加味参苓白术散对不同病情程度慢性阻塞性肺疾病稳定期患者临床疗效

Observation of Clinical Effect on Treating the Different Grades COPD Patients after Comprehensive Evaluation in the Stable Stage with Method of Modified Shenlin Baizhu Powder

目的:观察加味参苓白术散对经病情评估后不同病情程度的慢性阻塞性肺疾病(Chronic obstructivepulmonary diseases,COPD)稳定期患者的疗效。方法:将108例COPD稳定期患者随机分为对照组54例和治疗组54例。两组均给予常规治疗,治疗组在常规治疗基础上予参苓白术散(党参、茯苓、白术、薏苡仁等)加减治疗,疗程均为4周。对所有患者根据2011年COPD全球倡议的修订版首次提出的分组诊疗系统,对COPD患者进行病情综合评估,分为不同病情程度的A、B、C、D组,其中A、C两组临床症状(咳嗽、咯痰、气短等)较少,B、D两组临床症状多;A、B两组急性加重、住院或死亡的风险较低,而C、D两组风险高。观察加味参苓白术散对各组患者中医证候计分、肺功能、6分钟步行距离(6 minutes walking distance,6MWD)及圣乔治问卷评分(St.George RespiratoryQuestionnaire,SGRQ)的影响。结果:经病情评估后B、D组人数较多,所占比例较高;与对照组治疗后进行组间比较,A、C两组的中医证候计分、D组的一秒量比用力肺活量(FEV1/FVC)、SGRQ和B组的6MWD有明显差异(P<0.05),具有统计学意义。与治疗前相比,4组治疗组治疗后的6MWD、SGRQ及中医证候计分均有所改变(P<0.05),具有统计学意义。结论:参苓白术散对高风险(易急性加重、住院或死亡等)的COPD患者疗效显著,一方面改善C组患者临床症状(咳嗽、咯痰、气短等),另一方面提高D组患者生存质量;对低风险的COPD患者作用表现为改善A组患者的临床症状,提高B组患者运动耐力,从而更好地指导COPD的中医药治疗。

Objective:To observe the clinical effect clinical effect on treating the "ABCD" four grades patients in the stable stage of chronic obstructive pulmonary disease(COPD)with method of Modified Shenlin Baizhu Powder. Methods:108 cases of COPD in stable stage patients,were randomly divided into control group and treatment group,each group contains 54 cases. Both were given the conventional treatments,the treatment group received Modified Shenling Baizhu Powder based on the basic treatments.The courses of treatment were 4 weeks. Comprehensive assessment for all patients,which obey with the global strategy of COPD(Revised 2011),was conducted and ABCD four groups were graded. The observation indexes included TCM syndrome score,lung function,6 minutes walking distance(6 MWD)and St.George respiratory questionnaire(SGRQ). Results:The number of patients of group D and B was higher than that of group A and C after comprehensive evaluation of disease;Compared with control group after treatment,the score of TCM syndrome of group A and C;FEV1/FVC and SGRQ of group D;6 MWD of group B,were statistically different(P<0.05)in treatment group;Compared to pre-treatment,with difference(P<0.05)can be found in the index of TCM syndrome score,6 MWD and SGRQ in four groups of treatment group. Conclusion:Modified Shenling Baizhu Powder has a significant effect for COPD patients with high risk. on one hand,it improves the clinical symptoms(group C),on the other,it improves their life quality(group D);for COPD patients with low risk,it can improve the clinical symptoms(group A)or improve the exercise endurance(group B),and can effectively guide the TCM treatment of COPD.