清气化痰丸加减治疗慢性阻塞性肺疾病急性加重期痰热壅肺证的临床疗效及对血清TNF-α,IL-8,MMP-9的影响

Clinical Efficacy of Modified Qingqi Huatan Wan in Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Syndrome of Phlegm-heat Obstructing Lung and Effect on Serum TNF-α,IL-8 and MMP-9

目的:探讨清气化痰丸加减治疗慢性阻塞性肺疾病急性加重期痰热壅肺证的临床疗效及对患者血清肿瘤坏死因子-α(tumor necrosis factor-alpha,TNF-α),白细胞介素-8(interleukin-8,IL-8)和基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)的影响。方法:将64例患者按随机数字表法,分为对照组与治疗组,各32例,对照组根据指南和患者病情变化给予西医常规治疗,治疗组在对照组基础上加服清气化痰丸加减治疗,疗程均为14 d。比较两组患者治疗前后中医证候积分,慢性阻塞性肺疾病患者自我评估测试问卷(CAT)和改良版英国医学研究委员会呼吸问卷(m MRC),肺功能及血气分析指标,血清TNF-α,IL-8,MMP-9水平,临床疗效和安全性指标,以上指标治疗前及治疗14 d后各评价1次。结果:对照组临床疗效总有效率为76.67%,治疗组为96.67%,治疗组临床总有效率均明显高于对照组(χ~2=5.192,P<0.05)。两组治疗后中医证候积分,CAT和m MRC与本组治疗前比较均明显降低(P<0.05);且治疗组均明显低于对照组(P<0.05)。两组治疗后第1秒用力呼气容积(FEV_1),第1秒用力呼气容积占预计值百分比(FEV_1%),第1秒用力呼气容积占用力肺活量的百分比(FEV_1/FVC)较本组治疗前均明显升高(P<0.05);且治疗组明显高于对照组(P<0.05)。两组治疗后血氧饱和度(SaO_2),血氧分压(PaO_2)较本组治疗前均有升高,二氧化碳分压(PaCO_2)明显降低(P<0.05);且治疗组SaO_2,PaO_2均明显高于对照组,PaCO_2明显低于对照组(P<0.05)。两组治疗后血清TNF-α,IL-8和MMP-9水平较本组治疗前均明显降低(P<0.05);且治疗组明显低于对照组(P<0.05)。结论:清气化痰丸加减治疗慢性阻塞性肺疾病急性加重期痰热壅肺证疗效确切且安全,能够改善患者临床症状和肺功能,降低患者血清中TNF-α,IL-8和MMP-9水平,减轻炎症。

Objective: To explore the clinical efficacy of modified Qingqi Huatan Wan in treatment of acute exacerbation of chronic obstructive pulmonary disease( syndrome of phlegm-heat obstructing lung) and investigate its effects on serum tumor necrosis factor-alpha( TNF-α), interleukin-8( IL-8) and matrix metalloproteinase-9( MMP-9). Method: Sixty-four patients with acute exacerbation of chronic obstructive pulmonary disease( AECOPD) were randomly divided into control group( 32 cases) and treatment group( 32 cases) by random number table. The control group was treated with routine western medicine therapy according to the guidance and disease conditions. Based on treatment in control group,patients in treatment group also received modified Qingqi Huatan Wan. The treatment course was 14 days for both groups. The scores of traditional Chinese medicine( TCM) syndrome,chronic obstructive pulmonary disease( COPD) assessment test( CAT),and modified version of the British Medical Research Council’s Respiratory Questionnaire( mMRC),pulmonary function,blood gas analysis indicators,levels of serum TNF-α,IL-8 and MMP-9,clinical efficacy and safety were evaluated and compared once before treatment and 14 d after treatment. Result: The total clinical effective rate was 96. 67% in treatment group,higher than 76. 67% in control group(χ^2= 5. 192,P <0. 05).After treatment,scores of TCM syndrome,CAT and m MRC were reduced in both groups( P< 0. 05),and the scores in treatment group were all lower than those in control group( P <0. 05). Levels of forced expiratory volume in one second( FEV1),percent of FEV1 in predicted value( FEV1%),and ratio of FEV1 to forced vital capacity( FEV1/FVC) were increased in both groups after treatment( P< 0. 05),and the above levels in treatment group were higher than those in control group( P< 0. 05). After treatment,oxygen saturation( SaO2) and partial pressure of oxygen( PaO2) were increased in both groups,while partial pressure of carbon dioxide( PaCO2) was decreased( P <0. 05),and SaO2 and PaO2 in treatment group were higher than those in control group,while PaCO2 was lower than that in control group( P< 0. 05). After treatment,serum TNF-α,IL-8 and MMP-9 were decreased in both groups( P< 0. 05),and the levels in treatment group were lower than those in control group( P< 0. 05). Conclusion: Modified Qingqi Huatan Wan can control the symptoms safely and ameliorate pulmonary function,reduce the levels of serum TNF-α,IL-8,MMP-9 and inflammation in treatment of AECOPD.