“清热化痰、宣肺通络”法辅助治疗成人社区获得性肺炎痰热壅肺证临床疗效及对血清炎症因子影响

Effect of “Clearing Heat and Dissipating Phlegm,Ventilating Lung Qi and Dredging Collateral”Therapy Combined with Western Medicine on Adult Community-acquired Pneumonia with Syndrome of Phlegm-heat Congesting Lung and Influence on Serum Inflammatory Fact

目的观察"清热化痰、宣肺通络"法辅助治疗成人社区获得性肺炎(CAP)痰热壅肺证患者的临床疗效及对血清炎症因子的影响。方法选取2019年5月—2020年7月于本溪市中医院诊治的88例成人CAP痰热壅肺证患者作为研究对象,遵循随机、平行对照临床试验设计原则分为对照组和观察组。对照组给予注射用头孢美唑钠静脉滴注,观察组则在对照组基础上给予"清热化痰、宣肺通络"中药复方口服。两组疗程均为7 d。记录两组患者治疗前后的中医证候积分,发热、咳嗽、肺部罗音临床症状消退时间,胸部计算机断层扫描(CT)炎性反应吸收情况;检测两组患者治疗前后的外周血白细胞(WBC)、C反应蛋白(CRP)、降钙素原(PCT)以及血清炎症因子[白细胞介素-6(IL-6)、基质金属蛋白酶-9(MMP-9)、肿瘤坏死因子-α(TNF-α)]水平变化情况。结果治疗结束后观察组临床有效率(97.72%)明显高于对照组(84.09%),差异具有统计学意义(P<0.05);治疗结束后观察组发热、咳嗽、肺部罗音临床症状消退时间较对照组显著缩短,差异具有统计学意义(P<0.05);治疗结束后观察组胸部CT显示炎性反应吸收情况较对照组显著改善,差异具有统计学意义(P<0.05);治疗结束后两组患者的中医证候积分以及外周血WBC、CRP、PCT、血清炎症因子(IL-6、MMP-9、TNF-α)水平较治疗前显著降低,且观察组上述指标的下降幅度显著大于对照组,差异具有统计学意义(P<0.05)。结论"清热化痰、宣肺通络"法辅助治疗成人CAP痰热壅肺证患者疗效确切,缩短临床症状消退时间,降低外周血WBC、CRP、PCT与血清IL-6、MMP-9、TNF-α炎症因子水平,促进炎性反应吸收,具有极高推广价值。

Objective To observe the efficacy of"clearing heat and dissipating phlegm,ventilating lung Qi and dredging collateral"therapy combined with Western medicine on adult community-acquired pneumonia(CAP)with syndrome of phlegm-heat congesting lung and influence on serum inflammatory factors.Methods 88 patients of adult CAP with syndrome of phlegm-heat congesting lung in the Benxi hospital of traditional Chinese medicine from May 2019 to July 2020 were randomly divided into the observation group and the control group.Patients in the control group were treated with intravenous drip infusion of cefmetazole sodium for injection.Patients in the observation group were treated with compound prescription of"clearing heat and dissipating phlegm,ventilating lung Qi and dredging collateral"on the basis of the control group.Seven days was a treatment course.The TCM syndrome score,disappearance time of fever,cough and lung rale,inflammatory absorption of chest computed tomography(CT)was recorded before and after treatment between two groups.Peripheral white blood cell(WBC),C-reactive protein(CRP),procalcitonin(PCT)and serum inflammatory factors[interleukin-6(IL-6),matrix metalloproteinase-9(MMP-9),tumor necrosis factor-α(TNF-α)]levels were tested before and after treatment between two groups.Results After treatment,the clinical effective rate of the observation group was significantly higher than the control group(P<0.05).After treatment,the disappearance time of fever,cough and lung rale in the observation group were significantly shorter than the control group(P<0.05).After treatment,the inflammatory absorption of chest CT in the observation group was significantly improved compared with the control group(P<0.05).After treatment,the TCM syndrome score,peripheral WBC,CRP,PCT and serum inflammatory factors(IL-6,MMP-9,TNF-α)levels of the two groups were significantly lower than those before treatment,and the degree of decline of the observation group for the above indicators was significantly better than the control group(P<0.05).Conclusion"Clearing heat and dissipating phlegm,ventilating lung Qi and dredging collateral"therapy combined with Western medicine on adult CAP with syndrome of phlegm-heat congesting lung has definite curative effect,can effectively shorten the disappearance time of clinical symptoms,reduce peripheral WBC,CRP,PCT and serum IL-6,MMP-9,TNF-αlevels,promote the inflammatory absorption of chest CT.It has very high promotion value.