Effect of combined therapy in treatment of acute exacerbation of chronic obstructive pulmonary disease combined with phlegm turbidity and qi deficiency as well as blood stasis syndrome
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摘要:目的 探讨益气活血化痰汤联合穴位埋线治疗慢性阻塞性肺疾病（简称慢阻肺）急性加重期痰浊兼气虚血瘀证的临床效果。方法 将185例慢阻肺急性加重期痰浊兼气虚血瘀证患者随机分为A组（西医常规治疗）、B组（西医常规治疗联合益气活血化痰汤）、C组（西医常规治疗联合穴位埋线）与D组（西医常规治疗联合益气活血化痰汤及穴位埋线）。比较4组中医症状积分、第1秒用力呼气量（FEV1）、用力肺活量（FVC）、FEV1与FVC的比值（FEV1/FVC）及临床疗效，并观察治疗前后炎症因子[白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、肿瘤坏死因子-α（TNF-α）]水平与血液流变学指标[全血黏度、血浆黏度、血浆纤维蛋白原（FIB）]变化。结果 治疗后，D组咳嗽、咳痰、喘息、胸闷评分及中医症状总积分均较A、B、C组低，差异有统计学意义（P < 0.05）；治疗后，D组FEV1、FVC、FEV1/FVC及治疗总有效率均高于A、B、C组，差异有统计学意义（P < 0.05或P < 0.01）；D组治疗后血清IL-6、IL-8、TNF-α水平及全血黏度、血浆黏度、FIB水平均低于A、B、C组，差异有统计学意义（P < 0.05）。结论 益气活血化痰汤联合穴位埋线辅助治疗可明显减轻慢阻肺急性加重期痰浊兼气虚血瘀证患者的临床症状和炎性反应，改善肺功能与血液流变学，提高临床疗效。
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关键词:
- 益气活血化痰汤 /
- 穴位埋线 /
- 慢性阻塞性肺疾病急性加重期 /
- 痰浊兼气虚血瘀证 /
- 临床效果
Abstract:Objective To investigate the clinical effect of Yiqi Huoxue Huatan Decoction combined with acupoint catgut embedding in the treatment of acute exacerbation of chronic obstructive pulmonary disease combined with phlegm turbidity and qi deficiency as well as blood stasis syndrome.Methods A total of 185 patients with acute exacerbation of chronic obstructive pulmonary disease combined with turbidity of phlegm as well as qi deficiency and blood stasis syndrome were randomly divided into group A (conventional western medicine treatment), group B (conventional western medicine treatment combined with Yiqi Huoxue Huatan Decoction), group C (conventional western medicine treatment combined with acupoint catenary embedding) and group D (conventional western medicine treatment combined with Yiqi Huoxue Huatan Decoction and acupoint catenary embedding). TCM symptom score, forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), ratio of FEV1 to FVC (FEV1/FVC) and clinical efficacy were compared among the four groups. The changes of inflammatory cytokine levels[interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α)] and hemorheological indexes[whole blood viscosity, plasma viscosity, plasma fibrinogen (FIB)] were observed before and after treatment.Results The scores of cough, expectoration, wheezing and chest tightness and total scores of TCM symptoms in the D group after treatment were significantly lower than those in the A group, B group and C group (P < 0.05). The FEV1, FVC, FEV1/FVC and the total effective rate of the D group after treatment were higher than those of the A group, B group and C group (P < 0.05 or P < 0.01). The serum IL-6, IL-8 and TNF-α levels and whole blood viscosity, plasma viscosity and plasma fibrinogen (FIB) levels in the D group after treatment were lower than those in the A group, B group and C group (P < 0.05).Conclusion Yiqi Huoxue Huatan Decoction combined with acupoint catgut embedding can significantly reduce the clinical symptoms and inflammatory reaction, improve lung function and hemorheology, and enhance clinical efficacy of acute exacerbation of chronic obstructive pulmonary disease patients combined with phlegm turbidity combined and qi deficiency as well as blood stasis syndrome. -
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表 1 4组中医症状积分(x±s)
分 症状 时点 A组(n=46) B组(n=46) C组(n=46) D组(n=47) 咳嗽 治疗前 3.64±0.57 3.59±0.61 3.52±0.49 3.48±0.65 治疗后 1.67±0.31*# 1.54±0.28*# 1.46±0.25*# 1.06±0.18* 咳痰 治疗前 3.60±0.66 3.50±0.64 3.43±0.56 3.35±0.58 治疗后 1.57±0.29*# 1.43±0.23*# 1.35±0.26*# 1.02±0.19* 喘息 治疗前 3.79±0.72 3.72±0.67 3.59±0.63 3.52±0.65 治疗后 1.74±0.33*# 1.59±0.31*# 1.52±0.29*# 1.13±0.22* 胸闷 治疗前 3.45±0.59 3.41±0.55 3.30±0.58 3.24±0.53 治疗后 1.43±0.25*# 1.30±0.23*# 1.26±0.24*# 0.96±0.15* 中医症状总积分 治疗前 25.26±4.25 26.18±4.62 25.74±5.03 26.62±4.31 治疗后 11.09±2.06*# 8.45±1.36*# 8.92±1.41*# 7.15±1.24* 与治疗前比较, *P < 0.05; 与D组比较, #P < 0.05。 
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表 2 4组肺功能比较(x±s)
组别 n FEV1/L FVC/L FEV1/FVC 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 A组 46 1.42±0.27 1.85±0.33*# 2.75±0.46 3.06±0.34*# 51.64±4.36 60.46±3.54*# B组 46 1.39±0.25 2.09±0.34*# 2.72±0.41 3.31±0.26*# 51.10±4.47 63.14±3.25*# C组 46 1.37±0.22 2.03±0.36*# 2.68±0.52 3.23±0.35*# 51.12±4.63 62.84±3.39*# D组 47 1.34±0.25 2.35±0.41* 2.63±0.38 3.52±0.31* 50.95±4.22 66.76±3.69* FEV1: 第1秒用力呼气量; FVC: 用力肺活量; FEV1/FVC: 第1秒用力呼气量与用力肺活量的比值。
与治疗前比较, *P < 0.05; 与D组比较, #P < 0.05。
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表 3 4组临床疗效比较[n(%)]
组别 n 临床控制 显效 有效 无效 总有效 A组 46 6(13.04) 18(39.13) 10(21.74) 12(26.09) 34(73.91)* B组 46 10(21.74) 22(47.83) 6(13.04) 8(17.39) 38(82.61)* C组 46 9(19.57) 20(43.48) 8(17.39) 9(19.57) 37(80.43)* D组 47 13(27.66) 25(53.19) 8(17.02) 1(2.13) 46(97.87) 与D组比较, *P < 0.01。
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表 4 4组炎症因子水平比较(x±s)
ng/L 组别 n IL-6 IL-8 TNF-α 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 A组 46 117.65±20.13 86.95±14.13*# 22.95±4.45 14.83±2.27*# 89.58±13.62 46.04±6.71*# B组 46 114.04±19.67 72.81±13.67*# 22.38±4.37 11.69±2.15*# 88.36±14.71 42.59±6.25*# C组 46 112.37±19.52 71.34±13.85*# 21.84±4.29 11.24±2.08*# 86.71±15.29 41.63±7.04*# D组 47 109.95±18.64 60.59±10.42* 21.36±4.12 8.83±1.71* 85.43±14.02 36.05±6.38* IL-6: 白细胞介素-6; IL-8: 白细胞介素-8; TNF-α: 肿瘤坏死因子α。与治疗前比较, *P < 0.05; 与D组比较, #P < 0.05。
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表 5 4组血液流变学指标比较(x±s)
组别 n 全血黏度/mPa·s 血浆黏度/mPa·s FIB/(g/L) 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 A组 46 4.39±0.48 3.71±0.51*# 1.69±0.32 1.35±0.24*# 4.98±0.62 2.97±0.56*# B组 46 4.31±0.52 3.45±0.54*# 1.65±0.31 1.21±0.22*# 4.87±0.66 2.71±0.54*# C组 46 4.26±0.55 3.36±0.57*# 1.62±0.26 1.18±0.23*# 4.81±0.64 2.66±0.53*# D组 47 4.19±0.58 3.04±0.48* 1.58±0.29 1.06±0.18* 4.75±0.59 2.48±0.43* FIB: 血浆纤维蛋白原。与治疗前比较, *P < 0.05; 与D组比较, #P < 0.05。
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