健脾补肾法对慢性阻塞性肺疾病稳定期中IL-8与TNF-α的变化及意义

Strengthening Spleen and Invigorating Kidney in Patients with Chronic Obstructive Pulmonary Disease in Stable Period the Influence of the Content IL-8 and TNF-α

目的:通过临床观察,评价四君子汤和金匮肾气丸合方治疗慢性阻塞性肺疾病稳定期(脾肾气虚型)的临床疗效及对血清中细胞因子IL-8、TNF-α的影响。客观分析评价"健脾益肾"法在治疗COPD稳定期的应用价值,为该法的推广应用提供科学依据。方法:收集符合纳入标准的76例COPD稳定期患者,2组均可按需吸入沙丁胺醇气雾剂。随机分为治疗组(38例)和对照组(38例)。治疗组给予中药四君子和金匮肾气丸汤剂治疗,对照组予中药安慰剂治疗,疗程4 w;进行治疗前后对照,通过临床表现,检测IL-8、TNF-α以及肺功能(FEV1/FVC、FEV1%)、客观评价健脾补肾法对COPD稳定期的临床疗效。结果:治疗组患者的咳嗽、喘息、咳痰、乏力等临床症状改善优于对照组;细胞因子IL-8、TNF-α明显水平低于对照组;并显著提高患者生活质量评分(CAT评分)。治疗组和对照组治疗前后肺功能无明显改善。结论:四君子汤和金匮肾气丸合方治疗COPD稳定期(脾肾气虚型),能明显减轻患者临床症状,减少急性发作的频率,还可以显著改善患者的运动耐量,从而改善患者的生活质量。其治疗的机制之一可能是通过促进IL-8的下降以及延缓TNF-α水平而改善气道炎症。

Objective： through clinical observation, the evaluation Sijunzitang and Jinkuishenqitang treatment of chronic ob- structive pulmonary disease （ the type of syndrome of spleen and kidney Qi deficiency） in the clinical efficacy and the level of IL-8 and TNF-alpha the impact. Objectively analysis and evaluates of the value of ＂ Strengthening the spleen and invigorating the kidney＂ and provide a scientific basis for the promotion and application in the treatment of patients with stable COPD. Methods： 76 patients met the inclusion criteria of chronic obstructive pulmonary disease in patients with stable, two groups may be on-demand inhaled albuterol aero- sol. 76 patients were randomly divided into trial group （38 cases） and control group （38 cases） . The patients of trial Group take TCM decoction of Sijunzitang and Jinkuishenqiwan, the control group accept to the placebo, the period of treatment are 4 weeks; to compare the result of two groups by analyzing clinical symptom and sign, the level of TNF-alpha in peripheral blood and pulmonaryfunction （FEV1/FVC and FEV1 ）, objective evaluation of the clinical efficacy of the Strengthening the spleen and invigorating the kidney of stable COPD. Results： Compared with the control group, melioration of the trial group, such as cough, wheezing, spu- tum, fatigue are better than the control group. And the level of IL-8 and TNF-alpha was significantly lower than the control group; it also can significantly improve the patients＇ lives quality score （ CAT score）, the above result show that the treatment group is better than the control group. No significant improvement in lung function in the two groups. Conclusion： Sijunzitang is and Jinkuishenqitang soup treatment of chronic obstructive pulmonary disease stabilization period （ spleen and kidney qi deficiency）, can significantly re- duce the clinical symptoms of patients, to reduce the frequency of acute attacks, can also improve the patient＇s xercise tolerance sig- nificantly, thereby improving the patient＇squality of life. One of the mechanisms of the treatment may be improved by reducing the level of IL-8 and TNF-alpha as to decline ,the airway inflammation.