玉屏风散联合右归丸加减对肺肾两虚型COPD缓解期患者的疗效分析

Analysis of therapeutic effect of modified Yupingfeng powder combined with Yougui pill on COPD patients with deficiency of lung and kidney in remission period

目的探讨玉屏风散联合右归丸加减对肺肾两虚型慢性阻塞性肺疾病(COPD)缓解期患者的治疗效果。方法将2018年5月至2020年1月于江西省抚州市中医院就诊的处于COPD缓解期且中医证型属于肺肾两虚型的患者92例按随机数字表法分为对照组和观察组,每组46例。对照组患者采用西医常规治疗(给予噻托溴铵粉雾剂,18μg/吸,每日1剂),观察组在对照组基础上加用中药玉屏风散汤剂联合右归丸加减(每日煎煮1剂,每次滤汁300 mL,上、下午各服用150 mL),治疗8周后,比较2组患者的临床疗效、血清炎症因子及纤维化指标、T细胞亚群及肺功能指标,以及不良反应发生情况。结果治疗后,观察组患者治疗总有效率(91.30%)显著高于对照组(71.74%);观察组患者血清趋化因子C-X3-C基元配体1、转化生长因子β1、白细胞介素6、基质金属蛋白酶2、金属蛋白酶组织抑制剂2水平显著低于对照组,CD4~+、CD3~+、CD4~+/CD8~+、用力肺活量、第1秒用力呼气容积占用力肺活量的比值显著高于对照组,差异均有统计学意义(P<0.05)。2组患者不良反应均以胃肠道反应、皮疹为主,观察组患者不良反应发生率为13.04%,与对照组(10.86%)比较差异无统计学意义(P>0.05)。结论在噻托溴铵基础上使用玉屏风散联合右归丸加减可减轻肺肾两虚型COPD缓解期患者的气道炎症,提高其免疫力,改善其肺功能,且安全性较好。

OBJECTIVE To explore the therapeutic effect of modified Yupingfeng powder combined with Yougui pill on patients with chronic obstructive pulmonary disease(COPD)with deficiency of lung and kidney in remission period.METHODS Ninety-two patients,who were in remission of COPD and whose traditional Chinese medical syndromes belonged to deficiency of lung and kidney from Fuzhou Hospital of Traditional Chinese Medicine in Jiangxi province during May 2018-January 2020,were divided into control group and observation group according to random number table method,with 46 patients in each group.Control group was treated with conventional western medicine(given Tiotropium bromide powder spray,18 μg/inhalation,one dose per day);observation group was additionally treated with modified Yupingfeng powder decoction combined with Yougui pill(decocting one dose per day,filtering 300 m L per time,150 mL in the morning and afternoon)on the basis of control group.After8 weeks of treatment,the clinical efficacy,serum inflammatory factors and fibrosis indexes,T cell subsets and lung function indexes,and the occurrence of adverse drug reactions were compared between 2 groups.RESULTS After treatment,the total clinical effective rate of treatment(91.30%)in observation group was significantly higher than that of the control group(71.74%);the levels of serum chemokine C-X3-C motif ligand 1,transforming growth factor β1,interleukin-6,matrix metalloproteinase-2 and tissue inhibitor of metalloproteinase-2 in observation group were significantly lower than control group;there was statistical significance in CD4,CD3,CD4/CD8,forced vital capacity,the ratio of forced expiratory volume in the one second to forced vital capital(FEV1/FVC%)(P<0.05).The adverse drug reactions of the two groups were mainly gastrointestinal reactions and rashes.The incidence of adverse drug reactions in the observation group was 13.04%,and there was no statistical difference compared with control group(10.86%)(P>0.05).CONCLUSIONS Modified Yupingfeng powder combined with Yougui pill can reduce airway inflammation,improve immunity and improve lung function of COPD patients with deficiency of lung and kidney in remission period,and have good safety.