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天津中医药大学 第一附属医院,天津 300380
狄冠麟,硕士,副主任医师,从事中西医结合治疗呼吸系统疾病工作,E-mail:sdstl2014@163.com
收稿日期:2020-04-23,
网络出版日期:2020-05-28,
纸质出版日期:2020-11-20
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狄冠麟,朱振刚,郑延龙.越婢加半夏汤对老年社区获得性肺炎痰热壅肺证及对炎性标志物预后的影响[J].中国实验方剂学杂志,2020,26(22):59-64.
DI Guan-lin,ZHU Zhen-gang,ZHEN Yan-long.Effect of Yuebi Jia Banxiatang on Inflammatory Markers and Prognosis of Patients with Community Acquired Pneumonia in Old People[J].Chinese Journal of Experimental Traditional Medical Formulae,2020,26(22):59-64.
狄冠麟,朱振刚,郑延龙.越婢加半夏汤对老年社区获得性肺炎痰热壅肺证及对炎性标志物预后的影响[J].中国实验方剂学杂志,2020,26(22):59-64. DOI: 10.13422/j.cnki.syfjx.20200834.
DI Guan-lin,ZHU Zhen-gang,ZHEN Yan-long.Effect of Yuebi Jia Banxiatang on Inflammatory Markers and Prognosis of Patients with Community Acquired Pneumonia in Old People[J].Chinese Journal of Experimental Traditional Medical Formulae,2020,26(22):59-64. DOI: 10.13422/j.cnki.syfjx.20200834.
目的
2
观察越婢加半夏汤加减治疗痰热壅肺型老年社区获得性肺炎(CAP)的疗效及对炎性标志物和预后的影响。
方法
2
采用随机按数字表法,以1∶1将120例符合要求的患者分为对照组和观察组60例;除脱落、失访和剔除,对照组和观察组最终均完成55例观察。两组均给予抗感染等综合治疗。对照组口服肺力咳合剂,20 mL/次,3次/d;观察组采用越婢加半夏汤加减内服,每天1剂;两组疗程均为10 d。记录退热时间和第5 天的退热率,记录咳嗽、咯痰和肺部啰音缓解时间;进行临床肺部感染评分(CPSI)评分,记录CPSI
<
6分的时间,即停用抗生素时间;进行治疗前后痰热壅肺证评分;记录初始治疗失败情况;检测降钙素原(PCT) hs-CRP,红细胞体积分布宽度(RDW),
D
-二聚体(
D
-D)和合肽素水平等预后标志物,检测肿瘤坏死因子-
α
(TNF-
α
),白细胞介素-1
β
(IL-1
β
), IL-6和超敏C反应蛋白(hs-CRP )等炎性标志物水平;记录胸片复常率;进行安全性评价。
结果
2
观察组患者主要症状、体征病程(退热,咳嗽缓解、咯痰缓解及肺部啰音缓解)时间均短于对照组(
P
<
0.01);观察组第5天退热率为85.45%(47/55),停用抗生素率为94.55%(52/55),胸片复常率为90.91%(50/55),分别高于对照组的65.45%(36/55),81.82%(45/55),74.55%(45/55),组间差异均有统计学意义(
P
<
0.05);观察组和对照组的初始治疗失败率分别为5.54%(3/55),20.00%(11/55),观察组低于对照组(
P
<
0.05);观察组CPSI和痰热壅肺证评分均低于对照组(
P
<
0.01);观察组PCT,RDW,
D
-D和合肽素水平均低于对照组(
P
<
0.01);观察组患者hs-CRP,TNF-
α
,IL-1
β
和IL-6水平均低于对照组(
P
<
0.01);观察组中医证候疗效总有效率为96.36%(53/55),高于对照组的83.64%(46/55)(
χ
2
=4.949,
P
<
0.05);该研究未发现与服用中药相关不良反应。
结论
2
在抗感染等综合治疗的基础上,给予越婢加半夏汤加减内服治疗痰热壅肺型CAP患者,减轻了临床症状,改善了肺部感染和病情程度,控制了炎症反应,改善了预后,中医证候疗效显著,且临床使用安全。
Objective
2
To observe the efficacy of Yuebi Jia Banxiatang on old patients with community acquired pneumonia (CAP) combined with syndrome of phlegm heat damming lung, and observe effect on inflammatory markers and prognosis.
Method
2
A total of 120 patients with CAP were randomly divided into control group (60 cases) and observation group (60 cases) by random number table. In control group, 55 patients finished the therapy (3 patients fell off or were lost to follow-up, 2 were eliminated), 55 patients in observation group completed the therapy (5 patients fell off or were lost to follow-up). Both groups' patients got anti-infection and other comprehensive therapies. Patients in control group got Feilike mixture, 20 mL/time, 3 times/day. Patients in observation group obtained Yuebi Jia Banxiatang, 1 dose/day. The course of treatment for the two groups continued for 10 days. Antipyretic time and antipyretic rate at the 5
th
day after treatment, relief time of cough, expectoration and lung rale were recorded. And clinical pulmonary infection score (CPSI), time (CPSI
<
6) and time to stop antibiotics were recorded. Before and after treatment, syndrome of phlegm heat damming lung was scored, and failure of initial treatment was also recorded. Levels of procalcitonin (PCT), red blood cell volume distribution wid (RDW),
D
-dimer (
D
-D) and synpeptin, high sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-
α
(TNF-
α
), interleukin (IL-1
β
) and IL-6 were measured. Recurrence rate of chest radiograph was recorded, and safety was evaluated.
Result
2
Relief time of antipyretic, cough, expectoration and lung rale in observation group were less than those in control group (
P
<
0.01). Antipyretic rate at the 5
th
day after treatment, antibiotic discontinuation rate, recurrence rate of chest radiograph were 85.45% (47/55), 94.55% (52/55) and 90.91% (50/55), which were higher than 65.45% (36/55), 81.82% (45/55) and 74.55% (45/55) in control group. And initial treatment failure rate was 5.54% (3/55), which was lower than 20.00% (11/55) in control group (
P
<
0.05). Scores of CPSI and syndrome of phlegm heat damming lung were less than those in control group (
P
<
0.01). And levels of PCT, RDW,
D
-D, peptide, hs-CRP, TNF-
α
, IL-1
β
and IL-6 were all below the level in control group (
P
<
0.01). Total effective rate of traditional Chinese medicine (TCM) syndrome was 96.36% (53/55), which was higher than 83.64% (46/55) in control group (
χ
2
=4.949,
P
<
0.05). And there was no adverse reactions relating to traditional Chinese medicine.
Conclusion
2
In addition to anti-infection and other comprehensive therapies, Yuebi Jia Banxiatang can control the clinical symptoms, reduce the degree of pulmonary infection and disease, control the inflammatory reaction, shorten the course of disease and improve the prognosis, with a significant effect and safety in clinical use.
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