越婢加半夏汤化裁辨治风寒外束痰热内蕴证慢性支气管炎临床研究

Clinical Study on Modified Yuebi jia Banxia Tang in Differentiation and Treatment for Chronic Bronchitis with Syndromes of External Wind-cold Evil and Internal Accumulation of Phlegm-heat

目的:观察越婢加半夏汤化裁辨治风寒外束痰热内蕴证慢性支气管炎的临床效果。方法:选择106例风寒外束痰热内蕴证慢性支气管炎患者,按照随机数字表法分为对照组和观察组各53例。对照组给予西医常规对症处理,观察组则加用越婢加半夏汤化裁成的汤药口服,2组均连续治疗2周。于治疗前、治疗7天、治疗14天评价中医证候积分,检测肺功能变化,监测血清肿瘤坏死因子-α(TNF-α)、可溶性细胞间黏附分子-1 (sICAM-1)、白细胞介素-10 (IL-10)、干扰素-γ(IFN-γ)水平变化,比较临床效果,治疗后随访1年,统计复发率。结果:观察组、对照组的总有效率分别为92.45%、75.47%,2组比较,差异有统计学意义(P <0.05)。与治疗前比较,2组咳嗽气急、恶寒发热、咳痰色黄质稠、胸闷等症状的中医证候积分明显下降,肺功能指标呼吸系统静态顺应性(Crs)、第1秒用力肺活量(FEV1)、最大肺活量(FVC)、第1秒用力呼气容积占用力肺活量百分比(FEV1/FVC)、呼气峰流速值(PEF)明显升高,呼吸系统阻力(R rs)则明显下降,血清TNF-α、sICAM-1水平明显下降,IL-10、IFN-γ水平明显升高,差异均有统计学意义(P <0.05)。与对照组同期比较,观察组中医证候积分下降更明显,肺功能指标改善更明显,血清指标变化程度更为明显,差异均有统计学意义(P <0.05)。治疗后随访1年,观察组复发率为14.29%,明显低于对照组45.83%(P <0.05)。结论:越婢加半夏汤化裁辨治风寒外束痰热内蕴证慢性支气管炎疗效确切,能有效改善患者的临床症状,提高肺功能,其起效可能与调控血清TNF-α、sICAM-1、IL-10、IFN-γ水平以减轻炎性反应所致的气道损伤、调节Thl/Th2免疫平衡有一定关系,值得临床推广。

Objective:To observe the clinical effect of modified Yuebi jia Banxia tang in differentiation and treatment for chronic bronchitis.Methods:Selected 106 cases of patients with chronic bronchitis with syndromes of external wind-cold evil and internal accumulation of phlegm-heat and divided them into the control group and the observation group according to the random number table,53 cases in each group.The control group was given routine symptomatic treatment in western medicine,while the observation group was treated with the oral administration of modified Yuebi jia Banxia tang.The two groups were treated continuously for 2 weeks.Evaluated Chinese medicine syndrome scores before treatment and at 7 days and 14 days of treatment,detected the changes of lung function,and monitored the changes of levels of serum tumor necrosis factor-α(TNF-α),soluble intercellular adhesion molecule-1(sI CAM-1),and interleukin-10(IL-10)and interferon-γ(IFN-γ)and compared the clinical effect.Followed up for 1 year after treatment and analyzed the recurrence rate.Results:The total effective rate of the observation group and the control group were 92.45%and75.47%,respectively,compared the two groups,difference being significant(P<0.05).Compared with those before treatment,the Chinese medicine syndrome scores such as cough and breathlessness,aversion to cold and fever,yellowish and thick sputum,chest distress in the two groups were significantly decreased,while the lung function indexes such as respiratory system static compliance(Crs),forced expiratory volume in 1 second(FEV1),maximum forced vital capacity(FVC),ratio of forced expiratory volume in the first second to forced vital capacity(FEV1/FVC),and peak expiratory flow rate(PEF)were obviously increased;respiratory system resistance(Rrs)was decreased evidently;the levels of serum TNF-αand sI CAM-1 were significantly decreased;and the levels of IL-10 and IFN-γwere significantly increased,differences being significant(P<0.05).Compared with those in the control group in the same period,the decrease of Chinese medicine syndrome scores in the observation group was more significant;the improvement of lung function indexes was more obvious;and the change of serum indexes was more obvious,differences being significant(P<0.05).One year of follow-up was given after treatment,the recurrence rate in the observation group was 14.29%,being significantly lower than that of 45.83%in the control group(P<0.05).Conclusion:The application of modified Yuebi jia Banxia tang in differentiation and treatment has obvious curative effect in treating chronic bronchitis with syndromes of external wind-cold evil and internal accumulation of phlegm-heat.It can effectively improve the clinical symptoms of patients and the lung function.Its effect may be related to the regulation and control of levels of serum TNF-α,sI CAM-1,IL-10,IFN-γthat aims to reduce airway damage caused by inflammatory reaction and the regulation of Th1/Th2 immune balance,which is worthy of further clinical promotion.