翘芩清肺剂治疗痰热壅肺型慢性阻塞性肺疾病急性加重期疗效及对其炎症水平与气道黏液高分泌的影响

Clinical effect of Qiaoqin Qingfei Decoction on AECOPD with phlegm-heat obstructing lung syndrome and its effect on the inflammatory level and airway mucus hypersecretion

目的:观察翘芩清肺剂对慢性阻塞性肺疾病急性加重期(AECOPD)痰热壅肺证的临床疗效及其对气道黏液高分泌的影响。方法:将60例AECOPD病人随机分为对照组和治疗组(各30例)。对照组应用西医疗法;治疗组在对照组的基础上加服翘芩清肺剂。疗程均为10 d。比较治疗前后临床症状的改善(咳嗽、咳痰、气促及发热),痰液性状的改变,诱导痰液黏蛋白(MUC5AC)水平,炎症因子C-反应蛋白(CRP)、降钙素(PCT)、白介素-8(IL-8)、血细胞弹性蛋白酶(NE)、肿瘤坏死因子(TNF-α)及肺功能水平,并比较其总体疗效。结果:治疗后,对照组在发热、咳嗽、咳痰、气促症状评分和痰液性状评分均有下降(P<0.05),治疗组评分改善更明显(P<0.01),治疗后治疗组发热、咳嗽、咳痰、气促评分和痰液性状评分均低于对照组(P<0.05)。两组在呼气流量峰值(PEF)、第1秒用力呼气容积(FEV_(1)%)、1 s用力呼气容积与用力肺容量的比值(FEV1/FVC)较本组治疗前均有升高(P<0.05),其中治疗组PEF、FEV1%改善更明显(P<0.01),治疗后治疗组PEF、FEV_(1)/FVC及FEV1%水平均高于对照组(P<0.05)。两组治疗后痰MUC5AC水平较本组治疗前降低(P<0.05),治疗后治疗组痰MUC5AC水平低于对照组(P<0.05)。对照组治疗后PCT、TNF-α水平均较治疗前降低(P<0.05),CRP、IL-8、NE水平降低更明显(P<0.01),治疗组CRP、PCT、IL-8、NE和TNF-α均较治疗前有明显降低(P<0.01),治疗后治疗组CRP、PCT、IL-8、NE和TNF-α较对照组降低(P<0.05)。治疗组临床总有效率96.66%,高于对照组的80.00%(P<0.05)。结论:翘芩清肺剂治疗AECOPD痰热壅肺证可减轻临床症状,改善气道黏液高分泌,提高肺功能水平,降低炎症反应,临床疗效显著。

Objective:To observe the clinical effect of Qiaoqin Qingfei Decoction on phlegm-heat obstructing lung syndrome during acute exacerbation of chronic obstructive pulmonary disease (AECOPD)and its effect on airway mucus hypersecretion.Methods:60 AECOPD patients were randomly divided into control group and treatment group (30 cases each).The control group was treated with Western medicine;the treatment group was added Qiaoqin Qingfei Decoction on the treatment basis of the control group.The duration of treatment was 10 days.The improvement of clinical symptoms(cough,expectoration,shortness of breath and fever),changes in sputum properties,levels of induced sputum mucin(MUC5AC),inflammatory factors C-reactive protein (CRP),calcitonin (PCT),interleukin-8,hemocyte elastase(NE),tumor necrosis factor (TNF-α)and lung function levels were compared before and after treatment,and their overall efficacy was compared.Results:After treatment,the control group showed a decrease in fever,cough,expectoration,shortness of breath symptom scores and sputum properties scores (P<0.05),and the scores in the treatment group improved more significantly (P<0.01),while the fever,cough,expectoration,shortness of breath symptom scores and sputum properties scores were lower than in the treatment group than in the control group (P<0.05).In the control group and treatment group,peak expiratory flow(PEF),forced expiratory volume in the first second(FEV1%),and the ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC)were all increased compared with those before treatment(P<0.05),among which PEF and FEV1%improved more significantly in the treatment group(P<0.01),and PEF,FEV1/FVC and FEV1%levels were higher in the treated group than in the control group (P<0.05).Sputum MUC5AC levels were lower after treatment than before (P<0.05),and sputum MUC5AC levels were lower in the treatment group than in the control group after treatment(P<0.05).In the control group,PCT and TNF-α levels were reduced(P<0.05),and CRP,IL-8 and NE levels were reduced more significantly (P<0.01),and CRP,PCT,IL-8,NE and TNF-αwere significantly reduced in the treatment group (P<0.01),and CRP,PCT,IL-8,NE and TNF-α were lower in the treatment group than in the control group after treatment (P<0.05).The total clinical efficiency of the treatment group was 96.66%,higher than 80%of the control group (P<0.05).Conclusion:The treatment of Phlegm-heat Obstructing Lung Syndrome in AECOPD with Qiaoqin Qingfei Decoction can reduce clinical symptoms,improve airway mucus hypersecretion,improve lung function level and reduce inflammatory response,with significant clinical efficacy.