清金化痰汤加减治疗支气管扩张症急性加重期痰热蕴肺证的临床观察

Clinical Efficacy of Modified Qingjin Huatan Tang on Bronchiectasis with Syndrome of Phlegm-heat Accumulating Lung at Acute Exacerbation

目的:观察清金化痰汤加减治疗支气管扩张症急性加重期(痰热蕴肺证)的临床疗效及对促炎因子和蛋白分解活动抑制作用。方法:将130例患者采用随机按数字表法分为对照组和观察组各65例。对照组采用注射用哌拉西林钠他唑巴坦钠,3.375 g/次,静脉滴注,1次/6 h,并根据细菌培养结果调整抗生素种类;盐酸氨溴索注射液,30 mg/次,静脉滴注,2次/d;进行痰液体位引流。观察组在对照组治疗的基础上,给予清金化痰汤加减,1剂/d,分2次内服。进行治疗前后症状、体征评分;检测治疗前后外周血白细胞计数(WBC),中性粒细胞计数(GRAN),C反应蛋白(CRP)和降钙素原(PCT)水平;记录治疗前后第1秒最大呼气量(FEV1),用力肺活量(FVC)和呼气峰流速值(PEFR);进行治疗前后BODE指数评分;检测治疗前后痰液肿瘤坏死因子-α(TNF-α),白细胞介素-4(IL-4),IL-6,IL-8水平;检测治疗前后外周血中性粒细胞弹性蛋白酶(NE)和组织蛋白酶G水平。结果:经秩和检验,观察组临床疗效优于对照组(Z=2.086,P<0.05);观察组症状、体征评分均低于对照组(P<0.01);观察组外周血WBC,GRAN,CRP和PCT均低于对照组(P<0.01);观察组FEV1,FVC,PEF和FEV1/FVC均高于对照组(P<0.01);观察组气流受限程度(O),呼吸困难程度(D),运动能力(E)评分和BODE指数总分均低于对照组(P<0.01);观察组痰液TNF-α,IL-4,IL-6和IL-8水平均低于对照组(P<0.01);观察组血浆NE和组织蛋白酶G水平均低于对照组(P<0.01)。结论:在抗感染和排痰治疗基础上,清金化痰汤加减治疗支气管扩张症急性加重期(痰热壅肺证)患者,可进一步的控制症状、体征,减轻病情程度,改善肺功能,提高患者的生活质量,并具有抑制气道促炎因子表达和蛋白分解活动的作用,临床疗效优于单纯的西医治疗。

Objective:To observe the clinical efficacy of modified Qingjin Huatan Tang on bronchiectasis with syndrome of phlegm-heat accumulating lung at acute exacerbation and its inhibitory effect on pro-inflammatory factors and proteolytic activity.Method:One hundred and thirty patients were randomly divided into control group and observation group by random number table.Patients in control group got tazobactam sodium and piperacillin sodium for injection,3.375 g/time,1 time/6 hours,and the types of antibiotics were regulated according to the bacterial culture results.And patients in control group also got Ambroxol Hydrochloride injection,30 mg/time,2 time/days,and postural drainage.In addition to the therapy of control group,patients in observation group were also given modified Qingjin Huatan Tang,1 dose/day.Before and after treatment,symptoms and signs were scored.And levels of white blood cell count(WBC),neutrophile granulocyte(GRAN),C-reactive protein(CRP),procalcitonin(PCT)were detected.And scores of forced expiratory volume in one second(FEV1),forced vital capacity(FVC),peak expiratory flow rate(PEFR)and BODE were graded.And levels of tumor necrosis factor-α(TNF-α),interleukin-4(IL-4),IL-6 and IL-8 in sputum,peripheral neutrophil elastase(NE)and cathepsin G were detected.Result:By rank sum test,the clinical efficacy in observation group was better than that in control group(Z=2.086,P<0.05),while scores of symptoms and signs in observation group were lower than those in control group(P<0.01).WBC,GRAN,CRP,PCT,airflow limitation(O),dyspnea(D),motor ability(E)score,BODE index,TNF-α,IL-4,IL-6,IL-8,plasma NE and cathepsin G were all lower than those in control group(P<0.01).And levels of FEV1,FVC,PEF and FEV1/FVC were higher than those in control group(P<0.01).Conclusion:In addition to routine anti-infection and expectoration western medicine therapy,modified Qingjin Huatan Tang can be added to control symptoms and signs,alleviate the degree of illness,improve pulmonary function and the quality of life of patients,and inhibit expression of airway pro-inflammatory factor and proteolysis,with a better clinical efficacy than pure western medicine.