六君子汤治疗稳定期慢性阻塞性肺病肺脾两虚证的疗效及其对肺功能、运动耐力和血气分析的影响
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摘要
目的:探讨六君子汤治疗稳定期慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)肺脾两虚证疗效及其对肺功能、运动耐力和血气分析的影响。方法:106例COPD患者,用随机数字表法分为治疗组与对照组,每组53例。对照组患者仅给予沙美特罗替卡松气雾剂进行吸入治疗;治疗组患者在给予沙美特罗替卡松气雾剂的基础上口服六君子汤,治疗周期均为12周,分析两组患者治疗前后肺功能、运动耐力、呼吸肌疲劳、血清脑钠肽及炎症介质水平的变化。结果:临床疗效,治疗组患者总有效率为96.23%,对照组为83.02%,治疗组优于对照组(P<0.05)。肺功能,治疗组与对照组治疗前第1秒用力呼吸容积(forced expiratory volume in 1 second,FEV_1),用力肺活量(forced vital capacity,FVC)及1 s率(FEV_1/FVC)差异无统计学意义,两组患者接受治疗12周后FEV_1,FVC,FEV_1/FVC均较治疗前明显提高(P<0.05),且治疗组患者高于对照组(P<0.05)。运动耐力(6 m WD),治疗前,两组患者6 m WD比较,差异无统计学意义,治疗后,与治疗前比较,两组患者6 m WD均显著改善,且治疗组优于对照组(P<0.05)。血气分析(Pa O2,Sa O2,Pa CO2),与治疗前比较,治疗后两组患者血气分析指标均有明显改善,且治疗组改善程度优于对照组(P<0.05)。血清脑钠肽(brain natriuretic peptide,BNP)水平,治疗组与对照组治疗前差异无统计学意义,治疗组患者接受治疗12周后血清BNP显示低于对照组(P<0.05),且治疗组患者均低于对照组(P<0.05)。炎症介质,治疗组与对照组治疗前白细胞介素-6(interleukin-6,IL-6),白细胞介素-8(interleukin-8,IL-8)和超敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)差异无统计学意义,两组患者接受治疗12周后血清中IL-6,IL-8和hs-CRP水平均明显降低(P<0.05),且治疗组患者均低于对照组(P<0.05)。结论:六君子汤治疗COPD稳定期肺脾两虚证患者临床疗效明显,可提高患者肺功能及运动耐力,降低患者血清中BNP水平,减轻患者炎症反应。
Objective: To study the clinical efficacy of Liu Junzitang and its effect on lung function,exercise tolerance and blood gas analysis in patients with chronic obstructive pulmonary disease( COPD) with symptoms of lung and spleen deficiency at stable stage. Method: A total of 106 cases of patients with COPD at stable stage treated in our hospital were selected and divided into two groups by the random number table,with 53 cases in each group. Patients in both groups were treated with salmeterol and fluticasone propionate powder for inhalation,while treatment group was additionally given Liu Junzitang. The course of treatment was 12 weeks.Then,the changes in lung function,exercise tolerance,respiratory muscle fatigue,values of serum-BNP and inflammatory mediators in two groups were compared. Result: In terms of clinical efficacy,compared with control group( 83. 02%),treatment group showed the total effective rate of 96. 23%. There was a significant increase( P < 0. 05). In effect on lung function,forced expiratory volume in the first second( FEV_1),forced vital capacity( FVC) and FEV_1/FVC showed no difference between two groups. There were significant differences between two groups of patients before and after 4,12 weeks treatment( P < 0. 05) in FEV_1,FVC and FEV_1/FVC improvement.And the values of FEV_1,FVC and FEV_1/FVC in treatment group is superior to those of control group( P < 0. 05).Regarding exercise tolerance( 6 m WD),the value of 6 m WD before treatment between two groups showed no difference. There were significant differences between two groups of patients before and after 4,12 weeks treatment( P < 0. 05). And the value of 6 m WD in treatment group was superior to that of control group( P < 0. 05). In terms of blood gas analysis( Pa O2,Sa O2,Pa CO2),there were significant differences between two groups of patients before and after 4,12 weeks treatment( P < 0. 05). And the values of Pa O2,Sa O2,Pa CO2 in treatment group were superior to those of control group( P < 0. 05). The value of serum-BNP before treatment between two groups showed no difference. There were significant differences between two groups of patients before and after 4,12 weeks treatment( P < 0. 05). And the value of serum-BNP in control group was superior to that in treatment group. In terms of inflammatory mediators,values of IL-6,IL-8 and hs-CRP before treatment between two groups showed no difference. There were significant differences between two groups of patients before and after 4 and 12 weeks treatment( P < 0. 05). And the values of IL-6,IL-8 and hs-CRP in control group were superior to those in treatment group. Conclusion: Liu Junzitang has a good therapeutic effect on COPD with symptoms of lung and spleen deficiency at the stable stage. Liu Junzitang can significantly improve lung function and exercise tolerance,and relieve inflammatory reaction.
Objective: To study the clinical efficacy of Liu Junzitang and its effect on lung function,exercise tolerance and blood gas analysis in patients with chronic obstructive pulmonary disease( COPD) with symptoms of lung and spleen deficiency at stable stage. Method: A total of 106 cases of patients with COPD at stable stage treated in our hospital were selected and divided into two groups by the random number table,with 53 cases in each group. Patients in both groups were treated with salmeterol and fluticasone propionate powder for inhalation,while treatment group was additionally given Liu Junzitang. The course of treatment was 12 weeks.Then,the changes in lung function,exercise tolerance,respiratory muscle fatigue,values of serum-BNP and inflammatory mediators in two groups were compared. Result: In terms of clinical efficacy,compared with control group( 83. 02%),treatment group showed the total effective rate of 96. 23%. There was a significant increase( P < 0. 05). In effect on lung function,forced expiratory volume in the first second( FEV_1),forced vital capacity( FVC) and FEV_1/FVC showed no difference between two groups. There were significant differences between two groups of patients before and after 4,12 weeks treatment( P < 0. 05) in FEV_1,FVC and FEV_1/FVC improvement.And the values of FEV_1,FVC and FEV_1/FVC in treatment group is superior to those of control group( P < 0. 05).Regarding exercise tolerance( 6 m WD),the value of 6 m WD before treatment between two groups showed no difference. There were significant differences between two groups of patients before and after 4,12 weeks treatment( P < 0. 05). And the value of 6 m WD in treatment group was superior to that of control group( P < 0. 05). In terms of blood gas analysis( Pa O2,Sa O2,Pa CO2),there were significant differences between two groups of patients before and after 4,12 weeks treatment( P < 0. 05). And the values of Pa O2,Sa O2,Pa CO2 in treatment group were superior to those of control group( P < 0. 05). The value of serum-BNP before treatment between two groups showed no difference. There were significant differences between two groups of patients before and after 4,12 weeks treatment( P < 0. 05). And the value of serum-BNP in control group was superior to that in treatment group. In terms of inflammatory mediators,values of IL-6,IL-8 and hs-CRP before treatment between two groups showed no difference. There were significant differences between two groups of patients before and after 4 and 12 weeks treatment( P < 0. 05). And the values of IL-6,IL-8 and hs-CRP in control group were superior to those in treatment group. Conclusion: Liu Junzitang has a good therapeutic effect on COPD with symptoms of lung and spleen deficiency at the stable stage. Liu Junzitang can significantly improve lung function and exercise tolerance,and relieve inflammatory reaction.
引文
[1]徐翠容,贾坤林,钟晓莉,等.黄芪注射液联合沙美特罗替卡松粉吸入剂对COPD患者肺功能、细胞因子和血液流变学指标的影响[J].中国药房,2016,27(26):3678-3680.
[2]Wormald P J.The agger nasi cell:the key to understanding the anatomy of the frontal recess[J].Otolaryngol Head Neck Surg,2011,129(3):497-507.
[3]温学群.羧甲司坦联合沙美特罗替卡松气雾剂治疗对COPD稳定期患者肺功能和炎性因子的影响[J].临床医学工程,2016,23(8):1071-1072.
[4]王剑,李学军.沙美特罗替卡松对老年慢性阻塞性肺疾病急性发作期患者肺功能及血清炎性因子水平的影响分析[J].中国医学前沿杂志:电子版,2016,8(5):83-86.
[5]余国辉,陈敏.慢性阻塞性肺疾病发病机制的发展状况[J].临床肺科杂志,2010,15(1):72-74.
[6]程正良,王胜.慢性阻塞性肺疾病稳定期中医病机“虚、痰、瘀”的理论探讨[J].辽宁中医杂志,2014,41(8):1625-1627.
[7]陈静,张念志.中医药治疗慢性阻塞性肺疾病研究进展[J].江西中医药,2014,45(7):78-80.
[8]张雪.益气通络化痰方治疗慢性阻塞性肺疾病稳定期合并抑郁症的临床观察[D].济南:山东中医药大学,2015.
[9]刘娟.健脾益肺化痰方对COPD大鼠气道黏液高分泌的作用机制研究[D].北京:北京中医药大学,2016.
[10]王晓毅,谢志强,陈婉华,等.六君子汤治疗气虚痰瘀型高血压病30例[J].中国中医药现代远程教育,2011,9(14):31-32.
[11]彭腾,贺钢民,李柏群,等.白术、茯苓药对组方的益气健脾类方化学成分的比较研究[J].中药与临床,2011,2(2):47-49.
[12]陈磊,张国龙,陈敏,等.六君子汤治疗慢性阻塞性肺疾病稳定期肺脾两虚证的疗效观察[J].中医药导报,2015,21(2):79-81.
[13]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中华结核和呼吸杂志,2013,36(4):255-258.
[14]中华人民共和国卫生部.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:54.
[15]沈自尹.中医虚证辨证参考标准[J].中西医结合杂志,1983,3(2):117.
[16]汪丙柱,周国儿,邬易琳,等.补中固卫合剂对慢性阻塞性肺疾病稳定期患者肺功能及细胞因子的影响[J].浙江中医杂志,2015,50(4):241-242.
[17]孙杰,韩敏娟,曹鹏鹏,等.培土生金法治疗慢性阻塞性肺疾病理论探析[J].中国中医药信息杂志,2015,22(3):102-103.
[18]Chaouat A,Savale L,Chouaid C.Production by role for interleukin-6 in COPD-related pulmonary hypertension[J].Chest,2009,136(3):678-687.
[19]Rabe K F,Hurd S,Anzueto A,et al.Global strategy for the diagnosis,management,and prevention of chronic obstructive pulmonary disease:GOLD executive summary[J].Am J Respir Crit Care Med,2007,176(3):532-555.
[20]王玲,居来提·赛买提,杜丽娟,等.培土生金法对慢性阻塞性肺疾病患者BODE指数及生活质量的影响[J].中国实验方剂学杂志,2012,18(14):269-272.
[21]郭思佳,孙增涛,李月川,等.补肺颗粒对慢性阻塞性肺疾病稳定期患者血清炎性因子水平的影响[J].中国中西医结合杂志,2014,34(2):235-238.
[22]American Thoracic Society.Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease[J].Am J Respis Crit Care Ned,1995,152(5):77-78.
[23]European Respiratory Society(ERS):optimal assessment and management of chronic obstructive pulmonary disease(COPD)[J].Eur Respir J,1995,8(8):1398-1402.
[24]Stolz D,Breidthardt T,Christ-Crain M,et al.Use of Btype natriuretic peptide in the risk stratification of acute exacerbations of COPD[J].Chest,2008,133(5):1008-1094.
[25]高峰,吴蔚,王彬,等.中药干预对慢性阻塞性肺疾病稳定期患者临床疗效及生活质量的影响[J].中国中医药信息杂志,2012,19(10):8-10.
[26]Attaran D,Lari S M,Towhidi M,et al.Interleukin-6 and airflow limitalion in chemical warfare patients with chronic obstructive pulmonary disease[J].Int J Chron Obstruct Pulmon Dis,2010,doi:10.2147/COPD.S12545.
[27]程玉武.COPD患者IL-6、IL-8、TNF-α水平的检意义[J].山东医药,2010,50(27):47-48.
[28]汤翠英,吴镇湖,庾慧.慢性阻塞性肺疾病稳定期TNF-α、IL-8水平与中医证型相关性研究[J].山东中医药大学学报,2013,37(3):208-209.
[29]袁涛,王可.慢性阻塞性肺疾病患者肺功能与C反应蛋白的关系研究[J].海南医学,2009,20(7):9-12.
[2]Wormald P J.The agger nasi cell:the key to understanding the anatomy of the frontal recess[J].Otolaryngol Head Neck Surg,2011,129(3):497-507.
[3]温学群.羧甲司坦联合沙美特罗替卡松气雾剂治疗对COPD稳定期患者肺功能和炎性因子的影响[J].临床医学工程,2016,23(8):1071-1072.
[4]王剑,李学军.沙美特罗替卡松对老年慢性阻塞性肺疾病急性发作期患者肺功能及血清炎性因子水平的影响分析[J].中国医学前沿杂志:电子版,2016,8(5):83-86.
[5]余国辉,陈敏.慢性阻塞性肺疾病发病机制的发展状况[J].临床肺科杂志,2010,15(1):72-74.
[6]程正良,王胜.慢性阻塞性肺疾病稳定期中医病机“虚、痰、瘀”的理论探讨[J].辽宁中医杂志,2014,41(8):1625-1627.
[7]陈静,张念志.中医药治疗慢性阻塞性肺疾病研究进展[J].江西中医药,2014,45(7):78-80.
[8]张雪.益气通络化痰方治疗慢性阻塞性肺疾病稳定期合并抑郁症的临床观察[D].济南:山东中医药大学,2015.
[9]刘娟.健脾益肺化痰方对COPD大鼠气道黏液高分泌的作用机制研究[D].北京:北京中医药大学,2016.
[10]王晓毅,谢志强,陈婉华,等.六君子汤治疗气虚痰瘀型高血压病30例[J].中国中医药现代远程教育,2011,9(14):31-32.
[11]彭腾,贺钢民,李柏群,等.白术、茯苓药对组方的益气健脾类方化学成分的比较研究[J].中药与临床,2011,2(2):47-49.
[12]陈磊,张国龙,陈敏,等.六君子汤治疗慢性阻塞性肺疾病稳定期肺脾两虚证的疗效观察[J].中医药导报,2015,21(2):79-81.
[13]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中华结核和呼吸杂志,2013,36(4):255-258.
[14]中华人民共和国卫生部.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:54.
[15]沈自尹.中医虚证辨证参考标准[J].中西医结合杂志,1983,3(2):117.
[16]汪丙柱,周国儿,邬易琳,等.补中固卫合剂对慢性阻塞性肺疾病稳定期患者肺功能及细胞因子的影响[J].浙江中医杂志,2015,50(4):241-242.
[17]孙杰,韩敏娟,曹鹏鹏,等.培土生金法治疗慢性阻塞性肺疾病理论探析[J].中国中医药信息杂志,2015,22(3):102-103.
[18]Chaouat A,Savale L,Chouaid C.Production by role for interleukin-6 in COPD-related pulmonary hypertension[J].Chest,2009,136(3):678-687.
[19]Rabe K F,Hurd S,Anzueto A,et al.Global strategy for the diagnosis,management,and prevention of chronic obstructive pulmonary disease:GOLD executive summary[J].Am J Respir Crit Care Med,2007,176(3):532-555.
[20]王玲,居来提·赛买提,杜丽娟,等.培土生金法对慢性阻塞性肺疾病患者BODE指数及生活质量的影响[J].中国实验方剂学杂志,2012,18(14):269-272.
[21]郭思佳,孙增涛,李月川,等.补肺颗粒对慢性阻塞性肺疾病稳定期患者血清炎性因子水平的影响[J].中国中西医结合杂志,2014,34(2):235-238.
[22]American Thoracic Society.Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease[J].Am J Respis Crit Care Ned,1995,152(5):77-78.
[23]European Respiratory Society(ERS):optimal assessment and management of chronic obstructive pulmonary disease(COPD)[J].Eur Respir J,1995,8(8):1398-1402.
[24]Stolz D,Breidthardt T,Christ-Crain M,et al.Use of Btype natriuretic peptide in the risk stratification of acute exacerbations of COPD[J].Chest,2008,133(5):1008-1094.
[25]高峰,吴蔚,王彬,等.中药干预对慢性阻塞性肺疾病稳定期患者临床疗效及生活质量的影响[J].中国中医药信息杂志,2012,19(10):8-10.
[26]Attaran D,Lari S M,Towhidi M,et al.Interleukin-6 and airflow limitalion in chemical warfare patients with chronic obstructive pulmonary disease[J].Int J Chron Obstruct Pulmon Dis,2010,doi:10.2147/COPD.S12545.
[27]程玉武.COPD患者IL-6、IL-8、TNF-α水平的检意义[J].山东医药,2010,50(27):47-48.
[28]汤翠英,吴镇湖,庾慧.慢性阻塞性肺疾病稳定期TNF-α、IL-8水平与中医证型相关性研究[J].山东中医药大学学报,2013,37(3):208-209.
[29]袁涛,王可.慢性阻塞性肺疾病患者肺功能与C反应蛋白的关系研究[J].海南医学,2009,20(7):9-12.
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