沙参麦冬汤加减对阴虚肺热证肺炎支原体肺炎恢复期患者免疫炎症反应的影响

Effect of Addition and Subtraction Therapy of Shashen Maidongtang on Immune Inflammatory Response in Patients with Mycoplasma Pneumoniae Pneumonia and Syndrome of Yin Deficiency and Lung Heat at Convalescent Period

目的:观察沙参麦冬汤加减对肺炎支原体肺炎恢复期患者阴虚肺热证的疗效及对免疫炎症反应的调节作用。方法:将148例患者按随机数字表法分为对照组和观察组各74例。研究期间对照组脱落、失访2例,剔除3例完成70例;观察组脱落、失访4例,完成71例。两组患者均口服阿奇霉素片,10 mg·kg-1·d-1,连服3 d;和匹多莫德颗粒剂,0.4~0.8 g/次,2次/d;和氨溴特罗口服溶液,2.5~15 mL/次,2次/d。对照组口服养阴清肺口服液,5~10 mL/次,2~3次/d;观察组内服沙参麦冬汤加减,1剂/d。两组疗程均为7 d。进行治疗前后咳嗽症状评分和咳嗽视觉模拟评分(VAS);记录咳嗽、肺部湿啰音,咯痰消失时间和胸片复常时间;进行治疗前后阴虚肺热证评分和莱塞斯特咳嗽问卷(LCQ)评分;检测治疗前后T淋巴细胞亚群(CD3+,CD4+,CD8+和CD4+/CD8+)和白细胞介素-6(IL-6),IL-10,肿瘤坏死因子-α(TNF-α),P物质(SP),降钙素原基因相关肽(CGRP)水平;进行治疗后安全性评价。结果:观察组疾病疗效总有效为95.77%(68/71),优于对照组的82.86%(58/70)(χ2=6.186,P<0.05);观察组患者咳嗽症状积分和VAS评分均明显低于对照组(P<0.01);观察组患者LCQ量表各维度评分和LCQ总分均高于对照组(P<0.01);观察组患者咳嗽、肺部湿啰音、咯痰消失时间及胸片复常时间均短于对照组(P<0.01);观察组CD3+,CD4+,CD4+/CD8+均高于对照组(P<0.01),CD8+低于对照组(P<0.01);观察组血清IL-6,IL-10,TNF-α水平和痰液中SP和CGRP水均低于对照组(P<0.01)。结论:在西医常规治疗的基础上,采用沙参麦冬汤加减内服治疗MPP恢复期阴虚肺热证患者,可减轻咳嗽程度,缩短病程,改善了生活质量,提高了细胞免疫功能,减轻了炎性损伤,降低了咳嗽敏感性,有较好的临床疗效,且使用安全。

Objective: To observe the clinical efficacy of addition and subtraction therapy of Shashen Maidongtang for syndrome of Yin deficiency and lung heat at convalescent period in patients with mycoplasma pneumoniae pneumonia,and to investigate its regulatory effect on immune inflammatory response. Method:One hundred and forty-eight patients were randomly divided into control group(74 cases)and observation group(74 cases)by random number table. During the treatment,70 patients completed the study in control group(loss to follow-up in 2 cases,elimination in 3 cases),and 71 patients completed the study in observation group(loss to follow-up in 4 cases). Patients in both groups got Azithromycin tablets for 3 days,10 mg·kg-1·d-1,pidotimod granules,0.4-0.8 g/time,2 times/day,and Ambroxol oral solution,2.5-15 mL/time,2 times/day. The patients in control group additionally received Yangyin Qingfei oral liquid,5-10 mL/time,2-3 times/day,while the patients in observation group additionally received addition and subtraction therapy of Shashen Maidongtang,1 dose/day,with a treatment course of 7 days in both groups. Before and after treatment,scores of cough symptom and cough visual analogue score(VAS)were graded,and the time to disappearance of cough,lung rales and expectoration as well as the time to recovery of chest radiograph were recorded. Scores of syndrome of yin deficiency and lung heat and Leicester Cough Questionnaire(LCQ)were also graded. Levels of T lymphocyte subsets(CD3+,CD4+,CD8+and CD4+/CD8+),interleukin-6(IL-6),IL-10,tumor necrosis factor-α(TNF-α),substance P(Substance P)and procalcitonin gene related peptide(CGRP)were detected,and the safety was also evaluated. Result:Total effective rate for the disease was 95.77%(68/71)in observation group,higher than 82.86%(58/70)in control group(χ2=6.186,P<0.05). Scores of cough symptoms and VAS were higher than those in control group(P<0.01),and scores of various items in LCQ scale and the total score of LCQ were all higher than those in control group(P<0.01). The time to disappearance of cough,lung rales and expectoration as well as the time to recovery of chest radiograph in observation group were shorter than those in control group(P<0.01). Levels of CD3+,CD4+and CD4+/CD8+were higher than those in control group(P<0.01),and levels of CD8+,IL-6,IL-10,TNF-α,SP in serum and CGRP in sputum were all lower than those in control group(P<0.01). Conclusion: On the basis of conventional western medicine treatment,addition and subtraction therapy of Shashen Maidongtang can reduce the degree of cough,shorten the course of disease,improve the quality of life,improve the cellular immune function,reduce the inflammatory injury,and reduce the sensitivity of cough,with better clinical efficacy and safety as compared with Western medicine alone.