培土生金法配合天灸治疗慢性阻塞性肺疾病稳定期临床研究

Clinical Study of Chronic Obstructive Pulmonary Disease at Remission Stage Treated with Therapy of Supplementing Spleen to Strengthen Lung Combined with Vesiculating Moxibustion

【目的】研究培土生金法配合天灸治疗慢性阻塞性肺疾病(COPD)稳定期患者的临床疗效,为治疗COPD稳定期提供科学依据。【方法】采用前瞻性随机对照临床研究方法,将70例肺脾气虚证COPD稳定期患者随机分为治疗组和对照组各35例,对照组给予噻托溴铵吸入剂治疗,治疗组在对照组治疗基础上,同时给予培土生金法为主辨证口服中药饮片(以参苓白术散为主方进行加减)和天灸治疗,以COPD患者的症状和(或)体征、肺功能、生活质量为临床观察指标,比较2组的临床疗效。【结果】(1)治疗后,治疗组各项中医症状评分均较治疗前显著改善(P<0.01),而对照组仅咳嗽、咯痰、喘息、气短等4项指标较治疗前显著改善(P<0.05或P<0.01),治疗后2组比较,除喘息外,治疗组各项中医临床症状评分改善均优于对照组(P<0.05或P<0.01)。(2)治疗后,2组的第1秒用力肺活量(FEV1)、用力肺活量(FVC)和1秒用力肺活量占用力肺活量百分比(FEV1/FVC%)等各项肺功能指标均无显著改善(P>0.05),组间比较,差异均无统计学意义(P>0.05)。(3)经过治疗3个月后,治疗组St George呼吸系统问卷(SGRQ)评分中的呼吸症状、活动受限、疾病影响等3项指标均较治疗前明显改善(P<0.05或P<0.01),而对照组治疗前后SGRQ评分的3项指标均无显著改善(P>0.05);治疗后组间比较,治疗组在改善SGRQ评分方面均优于对照组(P<0.05或P<0.01)。(4)治疗期间,2组患者均无病例出现严重血液系统、肝肾功能异常和心血管疾病等不良反应发生。【结论】中医培土生金法配合天灸治疗慢性阻塞性肺疾病稳定期具有一定优势,能明显地改善患者的临床症状,提高患者的生活质量,可为慢性阻塞性肺疾病的防治提供新的思路。

Objective To observe the clinical efficacy of therapy of supplementing spleen to strengthen lung combined with vesiculating moxibustion for the treatment of chronic obstructive pulmonary disease（COPD）at remission stage. Methods A prospective randomized controlled trial was carried out in 70 COPD patients at remission stage with lung-spleen qi deficiency syndrome. The patients were evenly randomized into treatment group and control group. Both groups were given Tiotropium Bromide Powder for inhalation, and the treatment group was additionally given oral use of Chinese herbal medicine（maily composed of modified Shenling Baizhu Powder） for supplementing spleen to strengthen lung and received vesiculating moxibustion. Clinical outcomes of symptoms and signs, pulmonary function, and the quality of life were observed for the evaluation of clinical efficacy of the two groups. Results（1）After treatment,the scores of all traditional Chinese medical symptoms of the treatment group were markedly improved（P0.01 compared with those before treatment）,and in the control group,only 4 symptoms of cough,expectoration,asthma,and breath shortness were much improved（P〈0.05 or P〈0.01）. The treatment group had better effect on relieving all of the symptoms except asthma than the control group（P〈0.05 or P〈0. 01）.（2）After treatment,pulmonary function indexes of forced expiratory volume in one second（FEV1）, forced vital capacity（FVC） and FEV1/FVC% were not improved in both groups（P〉0.05 compared with those before treatment）,and the inter-group differences were insignificant（P〉0.05）.（3）After treatment for 3 months,the scores of respiration symptoms, activities limitation and impacts of daily life of St George＇s respiratory questionnaire（SGRQ） in the treatment group were much improved（P 0.05 or P 0.01 compared with those before treatment）,while the scores of the three indexes were not improved in the control group（P〉0.05）. And the treatment group had better effect on improving SGRQ scores than the control group（P〈0.05 or P〈0.01）.（4）During the treatment, severe adverse reaction of circulation system, hepatic and renal function and cardiovascular system was not found. Conclusion Therapy of supplementing spleen to strengthen lung combined with vesiculating moxibustion is effective for the treatment of COPD at remission stage,with the advantages of relieving symptoms and improving the quality of life obviously, which will supply a new way for preventing and treating COPD.