补虚汤合参蛤散加味对COPD稳定期肺肾气虚证的疗效以及免疫功能的改善作用

Study of Buxu Decoction Combined with Shenha San in the Treatment of Stable Stage of COPD with "Feishenqixu" Syndrome and its Immune Function

目的:探讨补虚汤合参蛤散加味对慢性阻塞性肺疾病(COPD)稳定期肺肾气虚证的疗效以及免疫功能的改善作用。方法:选取我院2016年11月至2018年12月收治的COPD稳定期患者104例,参照随机数字表法分为对照组和观察组。对照组给予沙美特罗替卡松粉吸入剂,1吸/次,2次/d;对症状控制不良者口服氨茶碱片,0. 1 g/次,2次/d。观察组在对照组治疗基础上给予补虚汤合参蛤散加味治疗,1剂/次,2次/d。两组连续治疗12 w。比较两组肺功能、肺肾气阴虚证症状评分、临床疗效、外周血T淋巴细胞亚群水平以及血清免疫球蛋白(Ig)水平。观察两组不良反应情况。结果:与对照组比较,观察组患者治疗后第1秒用力呼气容积(FEV1)和FEV1/用力肺活量(FVC)升高更明显,肺肾气虚证评分降低更明显(P <0. 01);治疗组的总有效率为92. 31%,对照组的总有效率为75%,治疗组明显高于对照组(P <0. 05);观察组治疗后CD3^+、CD4^+以及血清Ig A、Ig G、Ig M水平升高更明显,CD8^+降低更显著(P <0. 05或P <0. 01);对照组不良反应发生率为7. 69%,观察组不良反应发生率为3. 85%,差异无统计学意义(P> 0. 05),且两组患者未见严重不良反应发生。结论:补虚汤合参蛤散加味对COPD稳定期肺肾气虚证,可改善患者的肺功能和中医证候,提高临床疗效,且安全性较高,其疗效可能与增强免疫功能有关。

Objective: To investigate the efficacy of Buxu decoction and Shenha decoction in the treatment of stable stage of chronic obstructive pulmonary disease( COPD) with " Feishenqixu" syndrome and its improvement on immune function. Methods: 104 stable COPD patients admitted to the hospital from November of 2016 to December of 2018 were divided into the control group and the observation group according to the random number table. The patients in the control group were given salmeterol and fluticasone powder inhalation with 1 inhalation/time and 2 times/day,patients with poor symptom control were orally given aminophylline tablets with 0. 1 g/time and 2 times/day. On the basis of the same treatment with the control group,the patients in the observation group were treated with Buxu decoction and shenha decoction with 1 dose/time and 2 times/day. The patients in two groups were treated for 12 weeks. The lung function,scores of symptoms of " Feishenqixu" syndrome,the clinical efficacy,peripheral blood level of T lymphocyte subgroup,and serum level of immunoglobulin( Ig) were compared between two groups. The adverse reactions in the two groups were observed. Results: Compared with the control group,the first second forced expiratory volume( FEV1) and FEV1/forced vital capacity( FVC) in the observation group were significantly increased after treatment,and scores of symptoms of " Feishenqixu" syndrome were significantly decreased( P < 0. 01). The total effective rate in the treatment group was92. 31%,which was significantly higher than that in the control group as 75%( P < 0. 05). Compared with the control group,the levels of CD3^+,CD4^+ and serum Ig A,Ig G,and Ig M in the observation group were significantly increased,CD8^+ was significantly decreased( P < 0.01). The incidence of adverse reactions was 7. 69% in the control group and 3. 85% in the observation group,with no significant difference( P > 0. 05),and no serious adverse reactions were observed in the two groups. Conclusion: Buxu decoction and shenha decoction in the treatment of stable stage of COPD with " Feishenqixu" syndrome can improve the lung function and symptoms,increase the efficacy with high safety,which might be related to the improvement of immune function.