清热化痰法治疗慢性阻塞性肺疾病急性加重期全身炎症反应综合征的随机对照临床试验

Therapy for clearing heat and resolving phlegm in treatment of systemic inflammatory response syndrome in acute deterioration stage of chronic obstructive pulmonary disease:a randomized controlled trial

目的:观察清热化痰法治疗慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)急性加重期全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)的临床疗效及其对降钙素原(procalcitonin,PCT)这一炎性指标的作用。方法:将符合纳入标准的100例患者随机分为治疗组和对照组,每组各50例。治疗组在西医综合冶疗的基础上,加用清热化痰中药,对照组单纯用西医综合冶疗,两组疗程均为1周。在入院第1、3和第7天对患者分别进行血清PCT测定。在入院第1天和第7天分别记录患者中医证候积分,并进行疗效判定。结果:两组治疗后中医证候积分与治疗前比较均有改善,差异均有统计学意义(P<0.05)。治疗后,治疗组中医证候积分改善程度优于对照组,差异有统计学意义(P<0.05)。中医证候积分减少按≥70%和<70%进行比较,治疗组的治疗效果明显优于对照组,差异有统计学意义(P<0.05)。PCT浓度越高,中医证候积分越高(P<0.05)。两组入院第1、3和第7天血清PCT水平分布比较,差异均无统计学意义(P>0.05)。结论:清热化痰法联合西医综合治疗对患者的症状改善程度优于单纯西医综合治疗,更有利于患者症状的改善。COPD急性加重期SIRS的PCT与病情严重程度相关。

Objective： To investigate the effects of traditional Chinese medicine （TCM） therapy for clearing heat and resolving phlegm on systemic inflammatory response syndrome （SIRS） in acute deterioration stage of chronic obstructive pulmonary disease （COPD） and the serum procalcitonin （PCT） level. Methods： One hundred patients suffering from SIRS in acute deterioration stage of COPD were included and randomly divided into treatment group （50 cases） and control group （50 cases）. Patients in the treatment group were treated with routine Western medicine and Chinese herbal medicine for clearing away heat and eliminating phlegm, while patients in the control group were treated with routine Western medicine only. Patients in the two groups were treated for one week. The serum PCT levels in the two groups were measured at days 1, 3. and 7, and clinical symptom scores were recorded at days 1 and 7 in hospital to determine the effects. Results： Clinical symptom scores in the two groups decreased after the treatment （P〈0.05）, and the symptom score in the treatment group was lower than that in the control group （P〈0.05）. The effect of integrated traditional Chinese and Western medicine treatment was obviously better than that of the Western medicine treatment when improving rates in clinical symptom score were divided into over 70% and less than ？0% （P〈0.05）. Serum PCT concentration was in direct proportion to clinical symptom score （P〈0.05）. The patients with higher clinical symptom score were in more serious pathogenetic condition. There were no significant differences in the serum PCT concentrations among days 1, 3 and 7 in hospital. Conclusion： The effect of TCM therapy for clearing heat and removing phlegm combined with Western medicine treatment is better than that of the Western medicine treatment. TCM therapy has a satisfied effect in improving clinical symptoms, The serum PCT concentration is correlated with the severity of SIRS in acute deterioration stage of CQPD.