清肺定喘汤联合西药对哮喘-慢性阻塞性肺疾病重叠综合征患者肺功能、呼出气冷凝液及FeNO的影响

Effects of Qingfei Dingchuan Decoction combined with western medicine on pulmonary function, exhaled breath condensate and FeNO in patients with asthma- chronic obstructive pulmonary disease overlap syndrome

目的:探讨清肺定喘汤联合西药对哮喘-慢性阻塞性肺疾病重叠综合征(ACOS)患者肺功能、呼出气冷凝液(EBC)、呼出气一氧化氮(FeNO)的影响。方法:纳入88例ACOS急性加重期患者,随机分为治疗组45例和对照组43例。两组患者均给予常规抗感染、化痰治疗,并给予长效β受体激动剂(LABA)/长效抗胆碱能药(LAMA)/吸入糖皮质激素(ICS)治疗,治疗组在上述治疗基础上加用清肺定喘汤口服,治疗周期为10 d。评价并比较两组患者的主要临床症状、体征评分;检测患者的FeNO及肺功能指标[包括第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC、最大呼气流量(PEF)];收集患者的EBC,检测EBC中8-异前列腺素(8-isoPG)、白三烯B4(LTB4)及降钙素原(PCT)水平;比较两组患者在治疗过程中的抗生素使用天数。采用Pearson相关分析检验患者的FEV1与FeNO及EBC中LTB4、8-isoPG、PCT浓度的相关性。结果:①治疗后,两组患者的主要临床症状、体征评分较治疗前均明显降低(P<0.01),且治疗组患者的喘息评分低于对照组(P<0.05)。②治疗后,两组患者的FEV1、FEV1/FVC、PEF水平较治疗前均明显升高(P<0.01),且治疗组患者的FEV1水平高于对照组(P<0.05)。③治疗后,治疗组患者的FeNO及EBC中LTB4、8-isoPG、PCT浓度较治疗前均显著降低(P<0.01),对照组患者的EBC中LTB4、PCT浓度亦明显降低(P<0.01),且治疗组患者的EBC中LTB4、PCT浓度低于对照组(P<0.05)。④治疗过程中,治疗组患者的抗生素使用天数较对照组明显缩短(P<0.05)。⑤治疗后,FEV1与FeNO呈正相关(r=0.783,P<0.01),与8-isoPG无相关性,与LTB4、PCT呈负相关(r=-0.746,P<0.01;r=-0.569,P<0.01)。结论:清肺定喘汤联合西药能有效改善ACOS患者的临床症状、肺功能和气道炎症,且FeNO、EBC等无创检查有助于ACOS的诊断和疗效评价,便于临床推广。

Objective:To explore the effects of Qingfei Dingchuan Decoction combined with western medicine on the pulmonary function, exhaled breath condensate(EBC) and fractional exhaled nitric oxide(FeNO) in patients with asthma-chronic obstructive pulmonary disease overlap syndrome(ACOS). Methods:Eighty-eight patients with ACOS at acute exacerbation stage were included and randomly divided into the treatment group(45 cases) and the control group(43 cases). The patients in both groups were treated with routine therapy including anti-infection and phlegm-resolving, as well as the long acting β receptor agonists(LABA)/long-acting anticholinergic( LAMA)/inhaled corticosteroid( ICS) therapy. The patients in the treatment group were orally treated with Qingfei Dingchuan Decoction based on above therapies. The treatment course was 10 days. The scores of main clinical symptoms and signs in both groups were evaluated and compared;the levels of Fe NO and the indexes of pulmonary function including forced expiratory volume in one second( FEV1),forced vital capacity( FVC),FEV1/FVC ratio and peak expiratory flow( PEF) were detected;the EBC was collected,and the levels of 8-iso prostaglandin( 8-isoPG),leukotriene B4( LTB4) and procalcitonin( PCT) in the EBC were detected;during the treatment,the days of antibiotic use in both groups were compared;the correlation between the level of FEV1 and the level of Fe NO and the concentrations of LTB4,8-isoPG and PCT in EBC was analyzed by Pearson correlation analysis. Results:(1)After treatment,the scores of main clinical symptoms and signs in both groups were obviously decreased compared with treatment before( P<0.01),and the score of wheezing in the treatment group was lower than that in the control group( P<0.05).(2)After treatment,the levels of FEV1,FEV1/FVC ratio and PEF in both groups were significantly increased compared with treatment before( P<0.01),and the level of FEV1 in the treatment group was higher than that in the control group( P<0.05).(3) After treatment,the level of Fe NO and the concentrations of LTB4,8-isoPG and PCT in EBC in the treatment group were obviously decreased compared with treatment before( P<0.01),the concentrations of LTB4 and PCT in EBC in the control group were also obviously decreased( P<0.01),and the concentrations of LTB4 and PCT in EBC in the treatment group were lower than those in the control group( P<0.05).(4)In the course of treatment,the days of antibiotic use in the treatment group were less than those in the control group( P<0.05).(5) After treatment,the level of FEV1 was positively correlated with the level of Fe NO( r = 0.783,P<0.01),and was negatively correlated with the levels of LTB4 and PCT( r =-0.746,P<0.01;r =-0. 569,P<0.01),but was not correlated with the level of 8-isoPG. Conclusion: Qingfei Dingchuan Decoction combined with western medicine can effectively improve the clinical symptoms,pulmonary function and airway inflammation in patients with ACOS,and the non-invasive examinations such as Fe NO and EBC are helpful to the diagnosis and efficacy evaluation,which is convenient for clinical popularization.