清肺生脉汤对AECOPD多重耐药鲍曼不动杆菌感染的临床疗效观察

Study on the Intervention Effect of Qingfei Shengmai Decoction on Multidrug-resistant Acinetobacter baumannii Infection in AECOPD

目的观察清肺生脉汤对慢性阻塞性肺疾病急性加重期(AECOPD)多重耐药鲍曼不动杆菌感染的干预效果。方法将60例患者随机分为对照组和观察组,每组30例。对照组给予西医综合治疗措施,观察组在对照组治疗的基础上加用清肺生脉汤内服。比较2组治疗前后的鲍曼不动杆菌(AB)检出序列数和治疗后的AB清除率;评价治疗前后慢阻肺患者自我评估测试(CAT)、肺功能[第1秒钟呼气流量占预计值百分比(FEV1%)]和中医证候评分;检测治疗前后血清炎症因子[基质金属蛋白酶9(MMP-9)、降钙素原(PCT)、超敏C反应蛋白(hs-CRP)、白细胞介素6(IL-6)、白细胞介素8(IL-8)]水平;观察2组患者的临床疗效和安全性。结果治疗后,2组患者AB检出序列数、CAT评分和痰热壅肺证积分明显下降(P<0.01),FEV1%显著升高(P<0.01),且观察组患者AB检出序列数、CAT评分和痰热壅肺证积分均低于对照组,FEV1%高于对照组(P<0.01)。治疗后,2组患者血清炎症因子(MMP-9、PCT、hs-CRP、IL-6、IL-8)水平明显下降(P<0.01),且观察组患者各炎症因子均低于对照组(P<0.01)。治疗后,观察组AB清除率为93.33%(28/30),高于对照组的70.00%(21/30)(P<0.05)。观察组愈显率为93.33%(28/30),高于对照组的70.00%(21/30)(χ^(2)=5.454,P<0.05)。未发现与清肺生脉汤应用相关的不良反应。结论西医综合治疗加用清肺生脉汤能降低AECOPD多重耐药鲍曼不动杆菌感染的细菌相对丰度,提高AB的清除率,减轻临床症状和中医证候,改善肺功能,并具有减轻气道炎症反应作用,临床疗效优于单纯西医治疗,且安全性较好。

Objective To observe the effect of Qingfei Shengmai decoction on the treatment of acute exacerbation ofchronic obstructive pulmonary disease(AECOPD)with multi-drug resistant Acinetobacter baumannii(AB)infection.Methods Sixty patients were randomly divided into a control group and an observation group with 30 cases in eachgroup. The control group was given comprehensive western medicine treatment measures,and the observation groupwas given Qingfei Shengmai decoction on the basis of the control group. The numbers of AB sequences detectedbefore and after treatment, and the AB clearance rate after treatment were compared. The self-assessment test(CAT),lung function[the first second expiratory flow as a percentage of the expected value(FEV1%)] and TCMsyndrome scores for COPD patients before and after treatment were evaluated. The levels of serum inflammatoryfactors before and after treatment [matrix metalloproteinase 9(MMP-9),procalcitonin(PCT),high-sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6),interleukin-8(IL-8)] were measured,and a safety evaluation was also conducted to compare the comprehensive efficacy after treatment. Results After treatment,the numbers ofdetected AB sequences, CAT scores and phlegm-heat stagnation syndrome scores in the two groups decreasedsignificantly(P<0.01). While FEV1% increased significantly(P<0.01). After treatment, the number of detectedAB sequences, CAT score and phlegm-heat stagnation syndrome score of the observation group were lower thanthose of the control group,and FEV1% was higher than that of the control group(P<0.01). After treatment,thelevels of serum inflammatory factors(MMP-9,PCT,hs-CRP,IL-6,IL-8)in the two groups were significantlydecreased(P<0.01),and serum levels of the inflammatory factors in the observation group were lower than those inthe control group after treatment(P<0.01). After treatment, the AB clearance rate in the observation group was93.33%(28/30), which was higher than 70.00%(21/30) in the control group(P<0.05). The cure rate in theobservation group was 93.33%(28/30),which was higher than 70.00%(21/30)in the control group(χ^(2)=5.454,P<0.05). The clinical efficacy of the observation group was better than that of the control group and the difference wasstatistically significant(P<0.05). No adverse reaction to the use of Qingfei Shengmai decoction was found.Conclusion Application of Qingfei Shengmai decoction in the treatment of AECOPD multi-drug resistant Acinetobacter baumannii infection can reduce the relative abundance of bacteria,increase the clearance rate of AB,alleviate clinical symptoms and TCM syndromes, improve lung function, and reduce airway inflammation. Theclinical efficacy was better than that of western medicine alone,and its safety is also good.