方剂治疗COPD急性加重期(痰热壅肺证)的临床疗效及对血清TNF-α、IL-8和MMP-9的影响

Clinical Effect of Prescriptions in Treatment of Acute Exacerbation of COPD(Phlegm-Heat Obstructing in Lung) and Its Effect on Serum TNF-α,IL-8 and MMP-9

目的:探讨清气化痰通络方治疗慢性阻塞性肺疾病急性加重期(痰热壅肺证)的临床疗效及对瘤坏死因子-α(TNF-α),白细胞介素-8(IL-8)和基质金属蛋白酶-9(MMP-9)的影响。方法:将60例患者按随机数字表法,分为对照组与治疗组各30例,对照组给予西医常规治疗,治疗组在对照组基础上加服清气化痰通络方治疗,两组疗程均为14d。比较两组患者治疗前后中医证候积分,慢阻肺患者自我评估测试问卷(CAT)和改良版英国医学研究委员会呼吸问卷(mMRC),肺功能指标,血气分析指标,炎性因子指标,临床疗效和安全性指标,以上指标,治疗前及治疗14天后各评价1次。结果:治疗组患者的临床疗效总有效率为96.67%,显著高于对照组的76.67%(χ2=5.192,P<0.05)。两组治疗后中医证候积分、CAT和mMRC与治疗前比较均明显降低(P<0.05);且治疗组低于对照组(P<0.05)。两组治疗后FEV1、FEV 1%、FEV1/FVC与治疗前比较均明显升高(P<0.05);且治疗组明显高于对照组(P<0.05)。两组治疗后SaO2,PaO2较治疗前均升高,PaCO2降低(P<0.05);且治疗组SaO2,PaO2均高于对照组,PaCO2低于对照组(P<0.05)。两组治疗后血清TNF-α、IL-8、MMP-9水平较治疗前均明显降低(P<0.05);且治疗组低于对照组(P<0.05)。两组治疗前后肝肾功能、心肌酶等检查均未见明显异常,治疗组中发生轻度腹泻1例,对照组中发生头晕1例,腹痛1例。均在停药后自行消失,组间比较差异无统计学意义(P>0.05)。结论:清气化痰通络汤治疗慢性阻塞性肺疾病急性加重期(痰热壅肺证)疗效确切且安全,能够改善临床症状和肺功能,减轻炎症反应,并能降低患者血清中TNF-α、IL-8和MMP-9水平。

Objective:To explore the clinical effect of Qingqi Huayu Tongluo Recipe on acute exacerbation of chronic obstructive pulmonary disease(syndrome of phlegm-heat obstructing lung)and influence on serum tumor necrosis factor-alpha(TNF-α),interleukin-8(IL-8)and matrix metalloproteinase-9(MMP-9).Methods:Sixty AECOPD patients were randomly divided into control group(30 cases)and therapy group(30 cases)by random number table.The control group was treated with conventional therapy.Based on the treatment in control group,the patients in therapy group also received Qingqi Huayu Tongluo Recipe.The treatment course was 14 days for both groups.The main outcome measures were scores of TCM syndrome,COPD patients self-assessment test questionnaire(CAT)and modified version of the British Medical Research Council′s Respiratory Questionnaire(mMRC).The secondary indicators were pulmonary function and arterial blood gas analysis.In addition,the levels of TNF-α,IL-8 and MMP-9 were detected.Furthermore,clinical efficacy and safety were evaluated.All of the above indicators were detected once before and 14 days after treatment.Results:The total clinical effective rate was 96.67%in therapy group,higher than 76.67%in control group(χ2=5.192,P<0.05).After treatment,scores of TCM syndrome,CAT and mMRC in therapy group were all lower than those in control group(P<0.05).Levels of PaCO2,TNF-α,IL-8 and MMP-9 were lower than those of the control group.And the levels of SaO2,PaO2,FEV1,FEV1%and FEV1/FVC were higher than those in the control group(P<0.05).However,there was no significant abnormality in liver and kidney function and myocardial enzymes before and after treatment in both groups.One case of mild diarrhea occurred in the therapy group,one case of dizziness and one case of abdominal pain in the control group.All disappeared after drug withdrawal.There was no significant difference between the two groups(P>0.05).Conclusion:Qingqi Huayu Tongluo Recipe can control the symptoms safely,ameliorate pulmonary function,reduce inflammation and the levels of TNF-α,IL-8 and MMP-9 and improve the clinical efficacy in patients with AECOPD and syndrome of phlegm-heat obstructing lung.