清金化浊方协同治疗对慢性阻塞性肺疾病急性加重痰热瘀肺证患者住院期间血栓事件影响的回顾性队列研究

Effect of Synergistic Treatment with Qingjin Huazhuo Formula(清金化浊方)on Thrombotic Events in Hospitalized Patients of Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Phlegm Heat Stasis Obstructing in the Lung Syndrome:A Retrospective

目的分析清金化浊方协同治疗对慢性阻塞性肺疾病急性加重(AECOPD)痰热瘀肺证住院患者发生血栓事件的影响及其可能的机制。方法采用回顾性队列研究,纳入AECOPD痰热瘀肺证住院患者305例,根据是否应用清金化浊方(要求疗程≥7天)分为暴露组(193例)和非暴露组(112例),并经1∶1倾向性评分匹配(PSM)得到109对病例,比较匹配后两组患者住院期间血栓事件发生情况,治疗(10±3)天后主要症状或体征(包括咳嗽、咯痰、喘息、紫绀)缓解情况,治疗前及治疗(10±3)天后首次辅助检查[包括D-二聚体、中性粒细胞百分比(NEUT%)、C反应蛋白(CRP)、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))]的差异。结果匹配后,暴露组患者住院期间血栓事件发生率(5例,4.59%)较非暴露组(15例,13.76%)降低(P<0.05),暴露因素(应用清金化浊方≥7天)是AECOPD痰热瘀肺证住院患者发生血栓事件的保护因素[相对危险度(RR)=0.333,95%CI(0.126,0.885)];暴露组患者治疗后咳嗽缓解91.74%(100/109)、咯痰缓解94.50%(103/109)、喘息缓解93.58%(102/109)、紫绀缓解88.99%(97/109)均高于非暴露组的82.57%(90/109)、86.24%(94/109)、81.65%(89/109)、78.90%(86/109),暴露组缓解率均优于非暴露组(P<0.05);两组患者治疗后D-二聚体、NEUT%、CRP、PaCO_(2)水平均较治疗前降低(均P<0.05),PaO_(2)水平均明显升高(P<0.05);两组患者各指标治疗前后差值比较,暴露组D-二聚体、NEUT%、PaO_(2)水平改善均优于非暴露组(P<0.05),而CRP、PaCO_(2)水平差异均无统计学意义(P>0.05)。结论清金化浊方协同治疗能有效降低AECOPD痰热瘀肺证住院患者的血栓事件发生,并可缓解患者咳嗽、咯痰、喘息、紫绀的临床症状或体征,改善肺功能,其机制可能与改善血液高凝、炎症状态有关。

Objective To analyze the effect and possible mechanism of the synergistic treatment with Qingjin Huazhuo Formula(清金化浊方,QHF)on the occurrence of thrombotic events in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and phlegm heat stasis obstructing in the lung syndrome.Methods In a retrospective cohort study,305 AECOPD inpatients with the syndrome of phlegm heat stasis obstructing in the lung were included.According to whether using QHF(the course of treatment≥7 days),they were divided into the exposure group(193 cases)and the non-exposure group(112 cases).Totally,109 pairs of cases were obtained by 1∶1 propensity score matching(PSM).After matching,the occurrence of thrombotic events during hospitalization,the remission of main symptoms or signs(including cough,expectoration,wheezing,cyanosis)after 10 days(±3 days)of treatment,and the difference of the indicators including D-dimer,percentage of neutrophils(NEUT%),C-reactive protein(CRP),arterial partial pressure of oxygen(PaO_(2)),and arterial partial pressure of carbon dioxide(PaCO_(2))before treatment and after 10 days(±3 days)of treatment during the first auxiliary examination.Results After matching,the incidence of thrombotic events during hospitalization in the exposure group(5 cases,4.59%)were lower than that of the non-exposure group(15 cases,13.76%,P<0.05).The exposure factor that taking QHF for 7 days or above was a protective factor for thrombotic events in AECOPD hospitalized patients with phlegm heat stasis obstructing in the lung syndrome(RR=0.333,95%CI 0.126 to 0.885).The remission rates of cough(100/109,91.74%),expectoration(103/109,94.50%),wheezing(102/109,93.58%),and cyanosis(97/109,88.99%)in the exposure group were significantly higher than those in the non-exposure group(90/109,82.57%;94/109,86.24%;89/109,81.65%;86/109,78.90%)after treatment(P<0.05).After treatment,the levels of D-dimer,NEUT%,CRP and PaCO_(2)in both groups significantly decreased(all P<0.05),and the level of PaO_(2)significantly increased(P<0.05).The difference of the levels of D-dimer,NEUT%and PaO_(2)in the exposure group before and after treatment were larger than those in the non-exposure group(P<0.05),while the prepost difference of CRP and PaCO_(2)were not significantly different between the two groups(P>0.05).Conclusion The synergistic treatment with QHF can effectively reduce the occurrence of thrombotic events,alleviate the clinical symptoms or signs such as cough,expectoration,wheezing,and cyanosis,and can improve lung function in hospitalized patients with AECOPD and phlegm heat stasis obstructing in the lung syndrome.Its mechanism may be related to improving blood coagulation and inflammatory status.