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纸质出版日期:2018
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邓明玲, 巴燕, 温奕超. 稳定期辨证用药对慢性阻塞性肺疾病频繁急性加重表型的获益评价[J]. 中国实验方剂学杂志, 2018,24(16):182-187.
DENG Ming-ling, BA Yan, WEN Yi-chao. Evaluation of Differentiation Maintenance Treatment in Patients with Acute Exacerbation Type Chronic Obstructive Pulmonary Disease (COPD)[J]. Chinese journal of experimental traditional medical formulae, 2018, 24(16): 182-187.
邓明玲, 巴燕, 温奕超. 稳定期辨证用药对慢性阻塞性肺疾病频繁急性加重表型的获益评价[J]. 中国实验方剂学杂志, 2018,24(16):182-187. DOI: 10.13422/j.cnki.syfjx.20181629.
DENG Ming-ling, BA Yan, WEN Yi-chao. Evaluation of Differentiation Maintenance Treatment in Patients with Acute Exacerbation Type Chronic Obstructive Pulmonary Disease (COPD)[J]. Chinese journal of experimental traditional medical formulae, 2018, 24(16): 182-187. DOI: 10.13422/j.cnki.syfjx.20181629.
目的:探讨对稳定期慢性阻塞性肺疾病(COPD)频繁急性加重表型患者给予中药辨证维持治疗,对近期临床症状、肺功能的改善作用及远期急性加重情况的影响。方法:将168例患者采用SAS软件生成随机按数字表法分为对照组和观察组各83例。对照组采用福莫特罗/布地奈德吸入剂,2吸/次,2次/d。观察组在对照组治疗的基础上辨证给药,肺脾气虚证服用金咳息胶囊,4粒/次,3次/d;肺肾气虚证服用固肾定喘丸,1.5~2 g/次,3次/d;肺肾气阴两虚证服用补肾润肺口服液,30 mL/次,1次/d;兼热痰者加服清气化痰丸,6 g/次,3次/d;兼寒痰者加服咳喘顺丸,5 g/次,3次/d;兼血瘀者加服血府逐瘀丸,8 g/次,2次/d。两组患者均连续治疗6个月,疗程结束后进行6个月的随访。进行治疗前后临床症状和呼吸困难程度(mMRC)评分;检测治疗前后第1秒用力呼气容积(FEV1),FEV1占预计值百分比(FEV1%),并进行气流受限严重程度评估;检测治疗前后白细胞介素-6(IL-6),IL-8,肿瘤坏死因子-α(TNF-α)和C-反应蛋白(CRP)水平;随访记录急性加重情况比较。结果:观察组COPD临床控制总有效率为90.91%,高于对照组74.6%(χ2=6.058,P<0.05);治疗后观察组临床症状,改良版英国医学研究会呼吸问卷(mMRC)评分均低于对照组(P<0.01);观察组FEV1%高于对照组水平(P<0.05);治疗后观察组患者血清CRP,IL-6,IL-8,TNF-α水平均低于对照组(P<0.01);观察组气流受限严重程度轻于对照组(χ2=6.354,P<0.05);经随访,观察组平均急性加重次数少于对照组(P<0.05),住院次数少于对照组(P<0.05)。结论:中药辨证治疗稳定期COPD频繁急性加重表型患者近期可减轻临床症状、改善肺功能和呼吸困难症状,控制炎症反应,远期可减少急性加重次数、降低了急性加重风险因素,患者近期和远期均获益显著。
Objective: To discuss the effect of differentiation maintenance treatment of traditional Chinese medicine(TCM) in patients with acute exacerbation type chronic obstructive pulmonary disease (COPD)
and investigate its effects on recent symptoms
pulmonary function
and long term acute exacerbation. Method: One hundred and sixty eight patients were randomly divided into control group and observation group by random number table with use of SAS software. Patients in control group received budesonide and formoterol fumarate powder for inhalation
2 inhalations/days
2 times/days. Based on the treatment of control group
the patients in observation group received additional differentiation maintenance treatment of TCM. patients with lung-spleen Qi deficiency syndrome orally took Jinkexi capsules
4 capsules/time
tid. Patients with lung-kidney Qi deficiency syndrome orally took Gushen Dingchuan pills
1.5-2.0 g/time
tid. Patients with lung and kidney Qi-Yin deficiency syndrome took Bushen Ruifei decoction
30 mL/time
qd. Patients with heat-phlegm took Qingqi Huatan pills
6 g/time
tid. Patients with cold-phlegm took Kechuanshun pills
5 g/time
tid. Patients with blood stasis received Xuefu Zhuyu pills
8 g/time
bid. The course of treatment was 6 months for both groups
and 6 months of follow-up were recorded after the treatment. Before and after treatment
scores of clinical symptoms and modified British medical research council (mMRC) were graded. Levels of 1 second forced expiratory volume (FEV1)
percentage of estimated value of FEV1 (FEV1%) and severity of air flow limitation were evaluated. Levels of interleukins-6 (IL-6)
IL-8
tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) were detected. And acute exacerbation was recorded and compared during the follow-up. Result: The total effective rate for COPD was 90.91% in observation group
higher than 74.6% in control group (χ2=6.058
P<0.05). After treatment
the scores of clinical symptoms and mMRC in observation group were lower than those in control group (P<0.01)
and FEV1% was higher than that in control group (P<0.05). The levels of CRP
IL-6
IL-8
and TNF-α in serum were lower than those in control group (P<0.01). And the limited severity of airflow was lower than that in control group (χ2=6.354
P<0.05). During the follow-up period
mean number of acute aggravation times and number of hospitalization in observation group were less than those in control group (P<0.05). Conclusion: Differentiation maintenance treatment of TCM can relieve clinical symptoms
ameliorate pulmonary function and dyspnea
improve quality of life
control inflammatory reaction
decrease times of acute exacerbation in a long term and reduce acute aggravating risk factors
with both significant short-term and long-term benefits.
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