六君子汤治疗稳定期慢性阻塞性肺病肺脾两虚证的疗效及其对肺功能、运动耐力和血气分析的影响

Clinical Efficacy of Liu Junzitang and Its Effect on Lung Function,Exercise Tolerance and Blood Gas Analysis in COPD Patients with Symptoms of Lung and Spleen Deficiency at Stable Stage

目的:探讨六君子汤治疗稳定期慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)肺脾两虚证疗效及其对肺功能、运动耐力和血气分析的影响。方法:106例COPD患者,用随机数字表法分为治疗组与对照组,每组53例。对照组患者仅给予沙美特罗替卡松气雾剂进行吸入治疗;治疗组患者在给予沙美特罗替卡松气雾剂的基础上口服六君子汤,治疗周期均为12周,分析两组患者治疗前后肺功能、运动耐力、呼吸肌疲劳、血清脑钠肽及炎症介质水平的变化。结果:临床疗效,治疗组患者总有效率为96.23%,对照组为83.02%,治疗组优于对照组(P<0.05)。肺功能,治疗组与对照组治疗前第1秒用力呼吸容积(forced expiratory volume in 1 second,FEV_1),用力肺活量(forced vital capacity,FVC)及1 s率(FEV_1/FVC)差异无统计学意义,两组患者接受治疗12周后FEV_1,FVC,FEV_1/FVC均较治疗前明显提高(P<0.05),且治疗组患者高于对照组(P<0.05)。运动耐力(6 m WD),治疗前,两组患者6 m WD比较,差异无统计学意义,治疗后,与治疗前比较,两组患者6 m WD均显著改善,且治疗组优于对照组(P<0.05)。血气分析(Pa O2,Sa O2,Pa CO2),与治疗前比较,治疗后两组患者血气分析指标均有明显改善,且治疗组改善程度优于对照组(P<0.05)。血清脑钠肽(brain natriuretic peptide,BNP)水平,治疗组与对照组治疗前差异无统计学意义,治疗组患者接受治疗12周后血清BNP显示低于对照组(P<0.05),且治疗组患者均低于对照组(P<0.05)。炎症介质,治疗组与对照组治疗前白细胞介素-6(interleukin-6,IL-6),白细胞介素-8(interleukin-8,IL-8)和超敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)差异无统计学意义,两组患者接受治疗12周后血清中IL-6,IL-8和hs-CRP水平均明显降低(P<0.05),且治疗组患者均低于对照组(P<0.05)。结论:六君子汤治疗COPD稳定期肺脾两虚证患者临床疗效明显,可提高患者肺功能及运动耐力,降低患者血清中BNP水平,减轻患者炎症反应。

Objective： To study the clinical efficacy of Liu Junzitang and its effect on lung function,exercise tolerance and blood gas analysis in patients with chronic obstructive pulmonary disease（ COPD） with symptoms of lung and spleen deficiency at stable stage. Method： A total of 106 cases of patients with COPD at stable stage treated in our hospital were selected and divided into two groups by the random number table,with 53 cases in each group. Patients in both groups were treated with salmeterol and fluticasone propionate powder for inhalation,while treatment group was additionally given Liu Junzitang. The course of treatment was 12 weeks.Then,the changes in lung function,exercise tolerance,respiratory muscle fatigue,values of serum-BNP and inflammatory mediators in two groups were compared. Result： In terms of clinical efficacy,compared with control group（ 83. 02%）,treatment group showed the total effective rate of 96. 23%. There was a significant increase（ P〈0. 05）. In effect on lung function,forced expiratory volume in the first second（ FEV1）,forced vital capacity（ FVC） and FEV1/FVC showed no difference between two groups. There were significant differences between two groups of patients before and after 4,12 weeks treatment（ P〈0. 05） in FEV1,FVC and FEV1/FVC improvement.And the values of FEV1,FVC and FEV1/FVC in treatment group is superior to those of control group（ P〈0. 05）.Regarding exercise tolerance（ 6 m WD）,the value of 6 m WD before treatment between two groups showed no difference. There were significant differences between two groups of patients before and after 4,12 weeks treatment（ P〈0. 05）. And the value of 6 m WD in treatment group was superior to that of control group（ P〈0. 05）. In terms of blood gas analysis（ Pa O2,Sa O2,Pa CO2）,there were significant differences between two groups of patients before and after 4,12 weeks treatment（ P〈0. 05）. And the values of Pa O2,Sa O2,Pa CO2 in treatment group were superior to those of control group（ P〈0. 05）. The value of serum-BNP before treatment between two groups showed no difference. There were significant differences between two groups of patients before and after 4,12 weeks treatment（ P〈0. 05）. And the value of serum-BNP in control group was superior to that in treatment group. In terms of inflammatory mediators,values of IL-6,IL-8 and hs-CRP before treatment between two groups showed no difference. There were significant differences between two groups of patients before and after 4 and 12 weeks treatment（ P〈0. 05）. And the values of IL-6,IL-8 and hs-CRP in control group were superior to those in treatment group. Conclusion： Liu Junzitang has a good therapeutic effect on COPD with symptoms of lung and spleen deficiency at the stable stage. Liu Junzitang can significantly improve lung function and exercise tolerance,and relieve inflammatory reaction.