加味止哮汤结合西医综合疗法治疗支气管哮喘(热哮)急性发作的临床研究

Clinical evaluation of Jiawei Zhixiao Decoction on acute attack of bronchial asthma

目的评价加味止哮汤结合西医综合疗法治疗支气管哮喘(热哮)急性发作的临床疗效。方法随机对照试验研究。选取2021年1-12月本院支气管哮喘(热哮)急性加重患者80例作为观察对象,采用随机数字表法分为2组,每组40例。对照组给予西医综合疗法治疗(支气管扩张剂及糖皮质激素等),治疗组在对照组基础上加服加味止哮汤。2组均治疗14 d。分别于治疗前后进行中医症状评分;采用肺功能仪检测FEV1、第一秒用力呼气容积与用力肺活量比值(FEV1/FVC),采用呼吸峰流速仪检测呼气流速峰值(peak expiratory flow,PEF);采用ELISA法检测血清TNF-α、IL-8水平,电化学发光法检测降钙素原(procalcitonin,PCT);对支气管哮喘严重程度分级情况进行评估,记录不良反应,评价临床疗效。结果治疗组总有效率为95.0%(38/40)、对照组为80.0%(32/40),2组比较差异有统计学意义(χ^(2)=4.11,P=0.043)。治疗后,治疗组中医症状积分低于对照组(t=7.91,P<0.01);FEV1[(2.83±0.37)L比(2.38±0.32)L,t=6.77]、FEV1/FVC[(85.37±9.36)%比(75.50±10.24)%,t=4.50]、PEF[(4.84±0.82)L比(3.92±0.43)L,t=6.28]水平高于对照组(P<0.01);血清IL-8[(80.59±10.28)ng/L比(87.15±8.25)ng/L,t=3.15]、TNF-α[(43.18±4.08)ng/L比(51.78±7.58)ng/L,t=6.32]、PCT[(0.84±0.35)μg/L比(0.41±0.12)μg/L,t=7.35]水平低于对照组(P<0.01);哮喘等级改善情况优于对照组(Z=17.86,P<0.05)。2组治疗期间均未见严重不良反应。结论加味止哮汤结合西医综合疗法可有效改善支气管哮喘(热哮)急性发作患者的中医症状及肺功能,降低炎症因子水平及哮喘等级,提高临床疗效。

Objective To evaluate the clinical efficacy of Jiawei Zhixiao Decoction and western medicine comprehensive therapy in acute attack of bronchial asthma of heat asthma syndrome.Methods Randomized controlled trial.A total of 80 patients with acute exacerbation of bronchial asthma and TCM pattern heat asthma,who treated in the respiratory department of our hospital from January 2021 to December 2021,were selected.Accordlty to random number table method the patients were divided into the treatment group and control group,with 40 in each group.The patients in the control group were given comprehensive treatment of Western Medicine(bronchodilator and glucocorticoid,etc.).On the basis of comprehensive treatment of Western medicine,the treatment group was combined with Jiawei Zhixiao Decoction.All patients received a 14-day treatment.Before and after treatment,the TCM symptom scores were recorded,FEV1 and forced expiratory volume in one second to forced vital capacity ratio(FEV1/FVC)were measured by pulmonary function meter,and peak expiratory flow(PEF)was measured by peak expiratory flow meter.Serum TNF-αand IL-8 levels were detected by ELISA,and procalcitonin(PCT)was detected by electrochemiluminescence.The disease grade,clinical efficacy and adverse reactions were also recorded.Results The total effective rate was 95.0%(38/40)in the treatment group and 80.0%(32/40)in the control group,the difference between the two groups was statistically significant(χ^(2)=4.11,P=0.043).After treatment,the TCM symptom score of the treatment group was significantly lower than that of the control group(t=7.91,P<0.01).FEV1[(2.83±0.37)L vs.(2.38±0.32)L,t=6.77],FEV1/FVC[(85.37±9.36)%vs.(75.50±10.24)%,t=4.50],PEF[(4.84±0.82)L vs.(3.92±0.43)L,t=6.28]was significantly higher than that of control group(P<0.01).Serum IL-8[(80.59±10.28)ng/L vs.(87.15±8.25)ng/L,t=3.15],TNF-α[(43.18±4.08)ng/L vs.(51.78±7.58)ng/L,t=6.32],PCT[(0.84±0.35)μg/L vs.(0.41±0.12)μg/L,t=7.35]were significantly lower than those in control group(P<0.01).The improvement of asthma grade was significantly better than that of control group(Z=17.86,P<0.05).During the observation period,there were no serious adverse reactions in both groups,and the safety was high.Conclusion Application of Jiawei Zhixiao Decoction and western medicine comprehensive therapy in acute attack of bronchial asthma of heat asthma syndrome can effectively improve the TCM symptoms and lung function,attenuate the inflammation response,and alleviate the severity of asthma.