目的 探讨乙酰半胱氨酸颗粒联合莫西沙星治疗慢性阻塞性肺疾病急性加重期（AECOPD）的临床效果。方法 选取2017年6月—2020年6月天津市第五中心医院（北京大学滨海医院）收治的86例AECOPD患者，使用随机数字表法分成对照组（n=43）和治疗组（n=43）。对照组静脉滴注盐酸莫西沙星注射液，每次将0.4 g加入5%葡萄糖注射液250 mL中充分稀释后给药，1次/d。治疗组在对照组基础上口服乙酰半胱氨酸颗粒，1包/次，3次/d。两组均连续治疗14 d。观察两组临床疗效及患者典型呼吸道症状和体征的缓解时间。并比较治疗前后两组血清白三烯B4（LTB4）、白细胞介素-8（IL-8）、8异前列腺素F2α（8-iso-PGF2α）、前白蛋白（PA）、丙二醛（MDA）水平。结果 治疗后，治疗组总有效率为95.3%，显著高于对照组79.1%（P<0.05）。治疗后，治疗组咳嗽、咳痰、喘息和肺部哮鸣音缓解时间均显著短于对照组（P<0.05）。治疗后，两组血清LTB4、IL-8、8-iso-PGF2α及MDA水平均较本组治疗前显著下降（P<0.05），血清PA水平则均显著升高（P<0.05）；且治疗后，治疗组血清学指标改善优于对照组（P<0.05）。结论 乙酰半胱氨酸颗粒联合莫西沙星对AECOPD患者具有确切的临床疗效，能安全有效且迅速地稳定患者病情，改善肺功能，并可显著减轻机体炎症反应、降低氧化应激损伤，值得临床推广应用。

Objective To investigate the clinical effect of Acetylcysteine Granules combined with moxifloxacin in treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods A total of 86 AECOPD patients admitted to Tianjin Fifth Central Hospital (Peking University Binhai Hospital) from June 2017 to June 2020 were randomly divided into control group (n=43) and treatment group (n=43) by random number table method. Patients in the treatment group were iv administered with Moxifloxacin Hydrochloride and Sodium Chloride Injection, 0.4 g was added into 5% Glucose Injection 250 mL each time and fully diluted, once daily. Patients in the treatment group were po administered with Acetylcysteine Granules on the basis of the control group, 1 bag/time, three times daily. Patients in two groups were treated for 14 d. After treatment, the clinical efficacy and relief time of typical respiratory symptoms and signs were observed. Serum levels of LTB4, IL-8, 8-iso-PGF2α, PA, and MDA were compared between the two groups before and after treatment. Results After treatment, the total effective rate of treatment group was 95.3%, significantly higher than 79.1% of control group (P < 0.05). After treatment, the relief time of cough, expectoration, wheezing and pulmonary wheezing in treatment group was significantly shorter than that in control group (P < 0.05). After treatment, the levels of LTB4, IL-8, 8-iso-PGF2α, and MDA in two groups were significantly decreased compared with before treatment (P < 0.05), but the level of serum PA was significantly increased (P < 0.05). After treatment, the serological index of the treatment group was better than that of the control group (P < 0.05). Conclusion Acetylcysteine Granules combined with moxifloxacin has a definite clinical effect on AECOPD patients, and can safely, effectively and rapidly stabilize patients' condition, can improve lung function, and also can significantly reduce inflammatory response and oxidative stress injury, which is worthy of clinical application.

R974