竹叶石膏汤合清气化痰丸加减治疗急性加重期慢性阻塞性肺疾病

Add and Subtract Therapy of Zhuye Shigao Tang Combined with Qingqi Huatan Pills on Chronic Obstructive Pulmonary Disease at Acute and Aggravating Period

目的:探讨竹叶石膏汤合清气化痰丸加减治疗慢性阻塞性肺疾病急性加重期(AECOPD)痰热壅肺证患者的临床疗效及对患者超敏C-反应蛋白(hs-CRP),和肽素(CPP),血清淀粉样蛋白A(SAA),核转录因子-κB(NF-κB),降钙素原(PCT)的影响。方法:将166例AECOPD患者按SAS软件生成的随机数字表法,分为对照组和观察组各83例。对照组参照指南根据患者情况给予氧疗;注射用头孢替唑钠,2 g/次,静脉滴注,2次/d;和泼尼松龙片,10 mg/次,3次/d,口服;和异丙托溴铵气雾剂,3~4次/d,2喷/次。观察组在对照组的治疗基础上加服竹叶石膏汤合清气化痰丸加减辨证治疗。两组疗程均为14 d。主要疗效指标包括慢阻肺患者自我评估测试问卷(CAT),改良版英国医学研究委员会呼吸问卷(m MRC)和痰热壅肺证评分3个症状评估;次要指标包括动脉血气分析[血氧分压(PaO_2),二氧化碳分压(PaCO_2),血氧饱和度(Sa O_2)和p H]和肺功能[第1秒用力呼气容积(FEV1)和第1秒用力呼气容积占预计值百分比(FEV1%)],并检测hs-CRP,CPP,SAA,NF-κB,PCT等水平,以上指标,治疗前后各评价1次。结果:对照组临床疗效总有效率为83.54%,观察组为94.87%,观察组临床总有效率高于对照组(χ~2=4.721,P<0.05);治疗后观察组CAT,m MRC和痰热壅肺证评分低于对照组(P<0.01);治疗后观察组PaCO_2低于对照组,PaO_2和Sa O_2均高于对照组(P<0.01),p H组间比较,差异无统计学意义;治疗后观察组FEV1和FEV1%均高于对照组(P<0.01);治疗后观察组患者血清hs-CRP,CPP,SAA,NF-κB和PCT水平均低于对照组(P<0.01)。结论:在常规西医综合治疗的基础上,从气分病进行辨证,采用竹叶石膏汤合清气化痰丸加减,治疗AECOPD痰热壅肺证患者,可改善患者肺功能,控制感染,减轻炎症反应,提高临床疗效。

Objective ： To discuss with Qingqi Huatan pills in treating chronic with syndrome of phlegm-heat obstructing the clinical obstructive effect of modified pulmonary disease therapy of Zhuye Shigao Tang combined at acute exacerbation stage （AECOPD） lung and investigate its effect on levels of hypersensitive C-reactive protein （hs-CRP）, copeptin （CPP）, serum amyloid A （SAA）, nuclear factor-κB （NF-κB） and proealcitonin （PCT）. Method： One hundred and sixty-six AECOPD patients were randomly divided into control group （83 cases） and observation group （83 cases） by random number table. Patients in control group took oxygen therapy by referring to the guide. Received ceftezole sodium injection by intravenous infusion, 2 g/time, 2 times/day by oral administration. Prednisolone tablets, 10 mg/time, 3 times/day. And ipratropium bromide aerosol, 3-4 times/day, 2 sprays/time. Based on the treatment in control group, the patients in observation group also received modified therapy of Zhuye Shigao Tang combined with Qingqi Huatan pills. The treatment course was 14 days for both groups. The main outcome measures were COPD patients self-assessment test questionnaire （CAT）, modified version of the British Medical Research Council＇s Respiratory Questionnaire （mMRC） , and scores of phlegm-heat obstructing lung syndrome. The secondary indicators were arterial blood gas analysis [ blood oxygen （PaO2）, carbon dioxide partial pressure （PaCO2 ）, oxygen saturation （SaOz ） and pH value ] and pulmonary function [forced expiratory volume in 1 second （FEV~） and 1 second forced expiratory volume in percent predicted （FEV1%） ]. In addition, the levels of hs-CRP, CPP, SAA, NF-κB and PCT were detected. All of the above indicators were detected once before and after treatment. Result： The total clinical effective rate was 94. 87% in observation group, higher than 83.54% in control group （χ2=4. 721, P 〈0.05）. After treatment, scores of CAT, mMRC and syndrome of phlegm-heat obstructing lung in observation group were all lower than those in control group （P 〈 0.01 ）. Levels of PaCO2, hs-CRP, CPP, SAA, NF-κB and PCT were lower than control group. And the levels of PaO2, SaO2, FEV1and FEV1% were higher than those in control group （P 〈0. 01 ）, but there was no statistically significant difference in pH value between two groups. Conclusion： Based on the basic western medicine treatment, modified therapy of Zhuye Shigao Tang combined with Qingqi Huatan pills can control the symptoms and infection, ameliorate pulmonary function, reduce inflammation, and improve the clinical efficacy in patients with AECOPD and syndrome of phlegm-heat obstructing lung.