Effect of Gualou Xiebai Banxia decoction combined with Danshen Decoction on clinical efficacy of unstable angina with phlegm and blood stasis syndrome

Objective:To observe the clinical efficacy and safety of Gualou Xiebai Banxia decoction combined with Danshen decoction on unstable angina(UA)with phlegm and blood stasis syndrome.Method:Eighty patients with UA were randomly divided into treatment group(40 cases)and control group(40 cases)by random number table.The control group was given conventional western medicine treatment,and the experimental group was given Gualou Xiebai Banxia decoction and Danshen decoction on the basis of the control group.Both groups were treated for 4 weeks.Before and after treatment,the angina attacks,dosage of nitroglycerin,traditional Chinese medicine syndrome score,quality of life score,blood lipid,coagulation index and clinical total efficacy were observed and recorded.Results:After 4 weeks of treatment,the attack times and duration of angina in the two groups were both decreased compared with those before treatment.And the treatment group was more significantly reduced than the control group,the difference was statistically significant(p<0.05);the consumption of nitroglycerin of the treatment group was 90.0%,which was better than 67.5%of the control group,the difference was statistically significant(p<0.05);the total effective rate of the treatment group was 90%,which was better than 65%of the control group,the difference was statistically significant(p<0.05);the traditional Chinese medicine(TCM)syndrome score of the experimental group was lower than that of the control group,the differences was significant(p<0.05).The improvement of low density lipoprotein(LDL-C),total cholesterol(TC)and prothrombin time(PT)in the experimental group was better than that in the control group(p<0.05).During the study,there were no obvious adverse reactions in both groups.Conclusion:Gualou Xiebai Banxia decoction combined with Danshen decoction can effectively relieve the attack of angina and the consumption of nitroglycerin,improve clinical symptoms,regulate blood lipid and blood flow state,and improve the quality of life of patients with UA,with good clinical efficacy and safety.

Efficacy of Danlou Tablet in the Treatment of Coronary Heart Disease with Phlegm and Blood Stasis Syndrome and Its Effects on Serum Inflammatory Factors

[Objectives] To explore the efficacy of Danlou Tablet( DLT) in the treatment of coronary heart disease( CHD) with phlegm and blood stasis syndrome and its effects on serum inflammatory factors. [Methods]One hundred and ninety-seven patients with CHD and phlegm and blood stasis syndrome in our hospital from January 2016 to January 2018 were selected and randomly divided into two groups: control group( n =98) treated with aspirin plus atorvastatin,and research group( n =99) treated with DLT and aspirin plus atorvastatin for one month. The clinical efficacy and incidence of adverse reactions were observed. Serum secretory phospholipase A2( s PLA2),lipoprotein-associated phospholipase A2( LP-PLA2),oxidized low-density lipoprotein( ox-LDL),monocyte chemoattractant protein-1( MCP-1) and World Health Organization Quality of Life( WHOQOL-100) scores were compared before and after one month of treatment. [Results] The total effective rate was93. 94% in the research group,which was higher than that in the control group( 79. 59%,P < 0. 05);the levels of serum s PLA2,LP-PLA2,ox-LDL and MCP-1 in the research group were lower than those in the control group after one month of treatment( P < 0. 05). There was no statistical significance of the difference in the total incidence of adverse reactions between the research group and the control group( P > 0. 05).After one month of treatment,WHOQOL-100 scores were higher in two groups,which were higher in the research group than that in the control group( P < 0. 05). [Conclusions]DLT can significantly reduce the level of serum inflammatory factors,improve the quality of life in patients with CHD and phlegm and blood stasis syndrome.

Discussion on the Prevention and Treatment of COVID-19 Causing Lung Disease and Heart Damage Based on Lei Zhongyi's Theory of Intermingled Phlegm,Blood Stasis and Toxin

Novel coronavirus infection not only damages lung function,but also causes myocardial injury,elevated myocardial enzymes and heart failure,especially for patients with basic heart diseases who develop COVID-19,the first consideration should be the protection of cardiac function.Based on the theory of intermingled phlegm,blood stasis and toxin of heart disease put forward by Master Lei Zhongyi,the dialectical treatment thinking of COVID-19 patients from the concept of damage of phlegm,blood stasis and toxin to the heart were discussed.During the diagnosis,critical stage and recovery period of COVID-19,expectorant and blood-activating agents,heat and detoxification agents can be added to promote lung and asthma,free Bizheng and remove blood stasis,calm the heart and calm the mind,and promote the recovery of cardiopulmonary functions.

Comparing the mechanism of four classic Gualou-Xiebai prescriptions for cardiovascular diseases with phlegm and blood stasis syndrome based on molecular network modeling

Background:Four classical Traditional Chinese Medicine prescriptions,namely Gualou Xiebai Baijiu decoction,Gualou Xiebai Banxia decoction(GLXBBX),Zhishi Xiebai Guizhi decoction(ZSXBGZ)and Danlou prescription(DL),have been frequently used for treatment of phlegm and blood stasis syndrome(PBSS)-related cardiovascular diseases.However,its therapeutic mechanism has not been clearly elucidated.This study aimed to explore PBSS and its molecular mechanism,clarify and compare the mechanisms of four prescriptions in treating PBSS-related diseases.Method:In this study,we collected four prescriptions’compounds,predicted therapeutic targets,and enriched pathways which were based on network pharmacology.Then,we analysed the commen and different mechanisms by combing the network of components,targets and pathways.Finally,molecular docking was engaged to assess the binding potential of key compounds and hub targets.Results:We showed that four prescriptions’intersection genes(VEGFA,SRC,EGFR,etc.)were commonly enriched in PI3K-AKT signaling pathway,HIF-1 signaling pathway,etc.In addition,platelet activation and cAMP signaling pathway were singly enriched from the GLXBBX through unique compounds 12,13-epoxy-9-hydroxynonadeca-7,10-dienoic acid and Cyclo(L-tyrosyl-L-phenylalanyl).These bioactive compounds may exert GLXBBX’s unique pharmacological pathways via involving in mediating PPARA,PTGER3,etc.Sphingolipid signaling pathway was singly enriched from the ZSXBGZ through unique compounds tetramethoxyluteolin,ergosterol peroxide,etc.These bioactive compounds could mediate ADORA1,ADORA3 and TNFRSF1A to regulate ZSXBGZ’s unique pharmacological pathways.AMPK signaling pathway was singly enriched from the DL through unique compounds kaempferol,evofolinb,ethyl acid and aureusidin.These bioactive compounds were involved in mediating the main targets of AMPK signaling pathway,such as TNF,TNFRSF1A,etc.Conclusions:Our research demonstrated that GLXB-prescriptions involved in almost all pathological stages of PBSS-related cardiovascular diseases by modulating high-frequency shared pathways and targets mainly through key compounds(quercetin,mandenol,sitosteryl acetate and luteolin,etc.),for example,participate in the process of atherosclerosis,lipid metabolism,inflammation,immune response,thrombosis,inhibit inflammatory factors and platelet aggregation,regulate immune function,vascular function,oxidative stress.In addition to common pharmacological efficacies,there could also be specificities among GLXB prescriptions due to different compounds.For example,GLXBBX tends to regulate the function of vascular and endothelial barrier,prevent thrombosis.ZSXBGZ tends to regulate lipid metabolism and protect the heart from lipid accumulation.DL tends to maintain energy homeostasis and improve inflammation.

Study on Correspondence between Prescription and Syndrome and the Essence of Phlegm and Blood Stasis Syndrome in Coronary Heart Disease Based on Metabonomics

Studying the essence of a syndrome has been a key challenge in the field of Chinese medicine.Until now,due to limitations of the methods available,the progress towards understanding such complicated systems has been slow.Metabonomics encompasses the dynamics,composition and analysis of metabolites,enabling the observation of changes in the metabolic network of the human body associated with disease.Being from the point of view of the whole organism,metabonomics provides an opportunity to study the essence of a syndrome to an unprecedented level.Phlegm and blood stasis syndrome is the main syndrome associated with coronary heart disease（CHD）,which bring difficulties in clinical treatment due to difficulties associated with differentiation of symptoms and signs.The fundamental differences of material between the two also need to be interpreted.The authors consider that we can use the method of combining a disease（in this case CHD）with associated syndromes（phlegm and blood stasis syndrome）to select patients with phlegm and blood stasis syndrome of CHD,and utilize metabonomics to explore the essence of the syndrome by difference analysis of metabolite spectra.Meanwhile,we can study the syndrome in CM,observe the change regularity of metabolism spectra after the treatment of corresponding and non-corresponding prescription and syndrome,in order to validate the material fundament in the progress of syndrome formation and their differences.This will not only have great significance in enhancing the ability to identify syndrome of phlegm and blood stasis in CHD and to establish the clinical curative criteria,but will also offer a new approach of studying the essence for a syndrome using metabonomics.

Diagnostic Accuracy of Chinese Medicine Diagnosis Scale of Phlegm and Blood Stasis Syndrome in Coronary Heart Disease: A Study Protocol

Background Phlegm and blood stasis syndrome(PBSS) is one of the main syndromes in coronary heart disease(CHD). Syndromes of Chinese medicine(CM) are lack of quantitative and easyimplementation diagnosis standards. To quantify and standardize the diagnosis of PBSS, scales are usually applied. Objective: To evaluate the diagnostic accuracy of CM diagnosis scale of PBSS in CHD. Methods: Six hundred patients with stable angina pectoris of CHD, 300 in case group and 300 in control group, will be recruited from 5 hospitals across China. Diagnosis from 2 experts will be considered as the "gold standard". The study design consists of 2 phases: pilot test is used to evaluate the reliability and validity, and diagnostic test is used to assess the diagnostic accuracy of the scale, including sensitivity, specificity, likelihood ratio and area under the receiver operator characteristic(ROC) curve. Discussion: This study will evaluate the diagnostic accuracy of CM diagnosis scale of PBSS in CHD. The consensus of 2 experts may not be ideal as a "gold standard", and itself still requires further study.(No. ChiCTR-OOC-15006599).

齐元富基于“解毒”治疗观辨治肺癌经验

齐元富教授重视毒邪在肺癌发生、发展中的重要作用,“解毒”是其治疗肺癌的经验特色之一。齐教授将导致肺癌的毒邪分为热毒、郁毒、痰毒、瘀毒四种类型,热毒者主以清热解毒治之,郁毒者主以理气消癥治之,痰毒者主以化痰除湿治之,瘀毒者主以活血散结治之,临床常获佳效。附验案1则。

“瘀毒”理论指导下不同肺系疾病诊疗思路

基于长期以来的临床实践经验和大量临床、基础研究,团队创新性提出“肺生血”“肺为血脏”理论,既拓展了既往教科书中的认识,又扩充了中医基础理论的内容;并以此为基础,系统提出“瘀毒”为肺系疾病病机变化的主要特点,构建“瘀毒”理论指导下的理法方药完备的肺系疾病证治体系,将“瘀毒”理论应用到支气管哮喘、慢性阻塞性肺疾病、肺间质纤维化、肺癌等肺系疾病的防治中。支气管哮喘、慢性阻塞性肺疾病急性发作期以标实为主,瘀毒兼痰,选用活血兼化痰之品;肺间质纤维化,瘀毒入络,选用活血作用较强且兼具通络作用的虫类药;肺癌,瘀毒兼癌毒,选用具有活血解毒和抗肿瘤作用的药物。临床治疗肺系疾病,需在考虑不同疾病特点的前提下,重视祛瘀解毒之法的运用。

基于UPLC/Q-TOF-MS研究代谢综合征痰瘀互结证的物质基础

目的:采用基于超高效液相色谱与串联四级杆飞行时间质谱仪(UPLC/Q-TOF-MS)联用的代谢组学技术,研究代谢综合征痰瘀互结证动物模型血清中小分子代谢物的变化。方法:模型组大鼠复制成痰瘀互结证代谢综合征,运用UPLC/Q-TOF-MS技术检测空白对照组和模型组血清样本中的小分子代谢产物,对所得到的代谢指纹图谱进行判别分析,找出具有差异的特征代谢物并追溯其来源。结果:鉴定出的潜在生物标志物主要有溶血磷脂酰胆碱、苯丙氨酸、酪氨酸、十四烷酸、硬脂酸、D-葡糖酸、前列腺素B1等内源性代谢物。结论:痰瘀互结证代谢综合征的发生与糖类、脂类、氨基酸代谢紊乱有关,这些体内的小分子化合物可能是痰瘀互结证代谢综合征中医证候的物质基础。

基于UPLC-Q/TOF-MS的痰瘀互结型冠心病患者尿液脂质组学研究

目的开展人尿液脂质组学研究,以期发现痰瘀互结型冠心病患者的脂质生物标志物。方法采集辨证为痰瘀互结型冠心病患者的尿液,同时采集同年龄段健康志愿者尿液,经真空冷冻干燥后采用超高效液相色谱四级杆飞行时间质谱联用仪(UPLC-Q/TOF-MS)进行脂质组学研究,建立正交偏最小二乘判别分析(OPLS-DA)的脂质组学模型,多元统计发现差异脂质代谢物,采用受试者操作特征曲线评价差异脂质代谢物区分痰瘀互结型冠心病患者与健康志愿者的诊断能力。结果健康志愿者与痰瘀互结型冠心病患者尿液脂质组学特征存在显著差异,OPLS-DA模型可有效区分两组样本,发现并鉴别了尿液中13种差异脂质代谢物。结论脂质组学是有效区分健康志愿者和痰瘀互结证患者的有效方法,差异脂质代谢物的发现有助于痰瘀互结型冠心病患者的辨证治疗。

高尿酸血症对痰瘀互结型急性冠脉综合征患者PCI预后的影响

[目的]基于真实临床诊疗数据,通过倾向性评分匹配法(PSM)探讨无症状高尿酸血症(HUA)对痰瘀互结型急性冠脉综合征(ACS)患者经皮冠状动脉介入(PCI)预后的影响,以便准确评估HUA患者心血管风险,为进一步探索中西医结合治疗方案提供理论基础。[方法]通过医院信息系统,获得2019年1月至2023年6月所有在天津中医药大学第二附属医院诊断为痰瘀互结型ACS并行PCI治疗的45岁及以上患者住院资料,随访至PCI后12月,主要终点为主要不良心脑血管事件(MACCE),次要终点为心源性死亡、非致死性心肌梗死、卒中、新发或加重心力衰竭(HF)。根据血清尿酸(SUA)浓度将患者分为HUA组和非HUA组,通过1∶2 PSM平衡协变量,采用多因素Cox回归分析HUA对终点事件的影响。[结果]共纳入484例患者,平均年龄(63.72±10.18)岁,74.59%为男性,25.41%为女性,与非HUA组相比,HUA组男性患者比例更高,诊断为ST段抬高型心肌梗死患者更多。PSM后HUA组68例(33.66%),非HUA组134例(66.34%),两组间各协变量分布均衡。PSM后多因素Cox回归表明,与非HUA组相比,HUA组PCI后12月内MACCE发生风险增加139%[HR=2.39,95%CI(1.13,5.07),P<0.05]、新发或加重HF发生风险增加272%[HR=3.72,95%CI(1.11,12.48),P<0.05],并且SUA浓度每升高1μmol/L,MACCE发生风险增加0.6%[HR=1.006,95%CI(1.002,1.010),P<0.05],新发或加重HF发生风险增加0.6%[HR=1.006,95%CI(1.000,1.012),P<0.05],但两组心源性死亡、非致死性心肌梗死、卒中的发生风险差异无统计学意义(P>0.05)。亚组分析进一步表明仅在年龄≥65岁、高血压、糖尿病、非ST段抬高型ACS、多支病变患者中,两组新发或加HF发生风险差异有统计学意义。[结论]入院时合并无症状HUA与45岁及以上的痰瘀互结型ACS患者PCI预后不良相关,对新发或加重HF具有潜在预测价值。

复方葶苈子汤干预LPS诱导的肺微血管内皮细胞TLR2/4-NLRP12-PANoptosis轴的实验研究

目的探究复方葶苈子汤对LPS诱导的大鼠肺微血管内皮细胞损伤模型中TLR2/4-NLRP12-PANoptosis轴的影响。方法制备复方葶苈子汤含药血清,通过LPS溶液构建大鼠肺微血管内皮细胞急性肺损伤模型,并设空白组、ALI模型组及复方葶苈子汤含药血清低、中、高剂量组。使用CCK-8法检测细胞活性,流式细胞术检测细胞凋亡率,Western blotting法检测TLR2/4-NLRP12-PANoptosis轴相关蛋白的表达。结果与空白组相比,ALI模型组细胞活性显著降低,凋亡率著升高(P<0.01);与ALI模型组相比,复方葶苈子汤含药血清各剂量组细胞活性显著增强,凋亡率均显著降低(P<0.01),其中高剂量组效果最为明显。ALI模型细胞中TLR2、TLR4、NLRP12及焦亡、凋亡、程序性坏死相关蛋白表达水平显著升高(P<0.01);而高剂量组中上述蛋白表达显著降低(P<0.05),其中NLRP12蛋白水平下降明显(P<0.01)。结论复方葶苈子汤含药血清能缓解LPS诱导的肺微血管内皮细胞损伤,并通过抑制TLR2/4-NLRP12-PANoptosis轴相关蛋白的表达减轻损伤。

从虚、痰、瘀、毒论治肺部磨玻璃结节

随着体检中胸部CT的普及,肺部磨玻璃结节(ground-glass nodule,GGN)的检出率越来越高,其具有一定比例的恶性概率,容易引起患者的恐慌,值得临床重视。目前对于无手术适应症的肺部GGN西医只是随访观察,而中医学对肺部GGN的研究尚不足,并且未形成统一的认识。通过查阅文献以及临床上四诊合参发现磨玻璃结节的病机特点多以虚痰瘀毒夹杂为主,基于虚、痰、瘀、毒讨论肺部GGN的病机特点及治疗方法,希冀为肺部磨玻璃结节的诊疗提供一定的思路。

Wellens综合征左前降支狭窄程度及预后与中医证型的相关性研究

【目的】探讨Wellens综合征(WS)冠状动脉(简称冠脉)左前降支狭窄程度及预后与中医不同证型之间的关系。【方法】采用回顾性分析方法,收集2021年9月至2023年9月于广州中医药大学第一附属医院心内科住院治疗,符合Wellens综合征诊断且完善冠脉造影检查的70例患者作为研究对象,整理资料,建立数据库,将所有患者分为气虚血瘀证、气阴两虚证、热毒血瘀证、痰浊血瘀证4种证型,分析所有患者的基本资料、中医证型分布特点、左前降支狭窄程度(Gensini评分)、风险预后的评分(TIMI危险评分),探讨Wellens综合征左前降支狭窄程度及预后与中医证型的关系。【结果】(1)中医证型分布方面,在70例Wellens综合征患者中,热毒血瘀证占比最多,为37.14%(26/70),气虚血瘀证占比最少,为12.86%(9/70),中医证型分布占比从高到低依次为热毒血瘀证>痰浊血瘀证>气阴两虚证>气虚血瘀证。(2)性别、年龄方面,不同中医证型间的性别、年龄分布比较,差异均无统计学意义(P>0.05)。(3)中医证型分布与Gensini评分、TIMI危险评分方面,不同中医证型组间的Gensini评分比较,差异有统计学意义(P<0.01),热毒血瘀证和痰浊血瘀证的Gensini评分较高,其中以痰浊血瘀证的Gensini评分最高,事后两两比较发现,热毒血瘀证组和痰浊血瘀证组的Gensini评分均明显高于气虚血瘀证组(P<0.05)。不同中医证型组间的TIMI危险评分比较,差异有统计学意义(P<0.05),事后两两比较发现,热毒血瘀证组的TIMI危险评分高于气虚血瘀证组(P<0.05),其余各组间两两比较,差异均无统计学意义(P>0.05)。(4)心电图分型与Gensini评分、TIMI危险评分方面,WS-Ⅱ型患者的Gensini评分、TIMI危险评分均高于WS-Ⅰ型患者(P<0.05)。(5)对TIMI危险评分及Gensini评分进行相关性分析,发现TIMI危险评分与Gensini评分之间存在相关关系(R_(S)=0.258,P<0.05)。【结论】在Wellens综合征患者中,热毒血瘀证和痰浊血瘀证的Gensini评分较高,提示左前降支狭窄程度更严重,且Gensini评分与TIMI危险评分存在一定的相关关系。

布地奈德联合清金化痰汤治疗慢性阻塞性肺疾病急性加重期痰热壅肺证的效果

目的:探讨布地奈德联合清金化痰汤治疗慢性阻塞性肺疾病急性加重期痰热壅肺证的效果。方法:选择2022年1月-2023年12月于黑龙江省中医药科学院治疗的86例慢性阻塞性肺疾病急性加重期痰热壅肺证患者作为研究对象,以随机数表法分为对照组和试验组,各43例。对照组给予布地奈德治疗,试验组给予布地奈德联合清金化痰汤治疗,比较两组中医症状积分、气道重塑介质[基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)、基质金属蛋白酶抑制剂-1(tissue inhibitors of metalloproteinase-1,TIMP-1)]、转化生长因子-β_(1)(transforming growth factor-β_(1),TGF-β_(1))、肺功能[呼气峰流速(peak expiratory flow,PEF)、第1秒用力呼气容积(forced expiratory volume in one second,FEV_(1))与用力呼气容积(forced vital capacity,FVC)比值(FEV_(1)/FVC)]、治疗效果及不良反应。结果:治疗后,两组各项症状积分、MMP-9、TIMP-1及TGF-β_(1)水平降低,且试验组较对照组低,差异有统计学意义(P<0.05);治疗后,两组PEF、FEV_(1)/FVC升高,且试验组较对照组高,差异有统计学意义(P<0.05);试验组总有效率高于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:布地奈德雾化吸入联合清金化痰汤口服治疗慢性阻塞性肺疾病急性加重期痰热壅肺证患者可抑制气道重塑,改善肺功能,减轻临床症状,且安全性高。

活血通窍法治疗儿童过敏性鼻炎临床观察

目的:观察活血通窍方治疗儿童痰瘀互结型过敏性鼻炎的临床疗效。方法:将60例符合纳入标准的过敏性鼻炎患儿随机分为两组各30例。对照组予口服盐酸西替利嗪片及糠酸莫米松喷鼻,治疗组在对照组基础上予活血通窍方,疗程均为28天。观察两组治疗前后中医各证候积分、鼻腔检查评分、PLT、EOS水平。结果:治疗组、对照组总有效率分别为96.67%、76.67%,两组比较差异无统计学意义(P﹥0.05),治疗组愈显率为70.00%高于对照组的40.00%(P﹤0.05);治疗后,两组患儿各主症、鼻腔检查积分、EOS水平均较治疗前明显下降(P﹤0.01),治疗组各次症积分、PLT水平较治疗前明显下降(P﹤0.01),对照组面色口唇、睡眠质量积分较治疗前下降(P﹤0.05)。治疗组主症、次症、鼻腔检查积分、PLT、EOS水平明显低于对照组(P﹤0.01,P﹤0.05)。结论:活血通窍方联合盐酸西替利嗪片、糠酸莫米松喷雾剂能有效改善过敏性鼻炎患儿的临床症状,同时可降低PLT、EOS水平。

基于经方化裁的消瘀散结方治疗痰瘀互结型中危肺结节的临床研究

【目的】观察基于经方柴胡桂枝干姜汤和活络效灵丹化裁的消瘀散结方治疗痰瘀互结型中危型肺结节的临床疗效。【方法】将104例符合纳入标准的痰瘀互结型中危型肺结节患者按随机数字表法随机分为试验组和对照组,每组各52例,因疫情等原因,最终共完成97例,其中试验组48例,对照组49例。在健康宣教基础上,对照组仅给予定期随访,试验组给予消瘀散结方汤药治疗,疗程为3个月。观察2组患者治疗前后中医证候积分及最大肺结节面积的变化情况,并评估2组患者整体上和不同结节类型的中医证候疗效和西医疗效。【结果】(1)中医证候积分方面,治疗后,试验组的中医证候积分分布情况较治疗前明显改善(P <0.01),而对照组较治疗前无明显改善(P> 0.05);治疗后组间比较,试验组对中医证候积分分布情况的改善作用明显优于对照组(P <0.01)。(2)中医证候疗效方面,从整体上来看,试验组的总有效率为81.25%(39/48),对照组为20.41%(10/49),组间比较(秩和检验),试验组的整体中医证候疗效明显优于对照组(P <0.01)。从结节类型来看,试验组对多发性结节、混合实性结节、纯磨玻璃结节、实性结节的中医证候疗效均优于对照组,其中以多发性结节和混合实性结节的疗效更为显著,差异均有统计学意义(P <0.05或P <0.01)。(3)最大肺结节面积方面,治疗后,试验组的最大肺部结节面积较治疗前明显缩小(P <0.01),而对照组较治疗前无明显缩小(P> 0.05);组间治疗后及治疗前后差值比较,差异均有统计学意义(P <0.05或P <0.01),提示试验组对最大肺结节面积的缩小作用明显优于对照组。(4)西医疗效方面,从整体上来看,试验组的总有效率为45.83%(22/48),对照组为6.12%(3/49),组间比较(秩和检验),试验组的整体西医疗效明显优于对照组(P <0.01)。从结节类型来看,试验组在治疗多发性结节方面的西医疗效优于对照组(P <0.01),而2组在治疗混合实性结节、实性结节及纯磨玻璃结节方面的西医疗效差异均无统计学意义(P> 0.05)。【结论】消瘀散结方能够显著改善痰瘀互结型中危型肺结节患者的临床症状,能有效稳定、缩小甚至消除部分肺结节,其组方思想具有进一步研究推广价值。

温肺祛痰散对稳定期慢性阻塞性肺疾病患者外周血T淋巴细胞、血清IL-2及sIL-2R的影响

目的:观察温肺祛痰散对稳定期慢性阻塞性肺疾病(COPD)患者外周血T淋巴细胞、血清白细胞介素-2(IL-2)及可溶性白细胞介素-2受体(sIL-2R)的影响,为临床治疗提供参考。方法:选取痰浊阻肺型稳定期COPD患者60例,采用随机数字表法分为两组,每组30例。两组患者均给予缩唇腹式呼吸。对照组给予噻托溴铵治疗,观察组给予噻托溴铵+温肺祛痰散治疗。记录两组治疗前、治疗后中医症候积分、咳嗽评分、生活质量评分及外周血T淋巴细胞、血清IL-2、sIL-2R水平变化,并记录两组疗效和COPD急性发作次数。结果:观察组治疗8周总有效率高于对照组,随访6个月内COPD急性发作次数少于对照组(P<0.05);治疗后两组生活质量评分、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、IL-2升高(P<0.05),中医症候积分、咳嗽评分、CD8^(+)、sIL-2R降低(P<0.05),观察组生活质量评分、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、IL-2高于对照组(P<0.05),中医症候积分、咳嗽评分、CD8^(+)、IL-2、sIL-2R低于对照组(P<0.05)。结论:温肺祛痰散可提高稳定期COPD患者免疫功能,调节血清IL-2及sIL-2R的表达,改善症状,提高生活质量。

温补肺肾与祛痰行瘀法联合布地格福治疗慢性阻塞性肺疾病临床观察

目的探究温补肺肾与祛痰行瘀法联合布地格福治疗慢性阻塞性肺疾病(COPD)的临床效果。方法将2021年4月—2022年11月婺源县中医院收治的80例COPD患者随机均分为两组,对照组行常规西医治疗,观察组予温补肺肾与祛痰行瘀法联合布地格福治疗,两组均持续2个疗程。评价两组的治疗效果及用药安全性。结果观察组的治疗总有效率95.00%(38/40)高于对照组的77.50%(31/40)(P<0.05)。治疗后,两组第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、肺总量(TLC)、呼气峰流速值占预计值百分比(PEF%pred)均提高,且观察组高于对照组(P<0.05)。治疗后,两组动脉血氧分压(PaO_(2))、血氧饱和度(SaO_(2))均提高,且观察组高于对照组(P<0.05);动脉血二氧化碳分压(PaCO_(2))、碱剩余(BE)水平均降低,且观察组低于对照组(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论温补肺肾与祛痰行瘀法联合布地格福治疗COPD,可改善患者肺功能及血气情况,有效且安全。

清气化痰汤加减治疗痰热壅肺证慢性阻塞性肺疾病效果观察

目的观察痰热壅肺证慢性阻塞性肺疾病患者实施清气化痰汤加减治疗的效果。方法选取2023年1—12月济南市中西医结合医院收治的65例痰热壅肺证慢性阻塞性肺疾病患者,根据治疗方法不同分为观察组(32例,西药联合中医清气化痰汤加减治疗)和对照组(32例,西药治疗),比较两组胸肺顺应性指标、气体交换参数等临床疗效指标。结果治疗后,观察组总顺应性、胸廓顺应性、肺顺应性、呼气峰值流速、平均有效压力、吸入最大空气量和动脉血氧分压高于对照组,动脉血二氧化碳分压和中医症候积分低于对照组,差异有统计学意义(P<0.05)。治疗期间,观察组症状缓解时间短于对照组,差异有统计学意义(P<0.05)。结论采用中西医结合(西药联合清气化痰汤加减)方案治疗痰热壅肺证慢性阻塞性肺疾病患者的效果十分显著,能提高患者的胸肺顺应性和气体交换参数,缓解患者的症状,且安全性较高。