加味定喘散联合西药治疗支气管哮喘50例临床观察

Clinical Observation on Modified Dingchuan San (定喘散) Combined with Western Medicine for 50 Cases of Bronchial Asthma

目的观察加味定喘散联合舒利迭治疗支气管哮喘的临床疗效及可能作用机制。方法将100例支气管哮喘患者随机分成治疗组和对照组各50例,两组均吸入舒利迭50/250μg,每12 h 1次,治疗组同时予加味定喘散口服,每日1剂,两组疗程均为3个月。比较两组患者治疗前及治疗后1、3个月哮喘控制测试(ACT评分)、肺功能[包括第1秒用力呼气容积的变异率(FEV1变异率)和第1秒用力呼气容积占预计值的百分比(FEV1%)]、血清白细胞介素4(IL-4)、肿瘤坏死因子α(TNF-α)、γ干扰素(IFN-γ)的变化,判定临床疗效。结果治疗组临床疗效总有效率为96.00%,对照组为84.00%,治疗组优于对照组(P<0.05)。两组治疗后1、3个月ACT评分均较本组治疗前升高,FEV1变异率、TNF-α、IL-4降低,FEV1%升高(P<0.05或P<0.01);两组治疗后3个月与治疗后1个月比较各指标改善更明显(P<0.05);治疗组治疗后1、3个月与对照组同时间比较ACT评分升高,FEV1变异率、TNF-α、IL-4降低,FEV1%升高(P<0.05)。治疗组治疗后1、3个月血IFN-γ较治疗前升高(P<0.05)。结论加味定喘散联合舒利迭吸入能持续改善哮喘患者症状、肺功能,抗炎性介质,调节免疫,疗效优于单用舒利迭治疗。

Objective To observe the clinical curative effect and possible mechanism of modified Dingchuan San（ 定喘散） combined with Seretide in the treatment of bronchial asthma. Methods Totally 100 patients with bronchial asthma were randomly divided into a treatment group and a control group,with 50 cases in each group. Both groups were given inhaled Seretide 50 /250 μg,once every 12 h. At the same time the treatment group was added with modified Dingchuan San,1 dose per day. Course of treatment of both groups are three months. Changes in asthma control test（ ACT score）,lung function [including the aberration rate of forced expiratory volume in the first second（ FEV1 aberration rate） and the percentage account for predicated value of forced expiratory volume in the first second（ FEV1%） ],serum levels of interleukin4（ IL-4）,tumor necrosis factor α（ TNF-α）,and γ interferon（ IFN-γ） in both groups in the first and third mouth before and after treatment were compared to determine clinical effects.Results Total effective rate of clinical effects was 96. 00% in the treatment group,and 84. 00% in the control group. The treatment group was better than that in control group（ P 〈0. 05）. ACT scores in both groups in the first and third mouth after treatment were higher than that of the corresponding group before treatment,and FEV1 aberration rate,level of TNF-α and IL-4 decreased,and FEV1% increased（ P 〈0. 05 or P 〈0. 01）. Every index in both groups in the third month after treatment improved more significantly than that in the first month after treatment（ P〈 0. 05）. Compared with the control group in the first and third months after treatment,ACT score at the same time increased,but FEV1 aberration rate,TNF-α and IL-4 decreased,and FEV1% increased in the treatment group（ P〈 0. 05）. The INF-γ levels in the treatment group in the first and third month after treatment were higher than that before treatment（ P〈 0. 05）. Conclusion Modified Dingchuan San combined with inhalation of Seretide may continuously improve symptoms and pulmonary function of patients with asthma,and could anti-inflammatory medium and regulate immune. The curative effect of modified Dingchuan San combined with Seretide is superior to only use Seretide.