麻杏石甘汤加减对痰热壅肺型社区获得性肺炎肺功能及免疫系统的影响

Effects of Modified Maxing Shigan Decoction on Pulmonary Function and Immune System in Community Acquired Pneumonia with Phlegm Heat Obstructing Lung

目的:观察麻杏石甘汤加减对痰热壅肺型社区获得性肺炎的临床疗效,同时探讨其对患者免疫系统的影响。方法:选取2017年3月至2018年3月随州市中心医院中西医结合科收治的痰热壅肺型肺炎患者80例作为研究对象,按照随机数字表法分为对照组和观察组,每组40例。2组患者均接受中西医结合科常规西医治疗,观察组在基础治疗方案上加用麻杏石甘汤加减,2组患者均以10 d为1个疗程,疗程结束后比较2组患者临床总有效率、临床症状、肺功能、T细胞亚群以及TNF-α、IL-6浓度的变化。结果:1)观察组临床总有效率是95.0%,对照组是75.0%,2组患者比较,差异有统计学意义(χ^2=4.05,P<0.05);2)治疗后2组患者中医证候积分降低,与治疗前差异有统计学意义(P<0.05),其中观察组改善较对照组明显,差异有统计学意义(P<0.05);3)治疗后观察患者咳嗽、咯痰、发热、罗音症状消失的时间较对照组短,差异有统计学意义(P<0.05);4)治疗后2组患者肺功能(FEV1,PEF)及血气分析(p H,Pa CO2,Pa O2)较治疗前改善,差异有统计学意义(P<0.05),其中观察组改善较对照组明显,差异有统计学意义(P<0.05);5)2组患者治疗后CD4^+、CD4^+/CD8^+明显升高,CD8^+、TNF-α、IL-6浓度下调,与治疗前比较,差异有统计学意义(P<0.05),其中观察组改善较对照组明显,差异有统计学意义(P<0.05)。结论:麻杏石甘汤对痰热壅肺型肺炎有理想疗效,其作用机制可能与改善患者的免疫功能有关。

Objective: To observe the clinical effects of modified Maxing Shigan Decoction on pulmonary community-acquired pneumonia with phlegm-heat obstructing lung,and to explore its effect on the immune system of patients. Methods: From March 2017 to March 2018,80 patients with pulmonary pneumonia phlegm-heat obstructing lung in the Department of Integrated Chinese and Western Medicine of Suizhou Central Hospital were randomly divided into a control group and an observation group,each of 40 cases according to random number table method.The 2 groups were both treated with routine western medicine in the Department of Integrated Chinese and Western Medicine.On the basis of the routine treatment,the observation group was treated with modified Maxing Shigan Decoction.The 2 groups were treated with Maxing Shigan Decoction for 10 days as a course.After the course of treatment,the total clinical efficacy,clinical symptoms,lung function,T lymphocyte subsets,TNF-α and IL-6 levels were compared between the 2 groups. Results: 1)The total effective rate was 95.0% in the observation group and 75.0% in the control group,and there was significant difference between the 2 groups(χ^2=4.05, P <0.05);2)After the treatment,the scores of TCM syndromes in the 2 groups decreased,and there was significant statistic difference between the 2 groups( P <0.05).3)After the treatment,the disappearance time of cough,sputum,fever and lung rale symptoms was shorter than that of the control group,and the difference was statistically significant( P <0.05);4)After the treatment,the lung function(FEV1,PEF)and blood gas analysis(pH,PaCO 2,PaO 2)of the 2 groups improved,and the difference was statistically significant( P <0.05).5)After treatment,the levels of CD4^+,CD4^+/CD8^+ significantly increased,and the levels of CD8 +,TNF-alpha and IL-6 decreased in the 2 groups.There was a significant statistic difference between the 2 groups( P <0.05),and the improvement in the observation group was more obvious than that in the control group and the difference was statistically significant( P <0.05). Conclusion: Maxing Shigan Decoction has an ideal effect on pulmonary pneumonia with phlegm-heat obstructing lung,and its mechanism may be related to improving the immune function of patients.