自拟宣肺消鼾汤联合Auto-CPAP模式治疗老年COPD合并OSAHS重叠综合征的疗效及对抗炎-促炎系统失衡的影响

摘要

目的 观察自拟宣肺消鼾汤联合自动持续气道正压通气 (AutoCPAP) 模式治疗老年慢性阻塞性肺疾病 (COPD) 合并阻塞性睡眠呼吸暂停低通气综合征 (OSAHS) 重叠综合征的疗效及对抗炎-促炎系统失衡的影响.方法 将72例老年COPD合并OSAHS重叠综合征患者按照随机数字表分为观察组36例和对照组36例, 2组均给予常规基础治疗, 对照组在其基础上给予Auto-CPAP模式治疗, 观察组在对照组治疗基础上加用自拟宣肺消鼾汤治疗, 疗程均为6个月.观察2组治疗前后临床症状、低通气指标和病情控制指标、心肺功能[第1秒用力呼气容积 (FEV1) 、FEV1/FVC、平均肺动脉压 (m PAP) 、左室Tei指数、右室Tei指数、血清B型脑钠肽 (BNP) 、左室射血分数 (LVEF) ]、炎性细胞因子[白细胞介素-6 (IL-6) 、IL-8、IL-10、IL-13、肿瘤坏死因子-α (TNF-α) 、转化生长因子-β (TGF-β) ]的变化情况.结果 2组治疗后的临床症状积分 (白天嗜睡、晨起头痛、晨起口干、鼾声、夜间憋醒、咳嗽咳痰) 、ESS评分、CAT评分、睡眠呼吸暂停低通气指数 (AHI) 、最长呼吸暂停时间 (LAT) 、m PAP、左室Tei指数、右室Tei指数、BNP及IL-6、IL-8、TNF-α水平均显著降低 (P均＜0. 05) , 夜间最低血氧饱和度[LSa (O2) ]、夜间平均血氧饱和[MSa (O2) ]、FEV1、FEV1/FVC、LVEF及TGF-β、IL-10、IL-13水平均显著升高 (P均＜0. 05) , 观察组以上指标改善情况均优于对照组 (P均＜0. 05) .结论 自拟宣肺消鼾汤联合Auto-CPAP模式治疗能够显著改善老年COPD合并OSAHS重叠综合征患者临床症状, 缓解低通气嗜睡状态, 并促进病情恢复和心肺功能的改善, 机制可能与调节抗炎-促炎系统失衡有关.%Objective It is to observe the curative effect of self-made Xuanfei Xiaohan Decoction combined with automatic continuous positive airway pressure (Auto-CPAP) in the treatment of elderly patients with chronic obstructive pulmonary disease (COPD) complicated with obstructive sleep apnea hypopnea syndrome (OSAHS) and its effect on anti-inflammatory-proinflammatory system imbalance. Methods 72 elderly patients with COPD and OSAHS overlap syndrome were divided into observation group (36 cases) and control group (36 cases) according to the random number table. Both groups were given routine basic treatment, and the control group was given Auto-CPAP mode treatment, the observation group was added with the self-made Xuanfei Xiaohan Decoction on the basis of the control group, both groups were treated for 6months. The changes of clinical symptoms, hypoventilation index and disease control index, cardiopulmonary function [1second forced expiratory volume (FEV1) , FEV1/FVC, mean pulmonary artery pressure (m PAP) , left ventricular Tei index, right ventricular Tei index, serum B-type brain natriuretic peptide (BNP) , left ventricular ejection fraction (LVEF) ], inflammatory cytokines [interleukin-6 (IL-6) , IL-8, IL-10, IL-13, tumor necrosis factor-α (TNF-α) and transforming growth factor-β (TGF-β) ] were observed before and after treatment. Results After treatment, the clinical symptom scores (daytime sleepiness, morning headache, morning dry mouth, snoring, night awakening, cough and cough) , ESS score, CAT score, sleep apnea hypopnea index (AHI) , most long apnea time (LAT) , m PAP, left ventricular Tei index, right ventricular Tei index, the levels of BNP, IL-6, IL-8, TNF-α were all significantly decreased (P ＜0. 05) , and nighttime minimum oxygen saturation [LSa (O2) ], nighttime mean oxygen saturation [MSa (O2) ], FEV1, FEV1/FVC, LVEF, and the levels of TGF-β, IL-10, IL-13 were significantly increased (P ＜ 0. 05) , and the improvement of the above indicators in the observation group were better than those in the control group (P ＜ 0. 05). Conclusion Selfmade Xuanfei Xiaohan Decoction combined with Auto-CPAP mode can significantly improve the clinical symptoms, relieve hypoventilation and sleepiness, and promote the recovery of disease and improvement of cardiopulmonary function in elderly patients with COPD and OSAHS overlap syndrome. The mechanism may be related to the regulation of anti-inflammatoryproinflammatory system imbalance.