针刺联合中药治疗支气管哮喘急性发作期的疗效观察

Therapeutic efficacy of acupuncture combined with Chinese medicine in the treatment of acute exacerbation of bronchial asthma

目的观察针刺联合均气汤加减治疗支气管哮喘急性发作期的临床疗效。方法将135例支气管哮喘急性发作期患者随机分为西药组、中药组和针药组,每组45例。3组患者均接受基础治疗,西药组予口服孟鲁司特钠片治疗,中药组予口服均气汤加减治疗,针药组予针刺联合均气汤加减治疗。比较3组治疗前后哮喘控制测试(asthma control test,ACT)评分、Marks-哮喘生存质量(Marks-asthma quality of life questionnaire,Marks-AQLQ)评分、咳嗽情况评分、CT气道重塑指标[气道壁厚度(airway wall thickness,AWT)、气道壁面积(airway wall area,AWA)、AWT占气道外径的百分比(AWT percentage,AWTP)、AWA占气道总横截面积的百分比(AWA percentage,AWAP)]的变化。观察3组治疗前后痰液和血清中炎性因子[半胱氨酰白三烯(cysteine leukotrienes,CysLTs)、CC趋化因子受体6(CC motif chemokine receptor 6,CCR6)、可溶性细胞间黏附分子-1(soluble intercellular adhesion molecule-1,sICAM-1)以及核因子-κB(nuclear factor-κB,NK-κB)]和T淋巴细胞亚群[调节T细胞(regulatory T-cells,Treg)、T细胞2(T helper 2 cell,Th2)、T细胞17(T helper 17 cell,Th17)及T细胞23(T helper 23 cell,Th23)]的水平变化。比较3组临床疗效和不良反应发生情况。结果针药组总有效率为97.8%,高于西药组的80.0%和中药组的82.2%,差异均具有统计学意义(P<0.05)。治疗后,针药组ACT评分高于西药组和中药组(P<0.05),Marks-AQLQ、日间咳嗽和夜间咳嗽评分均低于西药组和中药组(P<0.05),AWT、AWA、AWTP和AWAP水平低于西药组和中药组(P<0.05)。治疗后,针药组痰液和血清中CYSLTS、CCR6、sICAM-1、NK-κB、Th2、Th17和Th23水平均低于西药组和中药组(P<0.05),Treg水平高于西药组和中药组(P<0.05)。针药组和中药组的不良反应发生率均低于西药组(P<0.05)。结论在基础治疗基础上,针刺联合均气汤加减可明显缓解支气管哮喘急性发作期患者的气急、喘息等症状,减轻气道重塑,降低炎性因子水平,增强机体免疫力,疗效优于单纯西药治疗和单纯中药治疗。

Objective To observe the clinical efficacy of acupuncture combined with modified Jun Qi Tang in the treatment of acute exacerbation of bronchial asthma.Method A total of 135 patients with acute exacerbation of bronchial asthma were randomly divided into a Western medicine group,a Chinese medicine group and an acupuncture-Chinese medicine group,with 45 cases in each group.Three groups of patients received basic treatment,the Western medicine group was treated with oral Montelukast sodium tablets,the Chinese medicine group was treated with modified Jun Qi Tang orally,and the acupuncture-Chinese medicine group was treated with acupuncture combined with modified Jun Qi Tang.The asthma control test(ACT)score,Marks-asthma quality of life questionnaire(Marks-AQLQ)score,cough score,CT airway remodeling index[airway wall thickness(AWT),the airway wall thickness(AWT)score,airway wall area(AWA),AWT percentage of airway outer diameter(AWTP),and AWA percentage of total airway cross-sectional area(AWAP)]were compared among the three groups.The changes of inflammatory factors[cysteine leukotrienes(CysLTs),CC motif chemokine receptor 6(CCR6),soluble intercellular adhesion molecule-1(SIAM-1),and nuclear factor-κB(NK-κB)]and T-lymphocyte subsets[regulatory T-cells(Treg),T helper 2 cell(Th2),T helper 17 cell(Th17)and T helper 23 cell(Th23)]levels in sputum and serum before and after treatment were observed in the three groups.The clinical efficacy and the occurrence of adverse reactions were compared among the three groups.Result The total effective rate of the acupuncture-Chinese medicine group was 97.8%,which was higher than that of the Western medicine group(80.0%)and the Chinese medicines group(82.2%),and the differences were statistically significant(P<0.05).After treatment,the ACT score of the acupuncture-Chinese medicine group was higher than that of the Western medicine group and the Chinese medicine group(P<0.05),the Marks-AQLQ,daytime cough and nocturnal cough scores were lower than those of the Western medicine group and the Chinese medicine group(P<0.05),and the levels of AWT,AWA,AWTP and AWAP were lower than those of the Western medicine group and the Chinese medicine group(P<0.05).After treatment,the levels of CYSLTS,CCR6,sICAM-1,NK-κB,Th2,Th17 and Th23 in sputum and serum of the acupuncture-Chinese medicine group were lower than those in the Western medicine group and the Chinese medicine group(P<0.05),and the levels of Treg were higher than those in the Western medicine group and the Chinese medicine group(P<0.05).The incidence of adverse reactions in both the acupuncture-Chinese medicine group and the Chinese medicine group was lower than that in the Western medicine group(P<0.05).Conclusion On the basis of the basic treatment,acupuncture combined with modified Jun Qi Tang can significantly alleviate the symptoms of shortness of breath and wheezing in patients with acute exacerbation of bronchial asthma,reduce airway remodeling,lower the level of inflammatory factors,enhance the immunity,and the therapeutic effect is better than that of Western medicine treatment alone and Chinese medicine treatment alone.