清金化痰汤联合西医常规疗法治疗支气管扩张症急性加重期临床研究

Clinical study on Qingjin-Huatan Decoction combined with western medicine in the treatment of acute aggravation of bronchiectasis

目的评价清金化痰汤联合西医常规疗法治疗支气管扩张症急性加重期患者的临床疗效。方法选择2014年1月-2018年12月北京市第六医院患者80例,采用随机数字表法将患者分为2组,每组40例。对照组采用西医常规疗法治疗,研究组在对照组基础上加用清金化痰汤。2组均连续治疗7 d。分别于治疗前后进行症状、体征评分,采用肺功能仪检测FEV1、FVC及呼气峰流速值(peak expiratory flow,PEF),采用ELISA法检测血清中性粒细胞弹性蛋白酶(neutrophil elastase,NE)、组织蛋白酶G水平,采用ELISA法检测痰液中TNF-α、IL-4、IL-6水平,评价临床疗效。结果研究组总有效率为90.0%(36/40)、对照组为77.5%(31/40),2组比较差异有统计学意义(χ2=4.501,P=0.034)。治疗后,研究组咳嗽、咳痰、痰质、痰量、发热、气促、口渴、胸闷痛及湿啰音评分均低于对照组(t值分别为15.240、16.910、21.761、18.949、16.740、9.285、11.732、9.050、11.193,P值均<0.001);FEV1、FVC及PEF均高于对照组(t值分别为5.085、4.468、4.219,P值均<0.001);痰液TNF-α、IL-4及IL-6水平均低于对照组(t值分别为8.341、8.884、11.352,P值均<0.001);血清NE[(26.20±3.18)μg/L比(51.15±5.24)μg/L,t=25.744]、组织蛋白酶G[(5.62±1.01)μg/L比(8.05±1.33)μg/L,t=9.203]水平低于对照组(P<0.01)。结论清金化痰汤联合西医常规疗法可明显减轻支气管扩张症急性加重期患者的临床症状,改善肺功能,抑制气道炎性细胞因子表达与蛋白分解,提高临床疗效。

Objective To evaluate the clinical effect of Qingjin-Huatan Decoction combined with conventional western medicine in the treatment of acute aggravation of bronchiectasis.Methods A total of 80 patients in Beijing Sixth Hospital from January 2014 to December 2018 were included.Patients were divided into two groups according to random number table method,40 cases in each group.The control group was treated with conventional western medicine.The research group was treated with Qingjin-Huatan Decoction based on the control group.Both of the two groups were treated continuously for 7 days.Before and after the treatment,their symptoms and signs were scored,forced expiratory volume in one second(FEV1),forced vital capacity(FVC)and peak expiratory flow(PEF)were detected by pulmonary function tester,serum neutrophil elastase(NE)and cathepsin G were detected by ELISA,tumor necrosis factor-α(TNF-α),interleukin-4(IL-4)and interleukin-6(IL-6)in sputum were detected by ELISA,and clinical efficacy was evaluated.Results The total clinical effective rate of the research group and the control group was 90.0%(36/40)and 77.5%(31/40)respectively.The difference between the two groups was statistically significant(χ2=4.501,P=0.034).After the treatment,the scores of cough,expectoration,phlegm quality,phlegm quantity,fever,shortness of breath,thirst,chest distress and wet rales in the research group were significantly lower than those of the control group(t values were 15.240,16.910,21.761,18.949,16.740,9.285,11.732,9.050,11.193,all Ps<0.001),FEV1,FVC and PEF were all significantly higher than those of the control group(t values were 5.085,4.468 and 4.219,respectively,all Ps<0.001),the levels of TNF-α,IL-4 and IL-6 in sputum were all significantly lower than those of control group(t values were 8.341,8.884 and 11.352,respectively,all Ps<0.01),and the levels of serum NE(26.20±3.18 mg/L vs.51.15±5.24 mg/L,t=25.744)and cathepsin G(5.62±1.01 mg/L vs.8.05±1.33 mg/L,t=9.203)were significantly lower than those of control group(P<0.001).Conclusions The Qingjin-Huatan Decoction combined with conventional western medicine can relieve clinical symptoms of patients with acute aggravation of bronchiectasis,improve pulmonary function,inhibit the expression of inflammatory cytokines and proteolysis activities in the airway,and improve the clinical efficacy.