慢性阻塞性肺疾病生存质量评估与中医临床疗效评价的研究

Study on Survival Quality Evaluation and Traditional Chinese Medicine Clinical Effectiveness of Chronic Obstructive Pulmonary Disease

目的:探讨慢性阻塞性肺疾病(Chronic Obstructive Pulmonary Disease,COPD)缓解期患者国际生存质量量表[圣乔治呼吸问卷(SGRQ)]与中医症状分级量化表之间的相互关系;评价培土生金法对改善COPD缓解期患者生存质量的临床疗效及安全性。方法:(1)根据2007年修订的《慢性阻塞性肺疾病全球倡议(GOLD)》及中华医学会呼吸病学分会于2003年修订的《慢性阻塞性肺疾病诊治指南》[1]的诊断及分级标准入组确定患者;通过观察2008年10月-2011年6月期间杭州市中医院老年病科门诊及住院COPD稳定期患者,选择60～85岁COPD稳定期肺脾气虚证90例,分别记录患者病程、SGRQ评测生存质量、检测肺功能,统计分析肺脾气虚型稳定期COPD患者疾病程度与上述指标之间的相关性;(2)以随机编码法将上述入组病例随机分为两组,两组患者均采用西医标准疗法(茶碱缓释片,1片,每日2次),治疗组联合应用以培土生金法拟方的中药汤剂(由人参、生黄芪、炒白术、茯苓、当归、沙参等药组成),疗程6个月;从中医临床证候、肺功能(FEV1%)、营养状态、急性发作加重次数等指标评定疗效。结果:(1)COPD稳定期肺脾气虚型患者的中医症状得分与SGRQ评测生存质量量表之间呈正相关。(2)治疗前,两组病人中医症状评分均无统计学意义(P>0.05)。治疗后,两组综合疗效分析,有统计学意义(P<0.05)。而两组治疗前后喘息、哮鸣音症状于治疗前后均有统计学意义(P<0.05)。(3)治疗前两组患者的肺功能指标无统计学意义(P>0.05),治疗后有统计学意义(P<0.05),且治疗组对FEV1/FVC的提高明显于对照组,有统计学意义(P<0.05)。(4)治疗后,两组相比较,治疗组在预防感冒及预防COPD急性加重方面具有明显疗效(P<0.05),而对照组则治疗前后差异不显著。(5)营养状况比较,治疗前两组具有可比性,治疗后中药治疗组明显优于对照组(P<0.05)。结论:(1)COPD稳定期患者中医症状得分与SGRQ评价呈现正相关。(2)培土生金法治疗COPD稳定期患者,可以明显改善患者的临床症状及体征;有效提高患者肺功能;减少患者急性加重次数及外感次数。

Objective ： To approach the cot - relationship between ST. George＇s respiratory questionnaire （ SGRQ ） and quantization table of traditional Chinese medical symptoms in the remission period of COPD and to evaluate the clinical effect and safety of the method of strengthening earth to support metal in treating COPD. Methods ： Observe outpatients and inpatients in the remission period of COPD who were visited at the Geriatrics Dept. of Iqangzhou TCM Hospital during Oct. 2008 tn Jun. 2011 ,select and classify 90 cases of patients which belong to deficiency of spleen qi according to the Global Initiative on Obstructive Lung Disease（ GOLD ） of 2007 and Guide of COPD of 2003 which was issued by Chinese Society of Respiratory Diseases. Take notes of their course of disease, SGRQ and lung function, approach the cor - rela- tionship between these notes and the classification. Divide 90 cases into 2 groups by random methods, the control group and the treatment group extended action tablets of theophyllinum, and the treatment group used the decoction of strengthe- ning earth to support metal（ including Rensheng, I-luangqi, Baishu, Fuling, Danggui, Shasheng, etc. ） additionally, evaluate the curative effect according to clinical symptoms in TCM ,hmg function（ FEVI ） , nutritional state and the times of acute attack after 6 months. Result ： There was positive cor - relationship between SGRQ and quantization table of traditionalChinese medical symptoms in the remission period of COPD. Between 2 groups, there was no statistical difference （P 〉 0.05 ）in quantization table of traditional Chinese medical symptoms before the treatment, while statistical differences （P 〈 0. 05 ） after the treatment. There were both statistical differences （ P 〈 0.05 ） in the symptoms of dyspnea and wheezing rale before and after the treatment. There was no statistical difference（ P 〉 0.05 ）in lung function ,while statistical differences （ P 〈 0.05 ） after the treatment which had a higher raise of FEV1/FVC. There were statistical differences （ P 〈 0.05 ） in keeping away from catching the cold and acute attack after the treatment, while no statistical differences （ P 〉 0.05 ） in con- trol group. In nutrition state, the treatment group had a better effect. Conclusions ： There are positive cor - relationship be- tween SGRQ and quantization table of traditional Chinese medical symptoms in the remission period of COPD. In treating COPD in the remission period, the decoction of strengthening earth to support metal can improve the symptoms, signs and lung function and reduce the times of acute attack and catching the cold.