| 清燥润肺汤加味联合西药治疗气阴两虚证慢性阻塞性肺疾病伴肺炎的疗效观察 |
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| 引用本文： | 楼滟,王晓宇,陈敏华.清燥润肺汤加味联合西药治疗气阴两虚证慢性阻塞性肺疾病伴肺炎的疗效观察[J].中华全科医学,2018,16(2):243. |
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| 作者姓名： | 楼滟 王晓宇 陈敏华 |
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| 作者单位： | 1. 浙江省医疗健康集团杭州医院呼吸科, 浙江 杭州 310072; |
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| 基金项目： | 浙江省医药卫生科技计划项目(2015KYA018) |
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| 摘 要： | 目的 探讨清燥润肺汤加味联合西药治疗气阴两虚证慢性阻塞性肺疾病(COPD)伴肺炎患者的疗效及机制。 方法 将2015年2月-2016年11月浙江省医疗健康集团杭州医院收治的98例COPD急性加重期伴肺炎气阴两虚证患者随机分为对照组49例和观察组49例。对照组给予常规西医治疗,观察组另给予清燥润肺汤加味口服,每日1剂,均治疗2个月。观察临床疗效、中医证候积分、呼吸困难评分(mMRC)、6分钟步行试验(6MWT)、肺功能及治疗前后外周血CD3+、CD4+、CD8+、CD4+/CD8+、NK细胞、IgG、IgA、IgM、白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)、MMP、TIMP、TGF-β1及VEGF水平。 结果 观察组临床总有效率明显高于对照组(P<0.05)。观察组患者治疗后各项中医证候积分显著低于对照组(P<0.05)。经治疗后,2组患者各项肺功能指标、mMRC评分、6MWT均较治疗前好转(P<0.05)。2组患者治疗后CD3+、CD4+、CD4+/CD8+、NK细胞水平显著升高,CD8+水平显著降低(P<0.05)。观察组治疗后IgA、IgM水平显著升高(P<0.05),但IgG差异无统计学意义(P>0.05)。2组患者治疗后IL-8、TNF-α、MMP、TIMP、TGF-β1及VEGF水平显著降低(P<0.05)。且观察组经治疗后上述指标均明显优于对照组(P<0.05)。观察组患者人均年急性加重次数和住院次数均显著低于对照组(P<0.05)。 结论 清燥润肺汤加味联合西药治疗气阴两虚证COPD伴肺炎患者临床疗效确切,其机制可能与切断炎症级联反应,提高机体免疫功能,改善气道重塑状态有关。
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| 关 键 词： | 清燥润肺汤 慢性阻塞性肺疾病 肺炎 |
| 收稿时间： | 2017-09-19 |
Efficacy of TCM modified Qinggan Runfei Decoction combined with Western Medicine for chronic obstructive pulmonary disease with pneumonia in patients with Qi-Yin Deficiency syndrome |
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| Affiliation: | Department of Respiratory, Hangzhou Hospital of Zhejiang Medical and Health Group, Hangzhou, Zhejiang 310072, China |
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| Abstract: | Objective To investigate the clinical efficacy and mechanism of TCM modified Qingzao Jiufei decoction combined with western medicine on Qi and Yin deficiency patients with chronic obstructive pulmonary disease (COPD) and pneumonia. Methods Total 98 cases of Qi and Yin deficiency patients with acute exacerbation of COPD and pneumonia were randomly divided into control group (n=49) and observation group (n=49). The control group was given conventional anti-infective, bronchodilator, expectorant and other treatment for 2 months, while the observation group was given TCM Qingzao Jiufei decoction oral, one dose a day for 2 months. The clinical efficacy, TCM syndrome score, dyspnea score (mMRC), 6-minute walk test (6MWT), lung function and peripheral blood T lymphocyte subsets, natural killer cells, IgG, IgA, IgM (IL-8), tumor necrosis factor-α (TNF-α), MMP, TIMP, TGF-β1 and VEGF were measured. Results The total effective rate was 91.84% in the observation group, which was significantly higher than that in the control group (77.55%, P<0.05). The scores of TCM syndromes were significantly lower in the observation group than in the control group (P<0.05). After the treatment, the pulmonary function indexes, mMRC score and 6 MWT of the two groups were better than those before the treatment (P<0.05). CD8+, CD4+, CD4+/CD8+, NK cells were significantly increased and CD8+ levels were significantly decreased in the two groups (P<0.05). The levels of IgA and IgM in the observation group were significantly increased (P<0.05), but there was no significant difference (P>0.05). IL-8, TNF-α, MMP, TIMP, TGF-β1 and VEGF were significantly decreased in both groups (P<0.05). And the observation group after the treatment were significantly better than the control group after the treatment (P<0.05). The number of acute exacerbations and the number of hospitalizations in the observation group were significantly lower than those in the control group (P<0.05). Conclusion The therapeutic effect of TCM Qingzao Jiufei decoction combined with western medicine on qi and yin deficiency syndrome in patients with chronic obstructive pulmonary disease and pneumonia is obvious, and the mechanism may be related to stop cascade of inflammation and improve the immune function and airway remodeling state. |
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