清肺化痰汤治疗中重度慢性阻塞性肺疾病急性加重期临床研究

Clinical Study of Lung-Clearing and Phlegm-Resolving Decoction in the Treatment of Acute Exacerbation Stage of Moderate and Severe Chronic Obstructive Pulmonary Disease

目的:观察清肺化痰汤治疗中重度慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease, AECOPD)的临床疗效。方法:将90例中重度COPD急性加重期患者按照随机数字表法分为观察组和对照组,每组各45例。对照组给予常规对症支持治疗,观察组在对照组治疗基础上服用清肺化痰汤。比较两组患者的临床疗效及治疗前后临床症状积分变化情况,检测两组患者治疗前后肺功能指标[用力肺活量(forced vital capacity, FVC),第一秒用力呼气容积(forced expiratory volume in one second, FEV1)/FVC]、血清指标[白细胞介素-6(interleukin-6,IL-6)、降钙素原(procalcitonin, PCT)、金属蛋白酶-1组织抑制因子(tissue inhibitor of metalloproteinase-1,TIMP-1)、基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)]及动脉血气指标[动脉氧分压(arterial partial pressure of oxygen, PaO_(2))、动脉二氧化碳分压(partial pressure of carbon dioxide, PaCO_(2))、血氧饱和度(oxygen saturation, SaO_(2))]。结果:两组患者治疗后各项临床症状及总积分低于本组治疗前,且治疗后观察组低于对照组(P<0.05)。观察组有效率为95.56%,高于对照组的82.22%(P<0.05)。两组患者治疗后FVC、FVE1/FVC高于本组治疗前,且治疗后观察组高于对照组(P<0.05)。两组患者治疗后IL-6、PCT、TIMP-1、MMP-9含量低于本组治疗前,治疗后观察组IL-6、PCT、TIMP-1低于对照组,但MMP-9高于对照组,差异有统计学意义(P<0.05)。两组患者治疗后PaCO_(2)含量低于本组治疗前,PaO_(2)及SaO_(2)含量高于本组治疗前,且治疗后组间比较,差异有统计学意义(P<0.05)。结论:清肺化痰汤治疗中重度AECOPD,可缓解患者各项临床症状,改善肺功能和动脉血气指标,降低血清炎症因子水平,从而改善气道重塑。

Objective: To study the clinical efficacy of Lung-Clearing and Phlegm-Resolving Decoction on acute exacerbation of moderate and severe chronic obstructive pulmonary disease(COPD).Methods: A total of 90 patients with acute exacerbation of moderate and severe COPD were divided into the observation group and the control group according to the random number table method, with 45 cases in each group.The control group was given routine symptomatic support treatment, while the observation group was given Lung-Clearing and Phlegm-Resolving Decoction on the basis of the control group.The clinical efficacy and the changes in clinical symptoms of the two groups before and after treatment were compared.The changes in pulmonary function indexes, serum indexes [including interleukin-6(IL-6),procalcitonin(PCT),tissue inhibitor of metalloproteinase-1(TIMP-1),matrix metalloproteinase-9(MMP-9)],arterial blood-qi indexes [including arterial partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),oxygen saturation(SaO_(2))] of the two groups before and after treatment were measured.Results: After treatment, each clinical symptom and total score of the two groups were lower than those before treatment, and the clinical symptoms and total score of the observation group were lower than those of the control group(P<0.05).The effective rate of observation group was 95.56%,which was higher than that of the control group(82.22%)(P<0.05).After treatment, FVC and FVE1/FVC in the two groups were higher than those before treatment, and the above indexes in the observation group were higher than those of the control group(P<0.05);The contents of IL-6,PCT and TIMP-1 in the two groups were lower than those before treatment, while the content of MMP-9 was higher than that before treatment, and all the differences were statistically significant(P<0.05);The PaCO_(2) content was lower than that before treatment, while the PaO_(2) and SaO_(2) contents were higher than those before treatment, and all the differences between the two groups were statistically significant(P<0.05).Conclusion: In the treatment of moderate and severe AECOPD,Lung-Clearing and Phlegm-Resolving Decoction can alleviate various clinical symptoms, improve lung function and arterial blood-qi indexes, reduce the level of serum inflammatory factors, so as to improve airway remodeling.