苇芩泻白汤联合西药治疗社区获得性肺炎合急性肺损伤痰热郁肺证临床研究

Clinical Study on Weiqin Xiebai Decoction Combined with Western Medicine for Community-Acquired Pneumonia Complicated with Acute Lung Injury with Phlegm-Heat Constraining Lung Syndrome

目的:观察苇芩泻白汤联合西药治疗社区获得性肺炎合急性肺损伤痰热郁肺证的临床疗效。方法:按照随机数字表法将62例社区获得性肺炎合急性肺损伤患者分为治疗组、对照组各31例。对照组给予常规西药治疗,治疗组在对照组基础上给予苇芩泻白汤治疗。比较2组临床疗效及治疗前后中医证候积分、血氧分压(PaO_(2))、氧合指数(PaO_(2)/FiO_(2))、白细胞计数(WBC)、C-反应蛋白(CRP)、核转录因子-κB(NF-κB)、细胞间黏附分子-1(ICAM-1)、单核细胞趋化蛋白-1(MCP-1)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平。结果:治疗组脱落1例,纳入研究30例;对照组脱落1例,纳入研究30例。治疗组总有效率96.67%,高于对照组73.33%(P<0.05)。2组治疗后PaO_(2)、PaO_(2)/FiO_(2)较治疗前升高(P<0.05),中医证候积分、WBC、CRP水平降低(P<0.05),且治疗组治疗后PaO_(2)、PaO_(2)/FiO_(2)高于对照组(P<0.05),中医证候积分、WBC、CRP水平低于对照组(P<0.05)。2组治疗后NF-κB、ICAM-1、MCP-1、IL-6、TNF-α水平较治疗前降低(P<0.05),且治疗组治疗后上述炎症指标低于对照组(P<0.05)。结论:苇芩泻白汤联合西药治疗社区获得性肺炎合急性肺损伤痰热郁肺证疗效确切,能够有效降低患者炎症因子水平,改善患者PaO_(2)/FiO_(2)及临床症状。

Objective:To observe the clinical effect of therapy of Weiqin Xiebai Decoction combined with western medicine on community-acquired pneumonia complicated with acute lung injury with phlegmheat constraining the lung syndrome.Methods:A total of 62 patients with community-acquired pneumonia complicated with acute lung injury were divided into the treatment group and the control group according to the random number table method,with 31 cases in each group.The control group was given routine western medicine for treatment,and the treatment group was additionally treated with Weiqin Xiebai Decoction based on the treatment of the control group.The clinical effects,traditional Chinese medicine(TCM)syndrome scores,and levels of partial pressure of oxygen(PaO_(2)),ratio of PaO_(2)of O_(2)in arterial blood to fraction of inspired oxygen(PaO_(2)/FiO_(2)),white blood count(WBC),C-reactive protein(CRP),nuclear transcription factor-κB(NF-κB),intercellular adhesion molecule-1(ICAM-1),monocyte chemotactic protein-1(MCP-1),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were compared before and after treatment between the two groups.Results:With 1 case in the treatment group and 1 case in the control group being dropped out,finally 30 cases in the treatment group and 30 cases in the control group were included into the study.The total effective rate was 96.67%in the treatment group,significantly higher than that of 73.33%in the control group(P<0.05).After treatment,the PaO_(2)and PaO_(2)/FiO_(2)in the two groups were increased when compared with those before treatment(P<0.05),and the TCM syndrome scores and levels of WBC and CRP were decreased(P<0.05);the PaO_(2)and PaO_(2)/FiO_(2)in the treatment group were higher than those in the control group(P<0.05),and the TCM syndrome score and levels of WBC and CRP were lower than those in the control group(P<0.05).The levels of NF-κB,ICAM-1,MCP-1,IL-6 and TNF-αin both groups were decreased when compared with those before treatment(P<0.05),and the levels of above five inflammatory indexs in the treatment group were lower than those in the control group(P<0.05).Conclusion:The therapy of Weiqin Xiebai Decoction combined with western medicine has definite curative effect on community-acquired pneumonia complicated with acute lung injury with phlegm-heat constraining the lung syndrome,which can effectively reduce the levels of inflammatory factors and improve the PaO_(2)/FiO_(2)and clinical symptoms of patients.