健脾补肾化痰方在稳定期慢性阻塞性肺疾病中的作用机制探讨

Effect of Jianpi Bushen Huatan Fang in the treatment of stable chronic obstructive pulmonary disease and its mechanism

目的探讨健脾补肾化痰方治疗稳定期慢性阻塞性肺疾病(COPD)患者的临床疗效及作用机制。方法选取本院就诊的稳定期COPD患者70例,5例患者中途退出研究。所有患者维持原稳定期用药方案,其中中药组(n=32)患者口服健脾补肾化痰方一日2次,对照组(n=33)患者服用安慰剂一日2次,疗程均为2个月,随访4个月。以中医证候积分法判定中医疗效,应用气流受限的严重程度进行肺功能评估,使用慢性阻塞性肺疾病评估测试问卷(CAT)进行综合评估;检测外周血免疫细胞标志物(CD4^+及CD8^+T淋巴细胞)、炎性细胞因子和Th_1/Th_2细胞因子[肿瘤坏死因子(TNF)-α、白介素(IL)-8、重组人干扰素诱导蛋白10(CXCL10)、干扰素(INF)-γ和IL-4等]。结果随访2、4个月评估显示,中药组总有效率高于对照组(P<0.05)。随访4个月时,中药组肺功能分级和CAT评分轻度患者较对照组增加,肺功能分级重度、极重度和CAT评分极重度患者减少(P<0.05)。随访2、4个月时,与治疗前相比,中药组INF-γ、CXCL10下降,IL-4升高(P<0.05);与对照组相比,中药组INF-γ、CXCL10更低(P<0.05)。随访2、4个月时,两组TNF-α、IL-8、CD4^+、CD8^+T淋巴细胞组间差异无统计学意义(P>0.05)。结论健脾补肾化痰方通过调节Th_1/Th_2类细胞因子,提升CD4^+、CD8^+T淋巴细胞,从而缓解稳定期COPD患者病情进展,改善患者生活质量。

Objective To investigate the clinical effect and mechanism of Jianpi Bushen Huatan Fang in the treatment of stable chronic obstructive pulmonary disease（COPD）patients.Methods A total of 70 patients with stable COPD in our hospital were enrolled and 5 patients withdrew from the study.All the patients maintained the original regular medication program,they were divided into the Chinese medicine group（n=32,taken oral Jianpi Bushen Huatan Fang twice a day）,and the control group（n=33,taken placebo twice a day）.The treatment course was 2 months,and the follow-up was for4 months.The traditional Chinese medicine（TCM）syndrome score was used to determine the TCM curative effect.The lung function was evaluated by the severity of the airflow limitation,and the COPD assessment test（CAT）was used for comprehensive evaluation.The peripheral blood immunocytic markers（CD4~＋and CD8~＋T lymphocyte）,inflammatory cytokines and Th_1/Th_2 cytokine（TNF-α,IL-8,CXCL10,INF-γand IL-4）were detected as well.Results After 2 and 4months follow-up,the total effective rate of Chinese medicine group was higher than that of the control group（P0.05）.After 4 months of follow-up,the mild patients with lung function grade and CAT score in Chinese medicine group were increased than those of control group,and the severe or the extremely severe patients with lung function grade and extremely severe patients with the CAT score in Chinese medicine group were reduced than those of control group（P0.05）.After 2and 4 months of follow up,in Chinese medicine group the INF-γ,CXCL10 were decreased and the IL-4 was increased（P0.05）compared with before treatment,and the INF-γand CXCL10 were lower（P0.05）compared with those in control group.After 2 and 4 months of follow-up,there was no significant difference in the TNF-α,IL-8,CD4~＋and CD8~＋T lymphocyte between the two groups（P〉0.05）.Conclusion Jianpi Bushen Huatan Fang can alleviate COPD disease progression and improve the life quality of stable COPD patients by regulating Th_1/Th_2 cytokine and improving CD4~＋ and CD8~＋T lymphocytes.