三伏天穴位贴敷时间对COPD稳定期肺脾气虚证患者痰sIgA的影响

Study on Effect of Acupoint Application Time on Sputum sIgA in COPD Patients with Lung-Spleen Deficiency Syndrome in Stable Stage

目的探讨连续3年三伏天贴敷对慢性阻塞性肺疾病(COPD)稳定期患者痰sIgA影响以及寻找最适合穴位贴敷时长时间。方法将160例COPD稳定期肺脾气虚证肺功能分级为Ⅰ级、Ⅱ级或Ⅲ级患者随机分为A组(贴敷4 h)、B组(贴敷6 h)、C组(贴敷8 h)、阴性对照D组(无贴敷),每组各40例,治疗组贴敷药物组成、剂量和贴敷穴位一致,对照D组无穴位贴敷。1次/10 d,贴5次/年,连续敷贴3年三伏天,观察治疗前、治疗1年、2年、3年痰液sIgA含量及皮肤刺激评分。结果①痰液sIgA含量:治疗1年:治疗组同组治疗前后比较无明显差异(P>0.05),与对照组治疗后比较亦无明显差异(P>0.05);治疗2年、3年:治疗组同组治疗前后比较有明显差异(P<0.05),与对照组治疗后比较亦有显著差异(P<0.05)。治疗组组间同年比较:1年:各组间无差异。2年、3年:A组与B组比较P<0.05;B组与C组比较P<0.05;A组与C组比较P>0.05。同组治疗后年比较:2年与1年比较P<0.05;3年与2年比较P<0.05。以上结果显示:痰液sIgA含量,治疗1年,治疗组同组治疗前后、与对照组治疗后比较、及治疗组组间同年比较,均无明显差异。治疗2年、3年:治疗组与同组疗前、与对照组疗后比较,效果有显著差异,治疗组组间同年比较,B组(贴敷6 h)效果最明显。同组疗后年比较:随着服帖的年数增多,痰液sIgA含量逐年增高,疗效逐年明显。②对皮肤刺激:治疗组治疗1年、2年、3年,同年组间皮肤刺激评分比较,A组(贴敷4 h)与B组(贴敷6 h)比较差异无统计学意义(P>0.05),A组(贴敷4 h)与C组(贴敷8 h)比较、B组(贴敷6 h)与C组(贴敷8 h)比较有统计学意(P<0.05)。提示随着贴敷时间的延长,皮肤的刺激受损加重。结论三伏天贴敷,可促进COPD稳定期肺脾气虚证患者呼吸道黏膜sIgA分泌,提高体液免疫效应;三伏天贴敷最佳的贴敷时长为每次6 h。

Objective To investigate the effect of three consecutive years of application in dog days on sputum sIgA of COPD patients in stable stage andfind out the most suitable time for acupoint application.Methods A total of 160 COPD patients with lung-spleen-Qi deficiency syndrome in stable stage were randomly divided into group A(4 hours of application),group B(6hours of application),group C(8 hours of application)and negative control group D(no application).There were 40 cases in each group.In the treatment group,besides the length of application,the composition and dosage of the application drugs and the application points were the same.There was no acupoint application in control group D.Sputum sIgA levels and skin irritation scores were observed before treatment,1,2 and 3 years after treatment.Results①Sputum sIgA content:After 1 year treatment:there was no significant difference of treatment groups before and after treatment(P>0.05).After 2 and 3 years treatment,there was significant difference of treatment groups before and after treatment(P<0.05).Compared with the control group D,there was significant difference(P<0.05).After 1 year treatment,there was no difference among the treatment groups.After 2 and 3 years treatment,compared with group B,group A had significant difference(P<0.05).Compared with group C,group B had significant difference(P<0.05).Compared with group C,group A had no significant difference(P>0.05).The above results showed that there was no significant difference among the treatment groups.The comparison between the control group and the treatment groups and the comparison within treatment groups after 1 year treatment had no significant difference.Two and three years after treatment,there was significant difference between the treatment group and the control group after treatment.The treatment groups had significant difference before and after treatment.Compared with the treatment group in the same year,the effect of group B(application for 6 hours)was the most obvious.Compared with the same group in the year after treatment,the sIgA content in sputum increased year by year with the increase of the number of years and the curative effect was obvious year by year.②Skin irritation:There was no significant difference in skin irritation score between group A(4 h)and group B(6 h),group A(4 h)and group C(8 h),group B(6 h)and group C(8 h)(P<0.05).It is suggested that the skin irritation is aggravated with the prolongation of application time.Conclusion The application in dog days can promote the secretion of sIgA in respiratory mucosa of COPD patients with lung-spleen-Qi deficiency in stable stage,and improve the humoral immune effect.The best application time in dog days is 6 hours for each time.