宽胸理肺汤对痰浊壅肺型慢性阻塞性肺疾病急性加重期患者炎症因子的影响:一项多中心前瞻性研究

摘要

目的 探讨宽胸理肺汤对痰浊壅肺型慢性阻塞性肺疾病急性加重期(AECOPD)患者炎症因子的影响.方法 选择2017年5月至2018年3月就诊于上海中医药大学附属龙华医院、上海市第七人民医院、上海市浦东新区浦南医院、上海市浦东新区公利医院4家医院中医辨证为痰浊壅肺型AECOPD患者200例,将患者按随机数字表法分为试验组和对照组,每组100例.两组患者均根据指南接受常规西医治疗,试验组在西医常规治疗基础上加用中药宽胸理肺汤(组成:法半夏15 g、薤白12 g、麻黄9 g、全瓜蒌30 g、茯苓15 g、杏仁12 g、地龙12 g、陈皮12 g、桃仁12 g、炙甘草6 g),由龙华医院中药房统一煎制,每日1剂,分2次口服,每次200 mL饭前或饭后0.5 h温服.治疗10 d后评价疗效.观察两组患者治疗前后白细胞计数(WBC)、中性粒细胞比例(N)、C-反应蛋白(CRP)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)水平的变化和中医证候积分改善情况以及临床疗效.结果 两组治疗后WBC、N、CRP、IL-8、TNF-α和中医证候积分均较治疗前明显降低,且试验组治疗后上述指标均明显低于对照组〔WBC(×109/L):6.58±1.41比7.44±1.85,N :0.58±0.08比0.64±0.08,CRP(mg/L):7.3±1.8比9.6±1.7,IL-8(ng/L):23.5±6.2比27.8±9.8,TNF-α(ng/L):9.45±2.18比10.25±1.67,中医证候积分(分):4.0(3.0,8.0)比8.0(5.0,10.0),均P＜0.05〕.试验组治疗后总有效率明显高于对照组〔88%(88/100)比84%(84/100),P＜0.05〕.结论 宽胸理肺汤联能明显降低痰浊壅肺型AECOPD患者炎症因子水平,减轻患者全身症状,改善预后.%Objective To investigate the effect of Kuanxiong Lifei decoction on inflammatory factors in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and turbid phlegm obstructing lung syndrome. Methods Two hundred patients with AECOPD and turbid phlegm obstructing lung syndrome diagnosed by traditional Chinese medicine (TCM) differentiation visiting four hospitals of Longhua Hospital Affiliated to Shanghai University of TCM, Shanghai Seventh People's Hospital, Punan Hospital of Shanghai Pudong New Area, Gongli Hospital of Shanghai Pudong New Area were selected from May 2017 to March 2018, and they were divided into a test group and a control group by a random number table, 100 cases per group. The patients in the two groups were treated with routine western medicine according to the guidelines, and in the test group, additionally Kuanxiong Lifei decoction (components: pinellia ternate 15 g, allium macrostemon 12 g, ephedra 9 g, trichosanthes 30 g, poria cocos 15 g, almond 12 g, lumbricus 12 g, citrus peels 12 g, peach kernel 12 g , roasted licorice 6 g) was used for 10 days, the decoction was uniformly made by Chinese Medicine Pharmacy of Longhua Hospital, 1 dose daily, 2 times a day orally taken, warm 200 mL each time, 0.5 hours before or after meal. The efficacy was evaluated after treatment for 10 days. The level changes of white blood cell count (WBC), neutrophils (N), C-reactive protein (CRP), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α) before and after treatment and the improvement of TCM syndrome scores and clinical efficacy were observed in two groups. Results After treatment, the levels of WBC, N, CRP, IL-8, TNF-α, TCM syndrome score of the patients in the two group were significantly decreased compared with those before treatment in the two groups (P < 0.05), and the above indexes in the test group were all significantly lower than those in the control group after treatment [WBC (×109/L): 6.58±1.41 vs.7.44±1.85, N: 0.58±0.08 vs. 0.64±0.08, CRP (mg/L): 7.3±1.8 vs. 9.6±1.7, IL-8 (ng/L): 23.5±6.2 vs. 27.8±9.8, TNF-α (ng/L): 9.45±2.18 vs. 10.25±1.67, TCM syndrome total score: 4.0 (3.0, 8.0) vs. 8.0 (5.0, 10.0), all P < 0.05]. The total effective rate of the test group was significantly higher than that of the control group [88% (88/100) vs. 84% (84/100), P < 0.05]. Conclusion Kuanxiong Lifei decoction can significantly reduce lung inflammatory factors, ameliorate overall symptoms and improve the prognosis of AECOPD patients with turbid phlegm obstructing lung syndrome.