桑麻杏贝汤联合舒利迭治疗慢性阻塞性肺疾病临床研究

Clinical Study on the Treatment of Chronic Obstructive Pulmonary Disease with Cortex Mori and Ephedra andApricot Kernel and Bulbus Fritillariae Decoction Combined with Seretide

目的:观察桑麻杏贝汤联合舒利迭治疗慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)的临床疗效及其对导痰液中细胞间黏附分子-1(intercellular adhesion molecule-1,ICAM-1)、血管内皮生长因子(vascular endothelial growth factor,VEGF)水平的影响。方法:将120例COPD患者按照随机数字表法分为舒利迭组和联合组,每组各60例。舒利迭组给予舒利迭经口腔吸入治疗,联合组在舒利迭组治疗的基础上给予桑麻杏贝汤治疗。比较两组患者的临床疗效及不良反应发生率,测定两组患者治疗前后肺功能[第1秒用力呼气容积(forced expiratoryvolume at one second,FEV1)、用力肺活量(forced vital capacity,FVC)、FEV1/FVC],检测两组患者治疗前后诱导痰中白三烯B4(leukotriene B4,LTB4)、基质金属蛋白酶-9(matrix metallo proteinase-9,MMP-9)、VEGF、基质金属蛋白酶组织抑制剂-1(tissue inhibitor of metalloproteinase-1,TIMP-1)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、ICAM-1水平。结果:联合组有效率为95.00%,高于舒利迭组的83.33%(P<0.05)。两组患者治疗后FEV1、FVC、FEV1/FVC高于本组治疗前,且治疗后联合组高于舒利迭组(P<0.05)。两组患者治疗后LTB4、TIMP-1、TNF-α、MMP-9水平低于本组治疗前,且治疗后联合组低于舒利迭组(P<0.05)。两组患者治疗后ICAM-1、VEGF水平低于本组治疗前,且治疗后联合组低于舒利迭组(P<0.05)。联合组不良反应率为8.33%,舒利迭组不良反应率为5.00%,两组不良反应率比较,差异无统计意义(P>0.05)。结论:桑麻杏贝汤联合舒利迭治疗COPD,可提高临床疗效,改善患者肺功能,作用机制可能与抑制LTB4、TIMP-1、TNF-α、MMP-9、ICAM-1、VEGF水平有关。

Objective:To observe the clinical efficacy of Cortex Mori and Ephedra andApricot Kernel and Bulbus Fritillariae Decoction combined with Seretide on chronic obstructive pulmonary disease(COPD)and its influence on intercellular adhesion molecule-1(ICAM-1)level in sputum,and vascular endothelial growth factor(VEGF)level.Methods:The COPD patients were divided into the Seridium group and the combined group according to the random number table method,with 60 cases in each group.The Sulidiere group was given oral inhalation of Seridium,while the combined group was further given Cortex Mori and Ephedra andApricot Kernel and Bul-bus Fritllariae Decoction on the basis of the Sulidiere group.The clinical efficacy and incidence of adverse reactions were compared be-tween the two groups,and the pulmonary function including forced expiratory volume at one second(FEV1),forced vital capacity(FVC),and FEV1/FVC before and after treatment were measured.The changes in leukotriene B4(LTB4),matrix metalloproteinase-9(MMP-9),VEGF,tissue inhibitor of metalloproteinase-1(TIMP-1),tumor necrosis factor-α(TNF-α)and ICAM-1 levels in induced sputum of the two groups before and after treatment were detected.Results:The effective rate of the combined group was 95.00%,which was higher than that of the Seretide group:83.33%(P<0.05).After treatment,FEV1,FVC and FEV1/FVC in the groups were higher than those before treatment,and the above indexes in the combined group were higher than those in the Seretide group(P<0.05);The levels of LTB4,TIMP-1,TNF-αand MMP-9 in the two groups were lower than those before treatment,and the above levels in the com-bined group were lower than those in the Seretide group(P<0.05);The levels of ICAM-1 and VEGF in the two groups were lower than those before treatment,and the above levels in the combined group were lower than those in the Seretide group(P<0.05).The adverse reaction rate was 8.33%in the combined group and 5.00%in the Seretide group.There was no statistical significance in the adverse reaction rate between the two groups(P>0.05).Conclusion:Cortex Mori and Ephedra andApricot Kernel and Bulbus Fritillariae De-coction combined with Seretide in the treatment of COPD can improve clinical efficacy and pulmonary function of patients,and the mechanism of action may be related to the inhibition of LTB4,TIMP-1,TNF-α,MMP-9,ICAM-1 and VEGF levels.