.
[8] SAMUNI Y,GOLDSTEIN S,DEAN O M,et al. The chemistry and biological activities of N-acetylcysteine[J]. Biochim Biophys Acta,2013,1830(8):4117-4129.
[9] BAKER W L,ANGLADE M W,BAKER E L,et al. Use of N-acetylcysteine to reduce post-cardiothoracic surgery complications:a meta-analysis[J]. Eur J Cardiothorac Surg,2009,35(3):521-527.
[10] SADOWSKA A M,MANUEL-Y-KEENOY B,DE BACKER W A.Antioxidant and anti-inflammatory efficacy of NAC in the treatment of COPD:discordant in vitro and in vivo dose-effects:a review[J].Pulm Pharmacol Ther,2007,20(1):9-22.
[11] RAPADO-CASTRO M,DODD S,BUSH A I,et al. Cognitive effects of adjunctive N-acetyl cysteine in psychosis[J]. Psychol Med,2017,47(5):866-876.
[2] ABRAHAM E. Neutrophils and acute lung injury[J]. Crit Care Med,2003,31(S4):S195-S199.
[3]张笑天,郑晓瑛.氧化自由基清除剂超氧化物歧化酶与疾病[J].中国公共卫生,2014,30(10):1349-1352.
[4] PATRIARCA S,FURFARO A L,DOMENICOTTI C,et al. Supplementation with N-acetylcysteine and taurine failed to restore glutathione content in liver of streptozotocin-induced diabetics rats but protected from oxidative stress[J]. Biochim Biophys Acta,2005,1741(1/2):48-54.
[5] DUBE K M,DITCH K L,HILLS L. Use of Nebulized Heparin,Nebulized N-Acetylcysteine,and Nebulized Epoprostenol in a Patient With Smoke Inhalational Injury and Acute Respiratory Distress Syndrome[J]. J Pharm Pract,2017,30(6):663-667.
[6] BHAT P V,PANDAREESH M D,KHANUM F,et al. Cytotoxic effects of Ochratoxin A in Neuro-2a Cells:role of oxidative stress evidenced by N-acetylcysteine[J]. Front Microbiol,2016,7:1142-1153.
[7]江继鹏,程远驰,刘宝虎,等. N-乙酰半胱氨酸抑制急性脊髓损伤后炎症因子的作用研究[J].天津医药,2017,45(8):817-821.
[8] SAMUNI Y,GOLDSTEIN S,DEAN O M,et al. The chemistry and biological activities of N-acetylcysteine[J]. Biochim Biophys Acta,2013,1830(8):4117-4129.
[9] BAKER W L,ANGLADE M W,BAKER E L,et al. Use of N-acetylcysteine to reduce post-cardiothoracic surgery complications:a meta-analysis[J]. Eur J Cardiothorac Surg,2009,35(3):521-527.
[10] SADOWSKA A M,MANUEL-Y-KEENOY B,DE BACKER W A.Antioxidant and anti-inflammatory efficacy of NAC in the treatment of COPD:discordant in vitro and in vivo dose-effects:a review[J].Pulm Pharmacol Ther,2007,20(1):9-22.
[11] RAPADO-CASTRO M,DODD S,BUSH A I,et al. Cognitive effects of adjunctive N-acetyl cysteine in psychosis[J]. Psychol Med,2017,47(5):866-876.