利肺化痰解忧汤治疗慢性阻塞性肺疾病合并焦虑抑郁的临床研究

Clinical study of Lifei Huatan Jieyou decoction on chronic obstructive pulmonary disease complicated with anxious depression

目的观察利肺化痰解忧汤治疗慢性阻塞性肺疾病(以下简称慢阻肺)合并焦虑抑郁的临床疗效。方法将80例慢阻肺合并焦虑抑郁患者按照随机数字表法分为2组,对照组40例予西医常规治疗,治疗组40例在对照组基础上加用利肺化痰解忧汤治疗。2组治疗3个疗程后统计疗效,比较2组治疗前后中医症状评分(包括胸胁胀满、胸部闷塞、咳痰不爽、精神抑郁、心神不宁及心悸多梦)、慢阻肺患者自我评估测试问卷(CAT)评分及医院焦虑和抑郁量表(HADS)评分变化情况,比较2组治疗前、治疗后血清5-羟色胺(5-HT)、多巴胺(DA)、脑源性神经营养因子(BDNF)、核转录因子-κBp65(NF-κBp65)、白细胞介素6(IL-6)及粒细胞-巨噬细胞集落刺激因子(GM-CSF)水平变化情况,比较2组治疗前后痰液中中性粒细胞弹性蛋白酶(NE)及黏蛋白5AC(MUC5AC)水平变化情况。结果治疗组总有效率92. 5%(37/40),对照组总有效率75. 0%(30/40),治疗组疗效优于对照组(P <0. 05)。2组治疗后中医症状胸胁胀满、胸部闷塞、咳痰不爽、精神抑郁、心神不宁、心悸多梦评分及总分与本组治疗前比较均明显降低(P <0. 05),且治疗后治疗组各项中医症状评分及总分均低于对照组(P <0. 05)。2组治疗后CAT评分、HADS焦虑评分及HADS抑郁评分与本组治疗前比较均明显降低(P <0. 05),且治疗后治疗组各项评分均低于对照组(P <0. 05)。与本组治疗前比较,2组治疗后血清5-HT、DA及BDNF水平均明显升高(P <0. 05),NF-κBp65、IL-6及GMCSF水平均明显降低(P <0. 05),且治疗后治疗组各指标改善均优于对照组(P <0. 05)。2组治疗后痰液NE及MUC5AC水平与本组治疗前比较均明显降低(P <0. 05),且治疗后治疗组NE及MUC5AC水平均低于对照组(P <0. 05)。结论利肺化痰解忧汤治疗慢阻肺合并焦虑抑郁临床疗效确切,可有效改善患者中医症状,增加5-HT、DA及BDNF水平,改善焦虑抑郁状态,降低NF-κBp65、IL-6及GM-CSF水平,抑制炎性反应,降低NE及MUC5AC水平,抑制气道黏液高分泌,改善慢阻肺病情,提高疗效。

Objective To observe the clinical effects of Lifei Huatan Jieyou decoction( LHJD) on chronic obstructive pulmonary disease( COPD) complicated with anxious depression. Methods Eighty COPD patients complicated with anxious depression were divided according to the random number table into the control group( n = 40)with the conventional western medicine and the treatment group( n = 40) with LHJD on the basis of the treatment plan of the control group. The treatment period for the two groups was 3 courses. And the curative effect in the groups was evaluated. The scores of traditional Chinese medicine( TCM) symptoms( including fullness chest and hypochondrium,chest distress,ungratifying expectoration of phlegm,deprementia,malaise, and palpitation and dreaminess),COPD Assessment Test( CAT),and Hospital Anxiety and Depression Scale( HADS) in the two groups were compared before and after the treatment. And the levels of 5-hydroxytryptamine( 5-HT),dopamine( DA),brain-derived neurotrophic factor( BDNF),nuclear factor-κBp65( NF-κBp65),interleukin-6( IL-6),and granulocyte-macrophage colony stimulating factor( GM-CSF) as well as neutrophil elastase( NE) and mucoprotein 5 AC( MUC5 AC) in phlegm in the two groups were compared before and after the treatment. Results The curative effect in the treatment group [total effective rate of 92. 5%( 37/40) ] was higher than that of the control group [total effective rate of 75. 0%( 30/40) ]( P < 0. 05). After the treatment,each TCM symptom score and their total score,CAT score,HADS anxiety and depression score,the levels of NF-κBp65,IL-6,and GM-CSF,and the levels of NE and MUC5 AC in phlegm for patients in the two groups were obviously lower than those before the treatment( P < 0. 05),while the levels of 5-HT,DA and BDNF were obviously higher( P < 0. 05). After the treatment,each TCM symptom score and their total score,CAT score,HADS anxiety and depression score,and the levels of NE and MUC5 AC in phlegm for patients in the treatment group were lower than those of the control group( P < 0. 05),while the levels of 5-HT,DA,BDNF,NF-κBp65,IL-6,and GM-CSF were higher( P < 0. 05). Conclusion LHJD on COPD complicated with anxious depression has a definite therapeutic effect,which can significantly improve TCM symptoms,anxious depression state and COPD,increase the levels of 5-HT,DA and BDNF,reduce the levels of NF-κBp65,IL-6,GM-CSF,NE,and MUC5 AC,inhibit the inflammatory reaction and airway mucus hypersecretion,and then enhance the curative effect for patients.