化浊宣肺方辨治中老年慢性支气管炎患者急性发作期48例

Huazhuo Xuanfei Decoction Treatment in Patients with Acute Exacerbation of Chronic Bronchitis in 48 Cases

目的:探讨化浊宣肺方治疗中老年慢性支气管炎(CP)急性发作期的临床疗效及作用机制。方法:95例CP急性发作期患者随机分为对照组47例和观察组48例。对照组口服盐酸莫西沙星片,0.4 g/次,1次/d,盐酸氨溴索片,30 mg/次,2次/d,饭后服用。观察组在对照组治疗的基础上加用化浊宣肺方辨证加减治疗,1剂/d,常规水煎分2次服用。两组疗程均为10 d。记录治疗前、治疗后第3,7,10天主要症状、体积评分;记录主证咳嗽、咯痰起效时间和缓解时间;检测治疗前后血清白细胞介素-2(IL-2),白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)水平。结果:治疗后观察组疾病综合疗效及中医证候疗效均优于对照组(P<0.05);观察组治疗后咳嗽和咳痰有效率分别为72.92%和70.83%,均优于对照组的51.06%和46.81%(P<0.05);治疗后第3,7,10天,观察组主要症状、体征积分均低于对照组(P<0.05或P<0.01);治疗后观察组主要症状、体征积分减分幅度优于对照组(P<0.01);观察组咳嗽、咯痰起效时间和缓解时间比较均少于对照组(P<0.01);治疗后观察组血清IL-2水平高于对照组(P<0.01);治疗后观察组血清IL-6和TNF-α水平低于对照组(P<0.01)。结论:化浊宣肺方能减轻中老年慢性支气管炎急性发作期咳嗽、咯痰等主要症状,其作用机制可能与抑制炎症反应,减轻气道炎性损伤有关。

Objective：To investigate the clinical effects and mode of action of Huazhuo Xuanfei decoction to treat middle and old age chronic bronchitis （CP） at acute attack.Method：Ninety-five cases of patients were randomly divided into control group （47 cases） and observation group （48 cases）.The patients in control group took moxifloxacin hydrochloride tablets,0.4 g/time,1 does/day.Ambroxol hydrochloride tablets,30 mg/time,2 does/day,taken after meal.For patients in observation group,they took moxifloxacin hydrochloride tablets as the control group.Besides they were added Huazhuo Xuanfei decoction by dialectical add and subtract treatment,1 does/day,conventional water frying and drink it in two times.The treatment course was 10 days for both groups.Record the third,seventh,tenth day＇s cardinal symptom,size grading before and after treatment.Record onset time and response duration of main card cough and cough up phlegm.Detect the level of serum interleukin-2 （IL-2）,interleukin-6 （IL-6） and tumor necrosis factor alpha （TNF-α）.Result：After treatment,comprehensive therapeutic effect in observation group and traditional Chinese medicine syndrome curative effect were superior to control group （P ＜ 0.05）,the effective rate of cough and expectoration in observation group were 72.92％ and 70.83％,which were better than 51.06％ and 46.81％ of control group （P ＜ 0.05）.At the third,seventh,tenth day,cardinal symptom and signs of integral in observation group were lower than control group after the treatment （P ＜ 0.05 or P ＜ 0.01）,points in cardinal symptom and signs of integral of observation group were superior to control group （P ＜ 0.01）,onset time and response duration of observation group were less than observation group （P ＜0.01）,after treatment,the serum IL-2 level was superior to observation group （P ＜ 0.01）,serum IL-6 and TNF-α level were inferior to observation group （P ＜ 0.01）.Conclusion：Huazhuo Xuanfei decoction can reduce middle and old age chronic bronchitis＇cough and cough up phlegm at acute attack quickly.Clinical curative effect is distinct.Its mode of action may be associated with the inhibition of inflammatory reaction and reduce damage of airway inflammatory.