清燥救肺汤联合吡非尼酮治疗特发性肺纤维化疗效及对患者支气管肺泡灌洗液胰岛素样生长因子的影响

Effect of Qingzao Jiufei decoction combined with pirfenidone on idiopathic pulmonary fibrosis and insulin-like growth factor in patients with bronchoalveolar lavage solution

目的:探讨清燥救肺汤联合吡非尼酮治疗特发性肺纤维化疗效及对患者肺纤维化指标、支气管肺泡灌洗液胰岛素样生长因子的影响。方法:将96例特发性肺纤维化患者采用随机数字表法分为对照组和观察组,各48例。对照组给予吡非尼酮治疗,观察组则在对照组基础上联用清燥救肺汤。比较两组治疗效果,观察治疗前后两组患者的中医症候积分、肺纤维化指标[层粘蛋白(LN)、透明质酸(HA)和Ⅲ型前胶原(PCⅢ)]、支气管肺泡灌洗液胰岛素样生长因子[支气管肺泡灌洗液胰岛素样生长因子Ⅰ(IGF-Ⅰ)、胰岛素样生长因子结合蛋白(IGFBP-4)]水平和肺功能恢复指标[肺一氧化碳弥散量(DLCO)、第一秒用力肺活量(FEV_(1))和6 min步行实验(6MWD)],并统计两组不良反应发生率。结果:观察组临床治疗总有效率明显高于对照组(P<0.05)。两组治疗后气急喘促、咳吐浊唾、口渴咽干、手足心热和舌红脉虚数症候积分较治疗前显著降低,且观察组低于对照组(均P<0.05)。两组治疗后LN、HA、PCⅢ、IGF-Ⅰ和IGFBP-4水平较治疗前显著降低,且观察组治疗后低于对照组(均P<0.05)。两组治疗后DLCO、FEV_(1)、6MWD较治疗前显著升高,且观察组显著优于对照组(均P<0.05)。两组不良反应比较差异无统计学意义(P>0.05)。结论:清燥救肺汤联合吡非尼酮可有效缓解特发性肺纤维化患者肺纤维化程度,降低支气管肺泡灌洗液胰岛素样生长因子水平,提高肺功能,并改善阴虚肺燥症候,提高临床疗效,且未增加不良反应,安全性好。

Objective:To investigate the curative effect of Qingzao Jiufei decoction combined with pirfenidone in the treatment of idiopathic pulmonary fibrosis and the effects on pulmonary fibrosis indexes and insulin-like growth factor of bronchoalveolar lavage fluid.Methods:96 patients with idiopathic pulmonary fibrosis were randomly divided into control group and observation group,48 cases in each group.The control group was given pirfenidone treatment,and the observation group was given Qingzao Jiufei decoction on the basis of the control group.To compare the treatment effect between the two groups,the traditional Chinese medicine symptom scores,pulmonary fibrosis indexes[laminin(LN),hyaluronic acid(HA)and typeⅢprocollagen(PCⅢ)]of the two groups before and after treatment were observed,levels of insulin-like growth factor in bronchoalveolar lavage fluid[insulin-like growth factorⅠ(IGF-Ⅰ)and insulin-like growth factor binding protein(IGFBP-4)]and lung function recovery indicators[carbon monoxide dispersion(DLCO),first-second forced vital capacity(FEV 1)and 6 min walking test(6MWD)]were compared between the two groups.The incidence of adverse reactions in the two group was analyzed.Results:The total effective rate of the observation group was higher than that of the control group(P<0.05).Symptom scores of shortness of breath,cough and turbidness,dry thirst and pharynx,warm hands and feet and red tongue pulse were significantly decreased in both groups after treatment,and the TCM symptom scores of the observation group were significantly lower than those of the control group after treatment(all P<0.05).After treatment,the levels of LN,HA,PCⅢ,IGF-Ⅰand IGFBP-4 in both groups were significantly decreased compared with before treatment,and the above pulmonary fibrosis indexes and insulin-like growth factor levels in bronchoalveolar lavage fluid in the observation group were significantly lower than those in the control group(all P<0.05).The values of DLCO,FEV 1 and 6MWD in the two groups were significantly higher after treatment than before,and the above indexes of lung function recovery in the observation group were significantly better than those in the control group after treatment(all P<0.05).There was no statistically significant difference in adverse reactions between the two groups(P>0.05).Conclusion:Qingzao Jiufei decoction combined with pirfenidone can effectively relieve the degree of pulmonary fibrosis in patients with idiopathic pulmonary fibrosis,reduce the level of insulin-like growth factor in bronchoalveolar irrigation fluid,improve lung function and the syndrome of lung dryness,and improve clinical efficacy.It has good safety without increasing adverse reactions.