养阴益肺方对慢性阻塞性肺疾病稳定期气阴两虚证患者白三烯B4水平的影响

Effect of Yangyin Yifei Fang (养阴益肺方) on Leukotrience B4 Level in Patients with Chronic Obstructive Pulmonary Disease in Stable Stage of Qi and Yin Deficiency Type

目的探讨养阴益肺方治疗慢性阻塞性肺疾病(COPD)稳定期气阴两虚证患者的临床疗效及可能作用机制。方法将65例COPD稳定期气阴两虚证患者随机分为对照组33例和治疗组32例。两组均给予吸氧、化痰等常规治疗,治疗组另给予养阴益肺方口服,每日1剂,两组均治疗1个月。观察两组治疗前后血清白三烯B4(LTB4)、白细胞介素8(IL-8)、白细胞介素17(IL-17)及肿瘤坏死因子α(TNF-α)的水平,并进行相关性分析,比较两组治疗前后中医证候积分、呼吸困难评分(m MRC)、6分钟步行试验(6MWT)、肺功能,并评价临床疗效。结果治疗组和对照组临床疗效总有效率分别为87.5%和54.6%,治疗组优于对照组(P<0.05)。治疗组治疗后血清LTB4、IL-8、IL-17、TNF-α水平较治疗前下降(P<0.05),对照组治疗后血清IL-8、TNF-α水平较治疗前下降(P<0.05),治疗组治疗后血清LTB4、IL-17、TNF-α水平低于对照组(P<0.05)。相关性分析显示,两组治疗前血清LTB4分别与IL-8、IL-17、TNF-α呈正相关(P<0.05);治疗后治疗组LTB4与IL-17呈正相关(P<0.05),对照组治疗前后LTB4与IL-17、TNF-α均呈正相关(P<0.05)。两组治疗后中医证候各项积分、m MRC评分均较治疗前降低(P<0.05),且治疗组气短、喘息、自汗易感积分均低于对照组(P<0.05)。治疗组治疗后6MWT、肺功能较治疗前好转并优于对照组(P<0.05)。结论养阴益肺方治疗COPD稳定期气阴两虚证疗效确切,能改善临床症状,切断炎症级联反应降低LTB4水平可能是其作用机制之一。

Objective To discuss the clinical efficacy and potential mechanism of Yangyin Yifei Fang（ 养阴益肺方） in treating patients with chronic obstructive pulmonary disease（ COPD） in stable stage of Qi and Yin deficiency type. Methods Sixty-five patients with COPD in stable stage were randomized into a control group（ 33 cases） and a treatment group（ 32 cases）. The patients in both groups were given conventional treatment such as oxygen uptake and phlegm reducing,etc.,while the patients in the treatment group were additionally administered Yangyin Yifei Fang orally,with one dose each day. Both groups were treated for one month. The serum levels of leukotrience B4（ LTB4）,interleukin 8（ IL-8）,interleukin 17（ IL-17） and tumor necrosis factor α（ TNF-α） were observed before and after treatment,and correlation analysis was done. Also,Chinese medicine syndrome scores,modified dyspnea scale of English Medical Research Council（ m MRC）,6 minute walk test（ 6MWT） and lung function of both groups were compared before and after treatment,and clinical efficacy was evaluated. Results The overall response rates in the treatment group and the control group were respectively 87. 5% and 54. 6%,and the treatment group behaved better than the control group（ P 〈0. 05）. After treatment,serum levels of LTB4,IL-8,IL-17 and TNF-α declined significantly in the treatment group（ P〈 0. 05）,while in the control group,IL-8 and TNF-α did so（ P 〈0. 05）.After treatment,the serum levels of LTB4,IL-17 and TNF-α in the treatment group were significantly lower than those in the control group（ P 〈0. 05）. The correlation analysis showed that there were positive correlations between serum levels of LTB4 and IL-8,IL-17 as well as TNF-α before treatment in both groups（ P 〈0. 05）; there was a positive correlation between LTB4 and IL-17 after treatment in the treatment group（ P〈 0. 05）,and there was positive correlations between LTB4 and IL-17 as well as TNF-α both before and after treatment in the control group（ P 〈0. 05）. In both groups,each item of Chinese medicine syndrome scores and m MRC score decreased significantly after treatment compared with those before treatment（ P 〈0. 05）,while the scores of short breath,gasp and spontaneous perspiration in the treatment group were significantly lower than those in the control group（ P 〈0. 05）. In the treatment group,6MWT and lung function after treatment improved compared with those before treatment,and they were significantly better than those in the control group（ P 〈0. 05）. Conclusion Yangyin Yifei Fang shows good efficacy in treating COPD in stable stage of Qi and Yin deficiency type,and it could improve the clinical symptom. The potential mechanism may be blocking inflammatory cascade response and thus reducing the LTB4 level.