补中益气汤加味联合缩唇呼吸疗法对慢性阻塞性肺疾病稳定期患者血清TNF-α,IL-8,IL-6,IL-1β,Cys-C的影响

Effect and Mechanism of Modified Buzhong Yiqi Tang and Pursed-lips Breathing on Serum TNF-α,IL-8,IL-6,IL-1β and Cys-C in Patients at Stable Stage of COPD

目的:观察补中益气汤加味联合缩唇呼吸疗法(pursed-lips breathing,PLB)对稳定期肺脾气虚兼血瘀型慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者血清肿瘤坏死因子-α(tumornecrosis factor-a,TNF-α),白细胞介素-8(interleukin-8,IL-8),IL-6,IL-1β,血清胱抑素-C(Serum cystatin C,Cys-C)的影响。方法:2017年9月至2018年3月于江西中医药大学附属医院肺病科就诊的120例符合纳入标准的门诊或住院部COPD患者,采用随机数字表随机分为治疗组和对照组,对照组(60例)予噻托溴铵粉雾剂治疗(18μg/次,1次/d),治疗组(60例)在前者基础之上予以补中益气汤加味联合PLB疗法,两组均为期6个月的治疗。6个月后观察两组患者治疗前后患者临床有效率,第1秒用力呼气容积占预计值百分比(FEV1%),第1秒用力呼气容积占用力肺活量的百分比(FEV1/FVC),6 min步行距离(six-minute walk distance,6MWD),测定血液中TNF-α,IL-8,IL-6,IL-1β及Cys-C水平。结果:6个月后治疗组的临床有效率为93.33%,对照组的临床有效率为86.67%,治疗组临床有效率高于对照组(P<0.05)。与本组治疗前比较,两组治疗后FEV1%,FEV1/FVC,6MWD均增加(P<0.05);与对照组治疗后比较,治疗组FEV1%,FEV1/FVC及6MWD均增加(P<0.05)。与本组治疗前比较,两组治疗后血清TNF-α,IL-8,IL-6,IL-1β,Cys-C水平均减少(P<0.05);与对照组治疗后比较,治疗组TNF-α,IL-8,IL-6,IL-1β,Cys-C水平均减少(P<0.05)。结论:补中益气汤加味联合PLB疗法通过减少COPD患者气道中炎症细胞因子TNF-α,IL-8,IL-6,IL-1β水平,降低COPD慢性炎症的标记物Cys-C的水平,减少炎症反应发生,改善气流阻塞状况,提升COPD患者FEV1%,FEV1/FVC水平,从而达到改善COPD患者肺功能及生活质量的目的。

Objective:To observe the effect and mechanism of modified Buzhong Yiqi Tang and pursedlips breathing(PLB)on serum tumor necrosis factor-alpha(TNF-α),interleukin-8(IL-8),IL-6,IL-1βand serum cystatin C(Cys-C)in patients of chronic obstructive pulmonary disease(COPD)at the stable stage.Method:Totally 120 cases of COPD treated at Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine from September 2017 to March 2018 conformed to the inclusion criteria,and were randomly divided into treatment group(60 cases)and control group(60 cases).Cases of control group received Tiotropium(18μg/time,qd).In addition to the therapy of control group,cases of treatment group were also given Buzhong Yiqi Tang and PLB.Both groups were treated for 6 months.Percent of forced expiratory volume in one second in predicted value(FEV1%),ratio of FEV1to forced vital capacity(FEV1/FVC),six-minute walk distance(6MWD),TNF-α,IL-8,IL-6,IL-1βand Cys-C were compared between both groups.Result:After treatment,the clinical efficacy rate of observation group was 93.33%,which was evidently higher than 86.67%of control group(P<0.05).Compared with before treatment,both groups showed decreases in TNF-a,IL-8,IL-6,IL-1β,Cys-C but increases in FEV1%,FEV1/FVC(P<0.05).Compared with control group,treatment group showed decreases in TNF-a,IL-8,IL-6,IL-1β,Cys-C but increases in FEV1%,FEV1/FVC(P<0.05).Conclusion:Buzhong Yiqi Tang and PLB has an anti-inflammatory effect on COPD by reducing levels of inflammation cytokines TNF-α,IL-8,IL-6,IL-1βand chronic inflammation markers serum Cys-C and inflammatory reaction,and alleviating airflow obstruction,promoting the levels of FEV1%,FEV1/FVC,pulmonary function control inflammatory factors,so as to improve pulmonary function and the quality of life in patients with COPD.