Abstract:

Objective: To study the influence of ipratropium bromide combined with N-acety-L-cysteine(NAC) in the serum MMP -9 and TGF-β levels of the patients with chronic obstructive pulmonary disease(COPD) in stable phase, and to discuss the role in airway remodeling of the COPD patients. Methods: Eighty patients with COPD in stable phase were randomly divided into NAC group (n=27), ipratropium bromide group(n=27), and combination group (n=26).26 cases of healthy volunteers were selected as control group. The clinical symptom and physical sign scores and the lung function indexes(FVC,FEV₁,FEV₁%,and FEV₁/FVC) were monitored and the serum TGF-β and MMP-9 levels of the patients in various groups were detected before and after treatment.The relationships between the value of FEV₁ and the serum TGF-β and MMP-9 were analyzed with Spearman analysis. Results: Compared with before treatment,the symptom and physical sign scores of the patients in various treatment groups after treatment were significantly decreased(P < 0.05);compared with NAC group and ipratropium bromide group,the symptom and physical sign scores of the patients in combination group after treatment were significantly decreased(P < 0.05).Compared with before treatment, the lung function indexes of the patients in various treatment groups after treatment were improved(P < 0.05);compared with NAC group and ipratropium bromide group,the lung function indexes of the patients in combination group after treatment were significantly improved(P < 0.05).Compared with control group,the serum TGF-β and MMP-9 levels of the patients in various treatment groups before and after treatment were significantly decreased(P < 0.05);compared with NAC group and ipratropium bromide group,the serum TGF-β and MMP-9 levels of the patients in combintion group were significantly decreased(P < 0.05).The FEV₁ values of the patients in combination group had negative correlations with the serum TGF-β and MMP-9 levels before and after treatment (before:r=-0.554,-0.477,P < 0.05;after:r=-0.415,-0.654,P < 0.05). Conclusion: Ipratropium bromide combined with NAC can significantly improve the clinical symptoms, signs and lung function,and decrease the serum MMP-9 and TGF-β levels. Therefore, it can inhibit the airway remodeling in the treatment of the COPD patients in stable phase.

Key words: chronic obstructive pulmonary disease, transforming growth factor-β, matrix metalloprotein-9, ipratropium bromide, N- acety- L-cysteine