疏风润肺方联合布地奈德对慢性阻塞性肺疾病急性加重期伴肺炎患者气道重塑状态的改善作用

Improvement of Airway Remodeling in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease Accompanied by Pneumonia by Shufeng Runfei Decoction Combined with Budesonide

目的:观察疏风润肺方联合布地奈德对慢性阻塞性肺疾病急性加重期伴肺炎患者气道重塑状态的改善作用。方法:选取2018年1月至2019年1月静安区中医医院收治的慢性阻塞性肺疾病急性加重期伴肺炎患者116例作为研究对象,按照随机数字表法随机分为对照组和观察组,每组58例。对照组在常规治疗的基础上加用布地奈德雾化吸入,观察组在对照组治疗的基础上,口服疏风润肺方治疗。2组均治疗8周。比较2组治疗效果、中医症候积分、血清炎性反应因子指标、肺功能、呼吸功能以及运动情况以及细胞因子指标。结果:观察组患者治疗总有效率为89.66%,高于对照组治疗总有效率的74.14%,2组比较差异有统计学意义(P<0.05);治疗后观察组中医症候积分、血清炎性反应因子TNF-α、IL-8和ICAM-1水平低于对照组,2组比较差异均有统计学意义(P<0.05);治疗后观察组肺功能PEF、FEV1以及FEV1/FVC高于对照组,mMRC评分低于对照组,6MWT高于对照组,2组比较差异均有统计学意义(P<0.05);治疗后观察组MMP、TIMP以及VEGF水平低于对照组,2组比较差异有统计学意义(P<0.05)。结论:疏风润肺方治疗慢性阻塞性肺疾病急性加重伴肺炎疗效确切,可在一定程度上消除患者的临床症状,改善肺功能、呼吸功能以及运动情况,降低炎性反应,改善气道重塑状态,和布地奈德联合应用,可提高临床疗效,值得临床应用。

Objective:To observe the effects of Shufeng Runfei Decoction combined with budesonide on airway remodeling in patients with acute exacerbation of chronic obstructive pulmonary disease accompanied by pneumonia.Methods:A total of 116 patients with acute exacerbation of chronic obstructive pulmonary disease with pneumonia from Jingan District Chinese Medicine Hospital from January 2018 to January 2019 were selected and randomly divided into an observation group and a control group,with 58 cases in each group.The control group was treated with Budesonide aerosol inhalation on the basis of routine treatment,while the observation group was treated with oral administration of Shufeng Runfei Decoction on the basis of the control group.Both groups were treated for 8 weeks.The therapeutic effect,TCM symptom score,serum inflammatory factors,lung function,respiratory function,exercise and cytokine indexes were compared between the 2 groups.Results:The total effective rate of the observation group was 89.66%,higher than that of the control group(74.14%)(P<0.05);the scores of TCM symptoms in the observation group were lower than those in the control group(P<0.05);the levels of serum inflammatory factors TNF-α,IL-8 and ICAM-1 in the observation group were lower than those in the control group(P<0.05);the pulmonary function PEF,FEV1 and FEV1/FVC in the observation group were higher than those in the control group after treatment.MRC was lower than the control group,and 6 MWT was higher than the control group(P<0.05).The scores of MMP,TIMP and vascular endothelial growth factor in the observation group were lower than those in the control group(P<0.05).Conclusion:Shufeng Runfei Decoction is effective in treating acute exacerbation of chronic obstructive pulmonary disease with pneumonia.It can eliminate clinical symptoms,improve pulmonary function,respiratory function and exercise,reduce inflammation,improve airway remodeling.Combined with budesonide,it can improve the therapeutic effect and is worthy of clinical application.