调补肺肾方对慢性阻塞性肺疾病合并气管支气管软化症患者肺功能和生活质量的影响
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摘要
目的:探讨调补肺肾方对慢性阻塞性肺疾病合并气管支气管患者肺功能和生活质量的影响。方法:分析我科从2016年3月～2017年12月诊治的60例慢阻肺合并气管支气管软化症患者临床资料。根据入院先后及是否采用中医治疗分为对照组和观察组,2组各30例。对照组采用单纯西医对症治疗组,包括:轻度软化症患者常规给予沙美特罗替卡松(50/250 ug)2吸bid,或布地奈德福莫特罗(160/4.5 ug)2吸bid,或联合噻托溴铵(18 ug)1吸qd;中度患者在常规治疗基础上给予无创呼吸机辅助通气(模式BiPAP或CPAP),重度患者酌情给予气道支架植入,肺部感染患者给予抗感染治疗。观察组在对照组基础上加用中医调补肺肾方水煎剂,1剂/d, 3次/d。统计分析2组患者治疗前后肺功能、C反应蛋白(CRP, C-reactive Protein)、降钙素原(PCT, Procalcitonin)、改良英国医学研究学会呼吸困难指数(mMRC, Modified British Medical Research Council)、慢阻肺评估测试(CAT, Chronic Obstructive Pulmonary Disease Assessment Test)变化。结果:研究显示,与基线值比较,对照组与观察组都能改善患者肺功能FEV1值,降低CRP及PCT,改善呼吸困难指数及CAT评分,差异有统计学意义;但在改善FEV1/FVC、RV/TLC、DLCO、PO_2及PCO_2方面无统计学差异。组间比较显示,观察组较对照组能更好改善患者PO_2、mMRC及CAT评分,能进一步改善患者生活质量,差异有统计学意义,但2组在改善肺功能FEV1、FEV1/FVC、RV/TLC、DLCO及PCO2上无统计学意义。结论:调补肺肾方治疗慢阻肺合并气管支气管软化症疗效肯定,值得进一步研究。
Objective: To study the effect of Tiaobufeishen Recipe on pulmonary function and quality of life in patients with chronic obstructive pulmonary disease and tracheobronchomalacia. Methods: The clinical features, diagnosis and treatment methods of 60 patients with tracheobronchomalacia in COPD were retrospectively analyzed from March 2016 to December 2017. According to the order of admission and whether or not to use Chinese medicine, the patients were divided into the control group and the observation group. There were 30 cases in each group, and the control group was only treated with the Western medicine. Salmeterol and fluticasone propionate inhalant(50/250 ug) or Budesonide formotero inhalant(160/4.5 ug) 2 inhaled bid, or a combination of tiotropium bromide 18 ug inhaled qd was given in the control group,non-invasive ventilator ventilation(mode BiPAP or CPAP) was given to moderate tracheobronchomalacia patients on the basis of conventional treatment. Severe tracheobronchomalacia patients were given airway stent implantation according to theneeds, and patients with pulmonary infection were treated with anti-infective. On the basisof the control group, the observation group was supplemented with tiaobufeishen recipe, one dose per day, three times a day. The lung function, CRP(c-reactive protein), PCT(procalcitonin), mMRC(Modified British medical research council), and CAT(Chronicobstructive pulmonary disease assessment test)score were observed and analyzed in two groups before and after treatments. Results: Compared with baseline values, the control group and observation group can improve lung function in patients with FEV1, reduce CRP and PCT, improved dyspnea index and the CAT scores, which have statistical difference. But two groups both can't improve the FEV1/FVC, DLCO, PO2, PCO2 and RV/TLC. Compared with groups, observation groupcan better improve PO2, mMRC and the CAT scores, and improve the patients quality of life, which have statistical difference. But two groups both can't improve the FEV1,FEV1/FVC, DLCO, PCO2 and RV/TLC. Conclusion: The tiaobufeishen recipe have affirmative curative effect for COPD and tracheobronchomalacia, Which deserved further research.
Objective: To study the effect of Tiaobufeishen Recipe on pulmonary function and quality of life in patients with chronic obstructive pulmonary disease and tracheobronchomalacia. Methods: The clinical features, diagnosis and treatment methods of 60 patients with tracheobronchomalacia in COPD were retrospectively analyzed from March 2016 to December 2017. According to the order of admission and whether or not to use Chinese medicine, the patients were divided into the control group and the observation group. There were 30 cases in each group, and the control group was only treated with the Western medicine. Salmeterol and fluticasone propionate inhalant(50/250 ug) or Budesonide formotero inhalant(160/4.5 ug) 2 inhaled bid, or a combination of tiotropium bromide 18 ug inhaled qd was given in the control group,non-invasive ventilator ventilation(mode BiPAP or CPAP) was given to moderate tracheobronchomalacia patients on the basis of conventional treatment. Severe tracheobronchomalacia patients were given airway stent implantation according to theneeds, and patients with pulmonary infection were treated with anti-infective. On the basisof the control group, the observation group was supplemented with tiaobufeishen recipe, one dose per day, three times a day. The lung function, CRP(c-reactive protein), PCT(procalcitonin), mMRC(Modified British medical research council), and CAT(Chronicobstructive pulmonary disease assessment test)score were observed and analyzed in two groups before and after treatments. Results: Compared with baseline values, the control group and observation group can improve lung function in patients with FEV1, reduce CRP and PCT, improved dyspnea index and the CAT scores, which have statistical difference. But two groups both can't improve the FEV1/FVC, DLCO, PO2, PCO2 and RV/TLC. Compared with groups, observation groupcan better improve PO2, mMRC and the CAT scores, and improve the patients quality of life, which have statistical difference. But two groups both can't improve the FEV1,FEV1/FVC, DLCO, PCO2 and RV/TLC. Conclusion: The tiaobufeishen recipe have affirmative curative effect for COPD and tracheobronchomalacia, Which deserved further research.
引文
[1]Zhong N,Wang C,Yao W,et al. Prevalence of Chronic Obstructive Pulmonary Disease in China :a large,population-based survey [J].Am J Respir Crit Care Med,2007,176(8):753-760.
[2]Lee KS,Sun MR,Ernst A,et al.Comparison of Dynamic Expiratory CT with Bronchoscopy for Diagnosing Airway Malacia:a pilot evaluation [J].Chest.2007,131(131):758-764.
[3]Global Initiative for Chronic Obstructive Lung Disease (GOLD): Global Strategy for the Diagnosis,Management and prevention of Chronic Obstructive Pulmonary Disease. (2017 REPORT). Http://www.goldcopd.org.
[4]Lee EY, Litmanovich D, Boiselle PM, et al. Multidetector CT evaluation of tracheobronchomalacia [J]. Radiol Clin North Am,2009,47(2):261-269.
[5]Gilkeson RC,Ciancibello LM,Hejal RB,et al.Tracheobronchomalacia:Dynamic Airway Evaluation with Multidetector CT [J]. AJR Am J Roentgenol.2001,176(1):205-210.
[6]Ernst A, Odell DD, Michaud G, et al. Central airway stabilization for tracheobronchomalacia improves quality of life in patients with COPD [J]. Chest.2011,(140)5 :1162-1168.
[7]Heussel CP, Ley S, Biedermann A, et al. Respiratory lumenal change of the pharynx and trachea in normal subjects and COPD Patients:assessment by cine-MRI [J]. Eur Radiol.2004,14(12):2188-2197.
[8]Loring SH, O’donnell CR, Feller Kopman DJ, et al. Central airway mechanics and flow limitation in acquired tracheobronchomalacia [J]. Chest.2007,131(4):1118-1124.
[9]Sverzellati N, Rastelli A, Chetta A, et al. Airway malacia in chronic obstructive pulmonary disease: prevalence, morphology and relationship with emphysema, bronchiectasis and bronchial wall thickening [J]. Eur Radiol.2009,19(7) :1669-1678.
[10]赵会泽,于冰,汪建新. 气管支气管软化症2例[J]. 临床荟萃, 1994, 9(8): 381-382.
[11]周鹏程,夏前明,李雪莲,等. 慢性阻塞性肺疾病合并支气管软化症的临床分析[J]. 中华肺部疾病杂志(电子版), 2016, 9(6): 676-677.
[12]周鹏程,余薇,李雪莲,等. 气道支架置入治疗慢性阻塞性肺疾病相关性重度双侧主支气管软化症一例[J]. 中华肺部疾病杂志(电子版), 2016, 9(3): 320-321.
[13]中华中医药学会内科分会肺系病专业委员会. 慢性阻塞性肺疾病中医诊疗指南(2011版) [J]. 中医杂志, 2012, 53(1):80-84.
[14]郑劲平. 慢性阻塞性肺疾病的肺功能检查中FEV1与IC的临床应用[J]. 中国实用内科杂志2014,34(1):1-4.
[15]谢梅,骆艳妮,李娜,等. 慢性阻塞性肺疾病的长期肺功能变化及影响因素[J]. 中国临床研究, 2018, 31(11): 1449-1452.
[16]郭艳立. C-反应蛋白与降钙素原检测在慢性阻塞性肺疾病感染患者诊治中的临床应用[J].吉林医学, 2019, 40(1): 53-54.
[17]王金荣,邵立业,郭伟,等. 机械通气患者呼气末二氧化碳分压与动脉血二氧化碳分压的相关性研究[J]. 中国呼吸与危重监护杂志, 2018, 17(1): 71-75.
[18]陈培,官和立,杨恂,等. 残总比对慢性阻塞性肺疾病诊断的临床意义[J]. 现代临床医学, 2014,40(6): 416-418.
[19]张凤蕊,平芬,韩书芝,等. 老年慢性阻塞性肺疾病患者夜间经皮二氧化碳分压、氧分压及血氧饱和度的变化[J]. 中国老年学杂志, 2015, 35(20): 5849-5851.
[20]赵冲. CAT、mMRC、CCQ、SGRQ 四种评分系统在COPD患者肺功能及生活质量评价中的价值与差异[J]. 临床肺科杂志, 2018, 23(11): 2060-2064.
[21]曾时杰,汪丹阳,张至强,等. 六味补气颗粒剂联合舒利迭治疗COPD稳定期患者的临床研究[J]. 南京中医药大学学报, 2019, 35(1): 16-20.
[22]Zhou PC, Yu W, Chen KL, et al. Effect of the Tiaobufeishen decoction on Caveolin-1-p38 MAPK signaling pathway and mechanism of improving the tracheobronchomalacia in chronic obstructive pulmonary disease [J].TMR Integr Med, 2019, 3: e19002.
[2]Lee KS,Sun MR,Ernst A,et al.Comparison of Dynamic Expiratory CT with Bronchoscopy for Diagnosing Airway Malacia:a pilot evaluation [J].Chest.2007,131(131):758-764.
[3]Global Initiative for Chronic Obstructive Lung Disease (GOLD): Global Strategy for the Diagnosis,Management and prevention of Chronic Obstructive Pulmonary Disease. (2017 REPORT). Http://www.goldcopd.org.
[4]Lee EY, Litmanovich D, Boiselle PM, et al. Multidetector CT evaluation of tracheobronchomalacia [J]. Radiol Clin North Am,2009,47(2):261-269.
[5]Gilkeson RC,Ciancibello LM,Hejal RB,et al.Tracheobronchomalacia:Dynamic Airway Evaluation with Multidetector CT [J]. AJR Am J Roentgenol.2001,176(1):205-210.
[6]Ernst A, Odell DD, Michaud G, et al. Central airway stabilization for tracheobronchomalacia improves quality of life in patients with COPD [J]. Chest.2011,(140)5 :1162-1168.
[7]Heussel CP, Ley S, Biedermann A, et al. Respiratory lumenal change of the pharynx and trachea in normal subjects and COPD Patients:assessment by cine-MRI [J]. Eur Radiol.2004,14(12):2188-2197.
[8]Loring SH, O’donnell CR, Feller Kopman DJ, et al. Central airway mechanics and flow limitation in acquired tracheobronchomalacia [J]. Chest.2007,131(4):1118-1124.
[9]Sverzellati N, Rastelli A, Chetta A, et al. Airway malacia in chronic obstructive pulmonary disease: prevalence, morphology and relationship with emphysema, bronchiectasis and bronchial wall thickening [J]. Eur Radiol.2009,19(7) :1669-1678.
[10]赵会泽,于冰,汪建新. 气管支气管软化症2例[J]. 临床荟萃, 1994, 9(8): 381-382.
[11]周鹏程,夏前明,李雪莲,等. 慢性阻塞性肺疾病合并支气管软化症的临床分析[J]. 中华肺部疾病杂志(电子版), 2016, 9(6): 676-677.
[12]周鹏程,余薇,李雪莲,等. 气道支架置入治疗慢性阻塞性肺疾病相关性重度双侧主支气管软化症一例[J]. 中华肺部疾病杂志(电子版), 2016, 9(3): 320-321.
[13]中华中医药学会内科分会肺系病专业委员会. 慢性阻塞性肺疾病中医诊疗指南(2011版) [J]. 中医杂志, 2012, 53(1):80-84.
[14]郑劲平. 慢性阻塞性肺疾病的肺功能检查中FEV1与IC的临床应用[J]. 中国实用内科杂志2014,34(1):1-4.
[15]谢梅,骆艳妮,李娜,等. 慢性阻塞性肺疾病的长期肺功能变化及影响因素[J]. 中国临床研究, 2018, 31(11): 1449-1452.
[16]郭艳立. C-反应蛋白与降钙素原检测在慢性阻塞性肺疾病感染患者诊治中的临床应用[J].吉林医学, 2019, 40(1): 53-54.
[17]王金荣,邵立业,郭伟,等. 机械通气患者呼气末二氧化碳分压与动脉血二氧化碳分压的相关性研究[J]. 中国呼吸与危重监护杂志, 2018, 17(1): 71-75.
[18]陈培,官和立,杨恂,等. 残总比对慢性阻塞性肺疾病诊断的临床意义[J]. 现代临床医学, 2014,40(6): 416-418.
[19]张凤蕊,平芬,韩书芝,等. 老年慢性阻塞性肺疾病患者夜间经皮二氧化碳分压、氧分压及血氧饱和度的变化[J]. 中国老年学杂志, 2015, 35(20): 5849-5851.
[20]赵冲. CAT、mMRC、CCQ、SGRQ 四种评分系统在COPD患者肺功能及生活质量评价中的价值与差异[J]. 临床肺科杂志, 2018, 23(11): 2060-2064.
[21]曾时杰,汪丹阳,张至强,等. 六味补气颗粒剂联合舒利迭治疗COPD稳定期患者的临床研究[J]. 南京中医药大学学报, 2019, 35(1): 16-20.
[22]Zhou PC, Yu W, Chen KL, et al. Effect of the Tiaobufeishen decoction on Caveolin-1-p38 MAPK signaling pathway and mechanism of improving the tracheobronchomalacia in chronic obstructive pulmonary disease [J].TMR Integr Med, 2019, 3: e19002.
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