基于培土生金理论应用玉屏风散和六君子汤治疗痰湿阻肺型慢性阻塞性肺疾病急性加重期的临床研究

Clinical Study on Yupingfeng Powder and Liujunzi Decoction in the Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease of Phlegm-Dampness and Pulmonary-Obstruction Based on the Theory of Spleen Invigorating and Lung Benefiting

目的:探讨基于培土生金理论应用玉屏风散和六君子汤治疗痰湿阻肺型慢性阻塞性肺疾病急性加重期的疗效及对气道炎症和重塑的影响。方法:选取2017—2018年首都医科大学附属北京中医医院收治的痰湿阻肺型慢性阻塞性肺疾病急性加重期患者120例,采用随机数字表法分为对照组和观察组,每组60例。对照组患者采用西医常规治疗方案,观察组患者在对照组的基础上基于培土生金理论应用玉屏风散和六君子汤加减治疗。比较两组患者治疗前后肺胀中医证候积分、气道炎症因子[嗜酸性粒细胞比率(EOSR)、细胞间黏附分子-1(CAM-1)和血管内皮生长因子(VEGF)]水平、气道重塑指标[烟酰胺腺嘌呤二核苷酸磷酸氧化酶-4(NOX4)、转化生长因子-β1(TGF-β1)和基质金属蛋白酶9(MMP-9)]水平及肺功能指标[用力肺活量(FVC)、第1 s用力呼气容积(FEV1)、呼出75%肺活量时最大呼气流量(FEF75%)和最大呼气中段流速(MMEF)]水平的差异,统计两组患者的临床疗效。结果:两组患者治疗后咳嗽痰多、气喘痰鸣、胸膈满闷和苔白滑脉濡缓的证候积分与EOSR、ICAM-1、VEGF、NOX4、TGF-β1和MMP-9水平均较治疗前明显降低,且观察组患者治疗后上述肺胀中医证候积分、气道炎症因子水平和气道重塑指标水平明显低于对照组,差异均有统计学意义(P<0.05)。两组患者治疗后FVC和FEV1较治疗前明显升高,FEF75%和MMEF较治疗前明显降低,且观察组患者治疗后上述肺功能指标水平明显优于对照组,差异均有统计学意义(P<0.05)。观察组患者的治疗总有效率为93.33%(56/60),明显高于对照组的80.00%(48/60),差异有统计学意义(P<0.05)。结论:基于培土生金理论应用玉屏风散和六君子汤加减治疗痰湿阻肺型慢性阻塞性肺疾病急性加重期,可有效改善患者肺胀中医证候积分,减轻气道组织炎症细胞浸润,抑制气道重塑并改善肺功能,提高临床疗效。

OBJECTIVE:To probe into the efficacy of Yupingfeng powder and Liujunzi decoction in the treatment of acute exacerbation of chronic obstructive pulmonary disease(COPD)of phlegm-dampness and pulmonary-obstruction based on the theory of spleen invigorating and lung benefiting,and its effect on airway inflammation and airway remodeling.METHODS:120 patients with acute exacerbation of COPD of phlegm-dampness and pulmonary-obstruction admitted into Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University from 2017 to 2018 were selected and divided into control group and observation group via random number table,with 60 cases in each group.The control group was given conventional treatment of western medicine,on that basis,the observation group was given modified treatment of Yupingfeng powder and Liujunzi decoction based on the theory of spleen invigorating and lung benefiting.Differences in TCM symptom scores of lung-distension,airway inflammation factors[eosinophilic granulocyte rate(EOSR),intercellular adhesion molecule-1(CAM-1)and vascular endothelial growth factor(VEGF)],airway remodeling indicators[nicotinamide adenine dinucleotide phosphate oxidase-4(NOX-4),transforming growth factor-β1(TGF-β1)and matrix metalloproteinase-9(MMP-9)]and pulmonary function[forced vital capacity(FVC),forced expiratory volume in 1s(FEV1),maximum expiratory flow at 75%of capacity(FEF5%)and maximum mid-expiratory flow rate(MMEF)]between two groups were compared before and after treatment,and the clinical efficacy was collected.RESULTS:The TCM symptom scores(cough and excessive phlegm,asthma and wheezing,chest tightness,moss smooth and pulse slow),EOSR,ICAM-1,VEGF,NOX4,TGF-β1 and MMP-9 levels of both groups had been significantly decreased,and the above indicators of observation group was significantly lower than those of the control group after treatment,with statistically significant differences(P<0.05).The FVC and FEV1 levels of both groups were significantly higher than those of before treatment,while the FEF75%and MMEF levels were significantly lower,and the above pulmonary indicators of observation group were significantly better than those of the control group after treatment,with statistically significant differences(P<0.05).The total effective rate of observation group was 93.33%(56/60),which was significantly higher than that of the control group(80.00%,48/60),with statistically significant difference(P<0.05).CONCLUSIONS:The application of Yupingfeng powder and Liujunzi decoction in modified treatment of acute exacerbation of COPD of phlegm-dampness and pulmonary-obstruction based on the theory of spleen invigorating and lung benefiting can significantly improve the TCM symptom scores of lung-distension,relieve inflammatory infiltration of airway tissue,inhibit airway remodeling,promote pulmonary function and clinical efficacy.