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首页 » BIOON报道 » The Lancet:廉价祛痰药物可显著减少慢阻肺急性发作

The Lancet:廉价祛痰药物可显著减少慢阻肺急性发作

来源:生物谷 2008-06-16 22:26

生物谷报道:著名呼吸疾病专家、中国工程院院士钟南山领导的研究团队最新研究发现,一种常用的廉价祛痰药物羧甲司坦可减少24.5%的慢性阻塞性肺疾病,慢阻肺常规治疗费也可剧降85%。

此研究结果发表在刚刚出版的国际权威医学杂志《柳叶刀》上。著名医学专家保罗·艾伯特与彼得·卡尔弗利还在该杂志上发表了编者评述。

慢性阻塞性肺疾病(简称慢阻肺,COPD)是一种常见病、多发病,过去多以“慢性支气管炎、肺气肿”为人们熟知。全国每年患慢阻肺的人数达3500万,死亡人数达100万,致残人数达500万至1000万。

钟南山在16日举行的慢阻肺防治新进展新闻发布会上介绍说,中国共有14个城市、22家医院、709例慢阻肺患者参与临床实验。研究结果表明,羧甲司坦长期治疗能预防慢阻肺的急性发作。

据介绍,祛痰药物羧甲司坦是一种非处方药,这次的研究结果使这种老药焕发了生机。研究结果显示,羧甲司坦预防口服用药能显著减少慢阻肺的急性发作达24.5%,明显改善慢阻肺患者的生活质量,并基本无毒副作用。在6月14日发表于国际权威医学杂志《柳叶刀》的学术论文中,作者明确指出:“应该重新认识祛痰药物羧甲司坦在慢阻肺治疗中的地位”。

钟南山说,慢阻肺是以气流受限、肺功能进行性下降为特征的疾病,急性发作会使病情加重,患者的肺功能也相应减弱,严重者需要急诊、住院治疗,这消耗了大量医疗资源,也加重了患者家庭及社会的经济负担。因此,预防慢阻肺的急性加重能有效地降低医疗资源的消耗,减少患者的经济负担。

“羧甲司坦是国产药,服用方便,较之国际标准的吸入治疗方法,常规治疗费可减少85%,每人每年可节约治疗费3670元,平均每名患者的急性发作治疗费可节约2480元。如果服用羧甲司坦,每月只需花费52.5元,国际常用治疗慢阻肺的药物则要花费四五百元。”钟南山说。(生物谷www.bioon.com

生物谷推荐原始出处:

The Lancet 2008; 371:2013-2018 DOI:10.1016/S0140-6736(08)60869-7

Effect of carbocisteine on acute exacerbation of chronic obstructive pulmonary disease (PEACE Study): a randomised placebo-controlled study

Prof Jin-Ping Zheng MD a,   Prof Jian Kang MD b,   Prof Shao-Guang Huang MD c,   Ping Chen MD d,   Prof Wan-Zen Yao MD e,   Prof Lan Yang MD f,   Prof Chun-Xue Bai MD g,   Prof Chang-Zheng Wang MD h,   Prof Chen Wang MD i,   Bao-Yuan Chen MD j,   Yi Shi MD k,   Chun-Tao Liu MD l,   Prof Ping Chen MD m,   Qiang Li MD n,   Zhen-Shan Wang MD o,   Yi-Jiang Huang MD p,   Zhi-Yang Luo MD q,   Fei-Peng Chen MD r,   Jian-Zhang Yuan MD s,   Ben-Tong Yuan MD t,   Hui-Ping Qian MD u,   Rong-Chang Zhi MD v   and   Prof Nan-Shan Zhong MD  a 

Summary

Background

Chronic obstructive pulmonary disease (COPD) is characterised by airflow limitation, and has many components including mucus hypersecretion, oxidative stress, and airway inflammation. We aimed to assess whether carbocisteine, a mucolytic agent with anti-inflammatory and antioxidation activities, could reduce the yearly exacerbation rate in patients with COPD.

Methods

We did a randomised, double-blind, placebo-controlled study of 709 patients from 22 centres in China. Participants were eligible if they were diagnosed as having COPD with a postbronchodilator forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) ratio (FEV1/FVC) of less than 0·7 and an FEV1 between 25% and 79% of the predicted value, were aged between 40 and 80 years, had a history of at least two COPD exacerbations within the previous 2 years, and had remained clinically stable for over 4 weeks before the study. Patients were randomly assigned to receive 1500 mg carbocisteine or placebo per day for a year. The primary endpoint was exacerbation rate over 1 year, and analysis was by intention to treat. This trial is registered with the Japan Clinical Trials Registry (http://umin.ac.jp/ctr/index/htm) number UMIN-CRT C000000233.

Findings

354 patients were assigned to the carbocisteine group and 355 to the placebo group. Numbers of exacerbations per patient per year declined significantly in the carbocisteine group compared with the placebo group (1·01 [SE 0·06] vs 1·35 [SE 0·06]), risk ratio 0·75 (95% CI 0·62–0·92, p=0·004). Non-significant interactions were found between the preventive effects and COPD severity, smoking, as well as concomitant use of inhaled corticosteroids. Carbocisteine was well tolerated.

Interpretation

Mucolytics, such as carbocisteine, should be recognised as a worthwhile treatment for prevention of exacerbations in Chinese patients with COPD.

Funding

Kyorin Pharmaceuticals.

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