针刺结合清肺祛痰汤治疗痰热壅肺型卒中相关性肺炎及对细胞免疫功能的影响

Acupuncture combined with Qingfei Qutan decoction for stroke-associated pneumonia with phlegm-heat obstructing lung and its effect on cellular immune function

目的:观察针刺结合清肺祛痰汤治疗痰热壅肺型卒中相关性肺炎(SAP)的临床疗效,并探讨其可能的作用机制。方法:将99例痰热壅肺型SAP患者随机分为针药结合组(33例,脱落1例)、中药组(33例,脱落1例)和针刺组(33例,脱落1例)。在常规治疗基础上,针刺组加用针刺治疗,穴取天突、肺俞、太渊、三阴交等,每日1次,连续治疗6 d后休息1 d;中药组加用清肺祛痰汤治疗,每日1剂;针药结合组予针刺结合清肺祛痰汤治疗,均2周为一疗程,共治疗2个疗程。比较各组患者治疗前后临床肺部感染评分(CPIS)、炎性相关指标[中性粒细胞/淋巴细胞比值(NLR)、降钙素原(PCT)、C反应蛋白(CRP)]水平、细胞免疫功能(CD_(3)^(+)、CD_(4)^(+)、CD_(8)^(+)及CD_(4)^(+)/CD_(8)^(+)值),观察各组患者治疗后致病菌清除情况,并于治疗后评定各组临床疗效。结果:治疗后,各组患者CPIS评分、NLR、PCT、CRP、CD_(8)^(+)较治疗前降低(P<0.05),CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)值较治疗前升高(P<0.05);针药结合组以上指标优于针刺组与中药组(P<0.05),中药组以上指标优于针刺组(P<0.05)。各组患者致病菌清除率比较差异无统计学意义(P>0.05)。针药结合组愈显率为65.6%(21/32),高于中药组的43.8%(14/32)及针刺组的18.8%(6/32,P<0.05),中药组愈显率高于针刺组(P<0.05)。结论:针刺结合清肺祛痰汤可有效改善痰热壅肺型SAP患者临床症状,其机制可能与增强机体细胞免疫功能,降低炎性反应水平有关。

Objective To observe the clinical effect of acupuncture combined with Qingfei Qutan decoction for stroke-associated pneumonia(SAP)with phlegm-heat obstructing lung,and explore its possible mechanism.Methods Ninety-nine patients of SAP with phlegm-heat obstructing lung were randomly divided into a combination group(33 cases,1 case dropped off),a Chinese medication group(33 cases,1 case dropped off)and an acupuncture group(33 cases,1 case dropped off).On the basis of routine basic treatment,the patients in the acupuncture group were treated with acupuncture at Tiantu(CV 22),Feishu(BL 13),Taiyuan(LU 9),Sanyinjiao(SP 6),etc.,once a day,with an interval of 1 day after continuous 6-day treatment;the patients in the Chinese medication group were treated with Qingfei Qutan decoction,1 dose per day;the patients in the combination group were treated with acupuncture combined with Qingfei Qutan decoction.Two weeks were taken as a course of treatment,and two courses of treatment were given.Before and after treatment,the clinical pulmonary infection score(CPIS),inflammatory indexes(neutrophil-to-lymphocyte ratio[NLR],procalcitonin[PCT],C-reactive protein[CRP]),cellular immune function(CD_(3)^(+),CD_(4)^(+),CD_(8)^(+)and CD_(4)^(+)/CD_(8)^(+))were compared in the 3 groups.The clearance of pathogenic bacteria after treatment was observed in the 3 groups.The clinical efficacy of each group was evaluated.Results After treatment,the CPIS scores,NLR,PCT,CRP and CD_(8)^(+)in the each group were lower than those before treatment(P<0.05),while the levels of CD_(3)^(+),CD_(4)^(+),CD_(4)^(+)/CD_(8)^(+)were higher than those before treatment(P<0.05).The above indexes in the combination group were better than those in the acupuncture group and the Chinese medication group(P<0.05),and the above indexes in the Chinese medication group were better than those in the acupuncture group(P<0.05).There was no significant difference in the clearance rate of pathogenic bacteria among three groups(P>0.05).The cured and markedly effective rate was 65.6%(21/32)in the combination group,which was higher than 43.8%(14/32)in the Chinese medication group and 18.8%(6/32)in the acupuncture group(P<0.05).The cured and markedly effective rate in the Chinese medication group was higher than that in the acupuncture group(P<0.05).Conclusion Acupuncture combined with Qingfei Qutan decoction could effectively improve the clinical symptoms of SAP patients with phlegm-heat obstructing lung,and the mechanism may be related to enhancing the cellular immune function and reducing the level of inflammatory reaction.