咳喘宁穴位敷贴、抗敏治咳方联合沙美特罗替卡松治疗咳嗽变异性哮喘临床研究

Clinical Study on Kechuanning Acupoint Application and Kangmin Zhike Prescription Combined with Salmeterol/Fluticasone for Cough Variant Asthma

目的:观察咳喘宁穴位敷贴、抗敏治咳方联合沙美特罗替卡松治疗风寒型咳嗽变异性哮喘(CVA)的临床疗效。方法:将100例风寒型CVA患者按随机数字表法分为对照组和联合组各50例。对照组剔除4例,联合组剔除3例,最终纳入对照组46例、联合组47例。对照组给予沙美特罗替卡松粉吸入剂治疗8周,联合组给予沙美特罗替卡松粉吸入剂联合咳喘宁穴位敷贴治疗4周后,改予抗敏治咳方口服治疗4周。2组均随访12周。比较2组咳嗽症状积分,第1秒用力呼气容积(FEV_(1))、呼气峰值流速(PEF)、呼出气一氧化氮(FeNO)、嗜酸性粒细胞(EOS)、免疫球蛋白E (IgE)、白细胞介素-4 (IL-4)、肿瘤坏死因子-α (TNF-α)水平,以及复发率。评估治疗安全性。结果:治疗后,2组咳嗽症状积分均较治疗前降低(P<0.05);组间咳嗽症状积分比较,差异无统计学意义(P>0.05)。治疗后,2组FEV_(1)、PEF水平均较治疗前升高(P<0.05),FeNO水平均较治疗前降低(P<0.05);组间FEV_(1)、PEF水平比较,差异均无统计学意义(P>0.05);联合组FeNO水平低于对照组(P<0.05)。治疗后,2组血清EOS、IgE、IL-4、TNF-α水平均较治疗前降低(P<0.05),联合组上述4项炎症指标水平均低于对照组(P<0.05)。随访12周,联合组复发率8.51%,低于对照组23.91%(P<0.05)。治疗期间,对照组有5例、联合组有1例患者出现不良反应。结论:咳喘宁穴位敷贴、抗敏治咳方联合沙美特罗替卡松治疗风寒型CVA,可改善咳嗽症状,提升肺功能,减轻炎症状态,降低复发率。

Objective:To observe the clinical effect of the combination use of Kechuanning acupoint application,Kangmin Zhike Prescription and Salmeterol/Fluticasone on cough variant asthma(CVA)of wind-cold type.Methods:A total of 100 cases of CVA patients of wind-cold type were respectively assigned to the control group and the combination group according to the random number table method,with 50 cases in each group.Four and three cases were respectively culled in the control group and the combination group,and finally 46 and 47 cases were included in each group.The control group was treated with Salmeterol/Fluticasone for eight weeks,and the combination group was firstly treated with Salmeterol/Fluticasone combined with Kechuanning acupoint application for four weeks and then given oral administration of Kangmin Zhike Prescription for four weeks.The scores of cough-related symptoms,the levels of forced expiratory volume in one second(FEV_(1)),peak expiratory flow(PEF),fractional exhaled nitric oxide(FeNO),eosinophilic granulocyte(EOS),immunoglobulin E(lgE),interleukin-4(IL-4)and tumor necrosis factor-α(TNF-α),and the recurrence rate were compared between the two groups.Results:After treatment,the scores of cough-related symptoms in both groups were reduced when compared with those before treatment(P<0.05),there being no significance in the difference between the two groups(P>0.05).After treatment,the levels of FEV_(1) and PEF in both groups were elevated when compared with those before treatment(P<0.05),and the FeNO levels were down-regulated when compared with those before treatment(P<0.05);there was no significant difference being found in the comparisons of levels of FEV_(1) and PEF between the two groups(P>0.05);the FeNO level in the combination group was lower than that in the control group(P<0.05).After treatment,the levels of serum EOS,IgE,IL-4 and TNF-αin both groups were reduced when compared with those before treatment(P<0.05),and the above four levels in the combination group were lower than those in the control group(P<0.05).Upon 12 weeks of follow-up after treatment,the recurrence rate was 8.51%in the combination group,lower than that of 23.91%in the control group(P<0.05).During treatment,the adverse reactions happened to five cases in the control group and one in the combination group.Conclusion:The combination use of Kechuanning acupoint application,Kangmin Zhike Prescription and Salmeterol/Fluticasone can improve the cough-related symptoms and lung function of CVA patients of wind-cold type,mitigate the inflammation and decrease the recurrence rate.