补肺汤合参蛤散辨治联合伏九贴敷对稳定期COPD肺肾气虚证患者的防治

Effect of Dialectical Therapy of Bufeitang Combined with Shengesan and Fujiu Application on COPD at Stable Period and Lung-kidney Qi Deficiency Syndrome

目的:观察补肺汤合参蛤散辨治联合伏九贴敷对稳定期慢阻肺(COPD)肺肾气虚证的防治效果及对炎症损伤和气道重塑的影响。方法:选取134例患者作为研究对象,随机按数字表法分为对照组66例和观察组68例。对照组采用噻托溴铵粉吸入剂,每次采用药粉吸入器吸入1粒胶囊,1次/d,并视情况加用沙美特罗替卡松粉吸入剂,喷雾吸入,每次1吸,1~2次/d,连续治疗12个月;观察组西医治疗同对照组,并给予伏九贴敷,在三伏的每一伏的第1天和三九的每一九的第1天,将药饼贴敷于双侧肺俞、脾俞、肾俞,共计6次,并于三伏第1天和三九第1天分别开始给予补肺汤合参蛤散辨治,分别连续服用2个月,共服用4个月。两组疗程均为连续治疗12个月。进行治疗前后慢阻肺患者自我评估测试问卷(CAT)FEV1占预计值百分比(FEV1%),6 min步行距离(6 MWD),圣乔治呼吸问卷(SGRQ),呼吸困难严重程度(m MRC)和BODE指数评价;检测治疗前后肿瘤坏死因子-α(TNF-α),白细胞介素-6(IL-6),基质金属蛋白酶-9(MMP-9)和基质金属蛋白酶抑制因子1(TIMP-1)。结果:治疗后观察组患者CAT评分低于对照组(P<0.01),FEV1%较对照组升高(P<0.01);观察组患者SGRQ总分及各个维度评分均低于对照组(P<0.01);观察组患者6 min步行距离多于对照组(P<0.01),急性加重次数少于对照组(P<0.01),BODE指数评分低于对照组(P<0.01);观察组患者呼吸困难严重程度轻于对照组(Z=2.047,P<0.05);观察组MMP-9,TNF-α和IL-6水平均低于对照组(P<0.01),TIMP-1水平高于对照组(P<0.01),MMP-9/TIMP-1低于对照组(P<0.01)。结论:补肺汤合参蛤散辨治联合伏九贴敷干预稳定期慢阻肺(肺肾气虚证)患者,可减轻当前呼吸困难症状,改善了运动耐量和生活质量,提高了肺功能,减少了急性加重次数,减轻了炎症损伤和气道的重塑,临床综合效果优于西医常规治疗。

Objective:To observe the clinical efficacy of dialectical therapy of Bufeitang combined with Shengesan and Fujiu application on chronic obstructive pulmonary disease(COPD)and lung-kidney Qi deficiency syndrome,and its effect on inflammatory damage and airway remodeling.Method:One hundred and thirty-four patients were randomly divided into control group(66 cases)and observation group(68 cases)by random number table.Patients in control group got spiriva by powder inhaler,1 grain/time,1 time/day,and salmeterol xinafoate and fluticasone propionate powder for inhalation for spray as appropriate,1 suction/time,1-2 times/days,for a continued 12 months.In addition to the therapy of control group,patients in observation group were also given Fujiu application at two-tailed acupoints of Feiyu,Piyu and Shenyu for the first day of the every San Fu and San Jiu,and dialectical therapy of Bufeitang combined with Shengesan were given at the first day of San Fu and San Jiu for 2 months.The course of treatment was 12 months.Before and after treatment,FEV1%of self-assessment questionnaire of patients with COPD(CAT),6-min walking distance,St George’s respiratory questionnaire(SGRQ),severity of dyspnea(m MRC)and index of BODE were assessed.And levels of tumor necrosis factoralpha(TNF-alpha),interleukin-6(IL-6),matrix metalloproteinase-9(MMP-9)and matrix metalloproteinase inhibitor-1(TIMP-1)were detected.Result:After treatment,scores of CAT,the total score of SGRQ,scoring of each dimension and index of BODE in observation group were all lower than that in control group(P<0.01),while FEV1%was higher than that in control group(P<0.01).And 6-min walking distance was more than that in control group(P<0.01),and the numbers of acute exacerbations were less than that in control group(P<0.01).The severity of dyspnea was lighter than that in control group(Z=2.047,P<0.05).And levels of MMP-9,TNF-α,IL-6 and ratio of MMP-9/TIMP-1 were lower than those in control group(P<0.01),whereas the level of TIMP-1 was higher than that in control group(P<0.01).Conclusion:Dialectical therapy of Bufei decoction combined with Shenge powder and Fujiu application can alleviate the current symptoms of dyspnea,improve exercise tolerance,quality of life and pulmonary function,reduce the number of acute exacerbations,relieve inflammation damage and airway remodeling.The comprehensive clinical efficacy is better than that of conventional western medicine.