温阳补肾填精膏方对低剂量吸入性糖皮质激素维持治疗的哮喘患者激素撤停的影响

Effects of “Yang-warming and kidney essence-replenishing” herbal paste on withdrawal of inhaled corticosteroids in asthma patients using low-dose inhaled corticosteroids as maintenance treatment

目的观察温阳补肾填精膏方对低剂量吸入性糖皮质激素维持治疗的哮喘患者激素撤停的影响。方法将140例低剂量吸入性糖皮质激素维持治疗的哮喘患者随机分为治疗组(71例)、对照组(69例)。对照组入组后即停用激素,治疗组停用激素的同时加用有温阳补肾填精功效的膏方,膏方服用时间为8周;从病例纳入当天开始计算,共计随访16周。观察比较治疗失败率,以及哮喘症状发生次数、缓解药物用量、哮喘控制测试评分表(ACT)评分、呼气峰流速(PEF)、第一秒用力呼吸量(FEV_(1))、FEV_(1)实测值占预计值百分比(FEV_(1)%)的变化情况。结果(1)治疗组、对照组治疗失败率分别为8.45%、24.64%,治疗组治疗失败率低于对照组(P<0.01)。(2)与激素撤停前比较,治疗组患者激素撤停后每周日间症状发生次数、每周缓解药物用量增多(P<0.05),对照组患者激素撤停后每周日间症状发生次数、每周夜间症状发生次数、每周活动受限次数、每周缓解药物用量增多(P<0.05);激素撤停后组间比较,治疗组患者每周日间症状发生次数、每周夜间症状发生次数、每周活动受限次数及每周缓解药物用量少于对照组(P<0.01)。(3)与激素撤停前比较,治疗组患者激素撤停后ACT评分降低(P<0.01);对照组患者激素撤停后ACT评分及PEF、FEV_(1)、FEV_(1)%值降低(P<0.01);激素撤停后组间比较,治疗组ACT评分及PEF、FEV_(1)、FEV_(1)%值高于对照组(P<0.01)。结论温阳补肾填精膏方有助于低剂量吸入性糖皮质激素维持治疗的哮喘患者撤停激素。

Objective To investigate the effects of“Yang-warming and kidney essence-replenishing”herbal paste on withdrawal of inhaled corticosteroids(ICS)in asthmatic patients controlled by low-dose ICS therapy.Methods One hundred and forty patients with asthma treated with low-dose ICS as maintenance treatment were randomly divided into a treatment group(n=71)and a control group(n=69).ICS was withdrawn upon the case enrollment in both groups,and in the treatment group,“Yang-warming and kidney essence-replenishing”herbal paste was applied on withdrawal of ICS therapy.The herbal paste was used for 8 weeks.The total follow-up period lasted 16 weeks from the day of case inclusion.We observed and compared the rate of treatment failure,as well as the changes in the frequency of asthma symptoms,the dosage of relieving drugs,the Asthma Control Test Scale(ACT)score,peak expiratory flow rate(PEF),forced expiratory volume in the first second(FEV_(1)),and FEV_(1) percentage(FEV_(1)%).Results①Treatment failure occurred in 8.45%of patients in the treatment group,which was lower compared with 24.64%in the control group(P<0.01).②After ICS withdrawal,frequency of weekly daytime symptoms,weekly dosage of relieving drugs increased for patients of the treatment group(P<0.05),frequency of weekly daytime symptoms,frequency of weekly night symptoms,frequency of weekly activity restriction,weekly dosage of relieving drugs increased for patients of the control group(P<0.05).After ICS withdrawal,the frequency of weekly daytime symptoms,the frequency of weekly night symptoms,the frequency of weekly activity restriction and the weekly dosage of relieving drugs in the treatment group were less than those in the control group(P<0.01).③After ICS withdrawal,ACT score in the treatment group decreased(P<0.01);while in the control group ACT score,PEF,FEV_(1) and FEV_(1)%values decreased(P<0.01).After ICS withdrawal,ACT score,PEF,FEV_(1) and FEV_(1)%values in the treatment group were higher than those in the control group(P<0.01).Conclusion By applying“Yang-warming and kidney essence-replenishing”herbal paste,patients with asthma controlled by low-dose ICS can maintain sound condition control during the withdrawal of ICS.