升阳益胃汤加减方治疗慢性阻塞性肺疾病合并白色念珠菌感染的临床研究

Clinical Study of Modified Shengyang Yiwei Decoction for the Treatment of Chronic Obstructive Pulmonary Disease Complicated with Candida Albicans Infection

【目的】观察升阳益胃汤加减方对慢性阻塞性肺疾病(COPD)合并白色念珠菌感染的治疗作用。【方法】将40例COPD合并白色念珠菌感染,中医证型为痰浊阻肺并肺脾气虚证的患者随机分为试验组和对照组,每组各20例。对照组给予西医常规治疗(包括吸氧、平喘、化痰等基础治疗和氟康唑静脉滴注治疗),试验组在对照组治疗基础上配合升阳益胃汤加减方治疗,疗程为3周。观察2组患者治疗前后中医证候积分、血常规[白细胞计数(WBC)和中性粒细胞百分数(NEUT)]、血气分析[动脉血中二氧化碳分压(PaCO2)和氧分压(PaO2)]、肺功能指标[用力肺活量(FVC)和1秒用力呼气容积(FEV1)]的变化情况,评价2组患者的中医证候疗效、中医舌象和脉象改善疗效、胸部CT改善疗效、痰真菌培养转阴疗效及安全性。【结果】(1)治疗3周后,试验组的中医证候疗效、中医舌象和脉象改善疗效、胸部CT改善疗效、痰真菌培养转阴疗效的总有效率(或转阴率)分别为100.0%(20/20)、100.0%(20/20)、100.0%(20/20)、85.0%(17/20)和90.0%(18/20),对照组分别为100.0%(20/20)、50.0%(10/20)、45.0%(9/20)、50.0%(10/20)和55.0%(11/20);组间比较(秩和检验或χ^(2)检验),试验组的中医证候疗效、中医舌象和脉象改善疗效、胸部CT改善疗效、痰真菌培养转阴疗效均优于对照组(P<0.05或P<0.01)。(2)治疗后,2组患者的各项中医证候积分均较治疗前明显改善(P<0.05),且治疗组对咳嗽、咯痰、干湿啰音、食少纳呆、倦怠乏力、饭后腹胀、大便异常等中医证候积分的改善作用均明显优于对照组(P<0.05或P<0.01)。(3)治疗后,2组患者的WBC、NEUT水平均较治疗前改善(P<0.05),但治疗后组间比较,差异均无统计学意义(P>0.05)。(4)治疗后,2组患者动脉血中PaCO2水平均较治疗前降低,PaO2水平均较治疗前升高(P<0.05),且试验组对PaCO2水平的降低作用和对PaO2水平的升高作用均明显优于对照组(P<0.01)。(5)治疗后,2组患者的FVC和FEV1等肺功能指标均较治疗前改善(P<0.05),且试验组对FVC和FEV1等肺功能指标的改善作用均明显优于对照组(P<0.01)。(6)研究过程中,2组患者均无明显不良反应发生,患者的肝肾功能也均无异常变化。【结论】升阳益胃汤加减方联合氟康唑治疗COPD合并白色念珠菌感染患者疗效确切,其疗效优于单纯西药治疗。

Objective To investigate the therapeutic effect of modified Shengyang Yiwei Decoction for the treatment of chronic obstructive pulmonary disease(COPD)complicated with Candida albicans infection(CAI). Methods Forty COPD patients complicated with CAI and differentiated as the traditional Chinese medicine(TCM)syndrome of turbid phlegm obstructing lung and lung-qi and spleen-qi deficiency were randomly divided into trial group and control group,with 20 cases in each group. The control group was given conventional western medicine treatment including oxygen inhalation,antiasthmatic treatment,phlegm elimination and intravenous drip of Fluconazole,and the trial group was given modified Shengyang Yiwei Decoction orally on the basis of the treatment for the control group, the treatment lasting 3 weeks. Before and after treatment, we observed the changes in TCM syndrome scores,blood routine test of white blood cell count(WBC)and the percentage of neutrophils(NEUT),blood gas analysis of partial pressure of carbon dioxide(PaCO2)and oxygen partial pressure(PaO2)in the arterial blood,and pulmonary function indexes of forced vital capacity(FVC)and forced expiratory volume in one second(FEV1)in the two groups. After treatment,the efficacy of TCM syndromes,efficacy for improving the tongue coating and pulse condition,efficacy for chest CT,sputum fungus negative conversion and clinical safety in the two groups were also evaluated. Results(1)After 3 weeks of treatment,the total effective rates for improving TCM syndrome,tongue coating, pulse condition and chest CT,and sputum fungus negative conversion rate in the trial group were100.0%(20/20),100.0%(20/20),100.0%(20/20),85.0%(17/20)and 90.0%(18/20)respectively,and were100.0%(20/20),50.0%(10/20),45.0%(9/20),50.0%(10/20)and 55.0%(11/20)respectively in the control group. The intergroup comparison by rank sum test or chi-square test showed that the efficacy for the above indexes in the trial group was stronger than that in the control group(P<0.05 or P<0.01).(2)After treatment,the scores of each TCM syndrome in the two groups were significantly improved compared with those before treatment(P<0.05),and the treatment group had stronger effect on improving the scores of cough,expectoration,dry and wet rales,poor appetite and anorexia,fatigue,abdominal bloating after meal,and abnormal stool than the control group(P<0.05 or P<0.01).(3)After treatment,the levels of WBC and NEUT in the two groups were improved compared with those before treatment(P<0.05),whereas there was no statistically significant difference between the two groups after treatment(P>0.05).(4)After treatment,PaCO2 level in arterial blood of the two groups was lower and PaO2 level was higher than those before treatment(P<0.05),and the treatment group had stronger effect on decreasing PaCO2 level and increasing PaO2 level than the control group(P<0.01).(5)After treatment,pulmonary function indexes such as FVC and FEV1 in the two groups were improved compared with those before treatment(P<0.05), and the improvement of pulmonary function indexes in the trial group was significantly superior to that in the control group(P<0.01).(6)During the trial, there were no obvious adverse reactions occurring in the two groups, and there were no abnormal changes in liver and kidney function. Conclusion Modified Shengyang Yiwei Decoction combined with Fluconazole has certain effect on COPD patients complicated with Candida albicans infection, and the combined therapy is more effective than using western medicine treatment alone.