健脾清肺化痰法对慢性阻塞性肺疾病合并全身炎症反应综合征疗效及核因子-κB表达的影响

Therapeutic Effect of Spleen-strengthening,Lung-clearing and Phlegm-resolving Therapy for Chronic Obstrustive Pulmonary Disease Complicated with Systemic Inflammatory Response Syndrome and Its Influence on Nuclear Factor κB Expression

【目的】观察具有健脾清肺化痰作用的中药汤剂对辨证属于肺脾两虚、痰热郁肺型的慢性阻塞性肺疾病(慢阻肺,COPD)急性发作期合并全身炎症反应综合征(SIRS)患者临床症状、血气分析指标以及对核因子-κB(NF-κB)表达的影响。【方法】将60例中医辨证属于肺脾两虚、痰热郁肺型的慢性阻塞性肺疾病急性发作期、西医符合SIRS诊断标准的患者随机分为治疗组和对照组各30例。对照组给予常规的西医综合治疗(吸氧和抗生素、支气管扩张剂的应用等),治疗组在一般西医治疗的基础上加用具有健脾、清肺、化痰作用的中药汤剂(陈夏六君子汤合苇茎汤,每天1剂),疗程7 d,比较两组患者临床症状、体征和血气分析指标的变化以及对NF-κB表达的影响。【结果】临床症状和体征(咳嗽、咯痰、喘息、气短、哮鸣音)方面,两组治疗后均有改善(与治疗前比较,P<0.01),且治疗组的改善作用优于对照组(P<0.05)。在证候疗效方面,治疗组的治疗效果明显优于对照组,两组比较差异有显著性意义(P<0.01)。在血气分析方面,治疗组与对照组均可改善患者的缺氧及二氧化碳潴留的情况(P<0.01),且治疗组的改善程度与对照组比较有显著性差异(P<0.05)。在对NF-κB的影响方面,两组治疗后的NF-κB水平均有显著性降低(与治疗前比较,P<0.01),且治疗组的下降程度明显高于对照组(P<0.01)。【结论】在常规西医治疗的基础上加用健脾、清肺、化痰中药治疗肺脾两虚、痰热郁肺型的慢性阻塞性肺疾病急性发作期合并SIRS的患者,较之单纯使用西药治疗能更好地改善患者的临床症状和体征,以及患者缺氧和二氧化碳潴留的情况,使NF-κB水平下降更显著。

Objective To investigate the therapeutic effect of spleen-strengthening, lung-clearing and phlegm-resolving herbs for the treatment of acute attack of chronic obstrustive pulmonary disease （COPD） complicated with systemic inflammatory response syndrome （ SIRS ）, and to observe their effect on nuclear factor κB （ NF-κB ） expression level. Methods Sixty qualified patients differentiated as deficiency of spleen and lung, phlegm-heat accumulating the lung were equally randomized into two groups： the control group received routine western medical treatment including oxygen inhalation, antibiotics and bronchodilator, and the treatment group received Chen Xia Liujunzi Decoction and Weijing Decoction, which have the actions of strengthening spleen, clearing lung, and resolving phlegm, one dose per day, for 7 days. The changes of clinical symptoms and signs, blood gas parameters and NF-κB expression level were observed. Results After treatment, clinical symptoms and signs such as cough, expectoration, dyspnea, shortness of breath, and wheeze were relieved in both groups （P 〈 0.01）, and the relief was obvious in the treatment group （P 〈 0. 05）. The effect on TCM syndrome in the treatment group was better than that in the control group （P 〈0.01 ）. Hypoxia and carbon dioxide retention were improved in the two groups （P 〈0. 01 compared with those before treatment）, in particular in the treatment group （P 〈0.05）. NF-κB level was decreased in the two groups （P 〈 0. 01 ）, and the decrease was obvious in the treatment group （P 〈 0. 01 ）. Conclusion Based on treatment with routine western medicine, spleen-strengthening, lung-clearing and phlegm-resolving herbs are more effective than western medieine alone for the treatment of acute attack of COPD complicated with SIRS which are differentiated as deficiency of spleen and lung, phlegm-beat accumulating the lung, and they show a better effect on relieving clinical symptoms and signs, hypoxia and carbon dioxide retention, and on decreasing NF-κB level.