二陈汤合三子养亲汤联合盐酸溴己新治疗慢性阻塞性肺疾病疗效及对气道重塑的影响

Effectiveness of Erchen decoction and Sanziyangqin decoction combined with bromhexine hydrochloride in the treatment of chronic obstructive pulmonary disease and its effect on airway remodeling

目的探究二陈汤合三子养亲汤联合盐酸溴己新治疗慢性阻塞性肺疾病(COPD)疗效及对病人气道重塑的影响。方法选取2017年12月至2019年3月于南京市浦口区中医院接受治疗的COPD病人94例,按照随机数字表法将纳入对象分为治疗组与对照组,各47例。对照组予以盐酸溴己新4 mg+5%葡萄糖注射液100 mL静脉滴注治疗,1次/天治疗;在对照组基础上,治疗组予以二陈汤合三子养亲汤治疗,温水煎服,每日1剂,分早、晚2次于餐后服用。两组治疗时间均为2周。记录两组治疗效果及药物不良反应,同时检测所有病人肺功能指标、炎症反应相关指标、气道重塑相关指标以及氧化应激相关产物水平,同期对比两组上述指标的差异。结果治疗组临床疗效(89.36%)明显高于对照组(65.96%)(χ~2=7.419,P=0.006);治疗后,治疗组肺功能指标一秒用力呼气容积(FEV1)、呼气峰流速(PEF)、气道峰压(Ppeak)均明显高于对照组(P<0.01);治疗组氧化应激相关产物蛋白质羰基(PC)、8-羟化脱氧鸟苷(8-OHdG)、丙二醛均明显低于对照组(P<0.01);治疗组炎症反应相关指标白细胞介素-17(IL-17)、白细胞介素-33(IL-33)均明显低于对照组,而脂联素则明显高于对照组(P<0.01);治疗组气道重塑相关指标神经生长因子(NGF)、碱性成纤维细胞生长因子(b-FGF)、血管内皮生长因子(VEGF)、基质金属蛋白酶-9(MMP-9)、基质金属蛋白酶抑制因子-1(TIMP-1)均明显低于对照组(P<0.01);此外,治疗组的不良反应发生率较对照组明显偏低(P<0.05)。结论二陈汤合三子养亲汤联合盐酸溴己新可显著改善氧化应激和炎症反应对COPD病人肺功能的影响,并有效抑制气道重塑,疗效显著,且安全性较高,值得临床推广。

Objective To explore the effect of Erchen decoction and Sanziyangqin decoction combined with bromhexine hydrochloride on chronic obstructive pulmonary disease(COPD)and airway remodeling.Methods Ninety-four COPD patients treated in Nanjing Pukou District Hospital of Traditional Chinese Medicine from December 2017 to March 2019 were selected and divided into treatment group and control group according to random number table method,47 cases in each group.The control group was treated with bromhexine hydrochloride.On this basis,the treatment group was treated with Erchen decoction and Sanziyangqin decoction.Both groups were treated for 2 weeks.The therapeutic effect and adverse drug reactions of the two groups were recorded,and the lung function,inflammatory response,airway remodeling and oxidative stress related products were detected in all patients.The differences of the above indexes between the two groups were compared at the same time.Results The clinical efficacy of the treatment group(89.36%)was significantly higher than that of the control group(65.96%)(χ~2=7.419,P=0.006);after treatment,the lung function indexes FEV1,PEF and Ppeak of the treatment group were significantly higher than those of the control group(P<0.01);the oxidative stress related products PC,8-OHdG and MDA of the treatment group were significantly lower than those of the control group(P<0.01);IL-17,IL-33 were significantly lower than those in the control group,while APN was significantly higher than those in the control group(P<0.01);the related indexes of airway remodeling in the treatment group,such as NGF,b-FGF,VEGF,MMP-9 and TIMP-1,were significantly lower than those in the control group(P<0.01);in addition,the incidence of adverse reactions in the treatment group was significantly lower than that in the control group(P<0.05).Conclusions Erchen decoction combined with Sanziyangqin decoction combined with bromhexine hydrochloride can significantly improve the effects of oxidative stress and inflammation on pulmonary function in COPD patients,and effectively inhibit airway remodeling.It is effective and safe,and worthy of clinical promotion.