越婢加半夏汤治疗痰热郁肺型慢性阻塞性肺疾病急性加重期的中医证候疗效及对患者血清炎症指标的影响

Effect of Yuemai plus Banxia Decoction on acute exacerbation of chronic obstructive pulmonary disease of phlegm-heat stagnation sydrome and its influence on traditional Chinese medicine syndromes,and serum inflammation indicators

目的观察越婢加半夏汤治疗痰热郁肺型慢性阻塞性肺疾病急性加重期(AECOPD)的中医证候疗效及对患者血清炎症指标的影响。方法将60例痰热郁肺型AECOPD患者按照随机数字表法分为3组,西医组20例予西医常规治疗,中医组20例予越婢加半夏汤治疗,中西医结合组20例予西医常规+越婢加半夏汤治疗。3组均治疗10 d。比较3组治疗前后慢性阻塞性肺疾病评估测试(CAT)评分、改良版英国医学研究委员会呼吸问卷(mMRC)评分、中医证候评分变化;比较3组中医证候疗效;比较3组治疗前后血清细胞外信号调节蛋白激酶(ERK)、核转录因子κB(NF-κB)、白细胞介素1β(IL-1β)、肿瘤坏死因子α(TNF-α)水平变化;比较3组安全性。结果3组治疗后CAT各项评分及总评分均较本组治疗前降低(P<0.05);中西医结合组治疗后咳嗽评分低于西医组、中医组(P<0.05)。3组治疗后mMRC评分均较本组治疗前降(P<0.05)。3组治疗后各项中医证候评分及总评分均较本组治疗前降低(P<0.05);中西医结合组治疗后痰黄黏稠、口渴评分均低于西医组、中医组(P<0.05)。西医组总有效率88.2%(15/17),中医组总有效率90.9%(10/11),中西医结合组总有效率94.4%(17/18),中西医结合组中医证候疗效优于西医组、中医组(P<0.05)。中西医结合组治疗后ERK水平较本组治疗前降低(P<0.05)。西医组治疗后心率较本组治疗前降低(P<0.05);中医组治疗后呼吸频率、舒张压均较本组治疗前降低(P<0.05);中西医结合组治疗后体温、心率、呼吸频率、舒张压均较本组治疗前降低(P<0.05)。结论越婢加半夏汤联合西医常规治疗痰热郁肺型AECOPD,可有效改善患者中医证候,缓解临床症状,其机制可能与降低ERK、NF-κB表达水平、改善炎性反应有关。

Objective To observe the traditional Chinese medicine(TCM)syndrome curative effect of Yuebi Plus Banxia Decoction on acute exacerbation of chronic obstructive pulmonary disease(AECOPD)of phlegm-heat stagnation sydrome and its influence on TCM syndrome,COPD assessment test(CAT)scores,modified medical research council(mMRC)dyspnea scores and serum inflammatory markers.Methods Totally 60 AECOPD patients of phlegm-heat stagnation sydrome were randomly divided into three groups,the western medicine group(n=20;treated with conventional western medicine),TCM group(n=20;treated with Yuebi plus Banxia Decoction)and integrative medicine group(n=20;treated with Yuebi plus Banxia Decoction+western medicine).All patients in the three groups had being treated for 10 days.Among the three groups,those scores changes(CAT,mMRC,TCM symptom)were counted,and curative effect of TCM syndrome were observed,those clinical data including serum extracellular signal regulated kinases(ERK),nuclear transfer factor kappa b(NF-κB),interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α),safety were compared before and after treatment.Comparison before treatment,scores of CAT,mMRC,TCM symptom in the three groups were lower(all P<0.05);cough score,sputum viscous yellowness score and thirst were significantly decreased in the integrative medicine group(all P<0.05);total effective rate in the integrative medicine group higher than those in the western medicine group and the TCM group[94.4%(17/18)vs 88.2%(15/17)vs 90.9%(10/11),(P<0.05),respectively].ERK level,body temperature,heart rate,respiratory rate and diastolic blood pressure in the integrative medicine group were lower than those before treatment(all P<0.05);heart rate in the western medicine group was lower than that before treatment in this group(P<0.05);respiratory rate and diastolic blood pressure in the TCM group were lower than those before treatment(P<0.05).Conclusion Using Yuebi plus Banxia Decoction on AECOPD of phlegm-heat stagnation sydrome can effectively improve TCM syndromes and clinical symptoms of patients,thereby alleviating disease,which is related to reducing ERK,NF-κB levels,and inflammatory reactions.