中医定向透化治疗慢性阻塞性肺疾病并发Ⅱ型呼吸衰竭的临床疗效研究

Effects of Targeted Traditional Chinese Medicine Permeabilization Therapy in the Treatment of Type Ⅱ Respiratory Failure Associated with Chronic Obstructive Pulmonary Disease

背景慢性阻塞性肺疾病(COPD)是我国常见的一种慢性疾病,极易并发Ⅱ型呼吸衰竭。目前的治疗手段主要限于抗生素及激素类等药物,患者不良反应较大且容易耐药。目的评估中医定向透化治疗在COPD并发Ⅱ型呼吸衰竭患者中的治疗价值。方法选取2017年6月-2018年8月于江西省胸科医院就诊的符合纳入标准的COPD并发Ⅱ型呼吸衰竭患者160例,依据随机数字表法分为对照组和治疗组,每组80例。对照组采用常规抗感染、止喘治疗,并贴敷安慰剂贴膏(外观模糊,与治疗组透化贴重量相等)治疗。治疗组常规抗感染、止喘治疗同对照组,并贴敷透化贴剂治疗。两组患者均治疗2周后进行观察。比较两组患者治疗前后氧分压(PO2)、二氧化碳分压(PCO2)、第1秒用力呼气末容积(FEV1)/用力肺活量(FVC)、6 min步行试验(6MWT)、C反应蛋白(CRP)、降钙素原(PCT)、嗜酸粒细胞计数(EOS)。将治疗组患者按慢性阻塞性肺疾病全球倡议(GOLD)标准进行分级,比较不同GOLD分级患者治疗前后CRP、PCT、EOS。结果对照组患者试验过程中脱落6例,最终完成治疗74例。治疗组患者试验过程中脱落8例,最终完成治疗72例。治疗组患者按GOLD标准进行分级,其中GOLD A级12例,GOLD B级20例,GOLD C级22例,GOLD D级18例。治疗后治疗组患者FEV1/FVC高于对照组,6MWT长于对照组,PCO2、CRP、PCT、EOS低于对照组(P<0.05);治疗后两组患者PO2比较,差异无统计学意义(P>0.05)。对照组患者治疗后PO2、FEV1/FVC高于同组治疗前,6MWT长于同组治疗前,PCO2、CRP、PCT、EOS低于同组治疗前(P<0.05);治疗组患者治疗后PO2、FEV1/FVC高于同组治疗前,6MWT长于同组治疗前,PCO2、CRP、PCT、EOS低于同组治疗前(P<0.05)。治疗组患者临床疗效优于对照组(Z=-2.191,P<0.05)。在治疗组中,GOLD A、B、C、D级患者治疗后CRP均低于治疗前(t配对值分别为12.38、53.79、63.38、65.40,P值均<0.05);GOLD C、D级患者治疗后PCT均低于治疗前(t配对值分别为3.54、5.83,P值均<0.05);GOLD A、B、C、D级患者治疗后EOS均低于治疗前(t配对值分别为4.50、5.56、5.76、7.09,P值均<0.05)。结论中医定向透化治疗可以减轻COPD并发Ⅱ型呼吸衰竭患者的炎性反应程度,同时对改善其肺功能及预后有一定效果。

Background Chronic obstructive pulmonary disease(COPD)is a common chronic disease in China,which easily combines with type Ⅱ respiratory failure.COPD with type Ⅱ respiratory failure is treated mainly by antibiotics and hormones,but treatment-related side effects are serious and resistance easily develops.Objective To evaluate the effects of targeted Traditional Chinese Medicine(TCM)permeabilization therapy in the treatment of type Ⅱ respiratory failure associated with COPD.Methods One hundred and sixty patients suffering from COPD with type Ⅱ respiratory failure were recruited from Jiangxi Chest Hospital from June 2017 to August 2018 and were randomly divided into two equal groups,therapy group and control group,treated with conventional anti-infective and anti-asthma treatment,and external use of a permeabilized TCM patch,conventional anti-infective and anti-asthma treatment,and external use of a placebo patch(with fuzzy appearance,and the same weight as the permeabilized TCM patch used in the therapy group),respectively,for 2 weeks.PO2,PCO2,FEV1/FVC ratio,serum C-reactive protein(CRP),procalcitonin(PCT)and eosinophils(EOS)levels and six-minute walk test(6 MWT)results before and after treatment of both groups were compared.Patients in the therapy group were graded according to GOLD criteria,and CRP,PCT,and EOS were compared before and after treatment in different GOLD subgroups.Results After excluding 14 dropouts(6 in the control group,and 8 in the therapy group),the remaining 146 cases who completed the trial were finally included(74 in the control group and 72 in the therapy group).After treatment,PCO2,CRP,PCT and EOS in the therapy group were lower than those in the control group,FEV1/FVC was higher than that in the control group,6 MWT was longer than that in the control group(P<0.05);there was no significant difference in PO2 between the two groups after treatment(P >0.05).PO2,FEV1/FVC in control group was higher after treatment than before treatment,6 MWT was longer than before treatment in the same group,PCO2,CRP,PCT and EOS were lower than before treatment in the same group(P<0.05);PO2,FEV1/FVC in treatment group were higher than before treatment in the same group,6 MWT was longer than before treatment in the same group,PCO2,CRP,PCT and EOS were lower than before treatment in the same group(P<0.05).The clinical effect of the treatment group was better than that of the control group(Z=-2.191, P<0.05).Subgroup analysis by GOLD grade showed that,after treatment,mean CRP decreased significantly in all subgroups [GOLD A(n=12),GOLD B(n=20),GOLD C(n=22),GOLD D(n=18)](value of paired t-test=12.38,53.79,63.38,65.40,P<0.05);mean CRP decreased significantly in GOLD C and D subgroups(value of paired t-test=3.54,5.83,P<0.05);mean EOS decreased significantly across GOLD A,B,C and D subgroups(value of paired t-test=4.50,5.56,5.76,7.09,P<0.05).Conclusion Targeted TCM permeabilization therapy is a safe,simple and effective treatment for type Ⅱ respiratory failure associated with COPD,which can reduce the severity of inflammation,and improve lung functions and the prognosis to some extent.