补肾化痰、祛瘀通络膏对哮喘-慢阻肺重叠综合征缓解期患者肺功能和血清白三烯B_4水平的影响
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摘要
目的观察补肾化痰、祛瘀通络膏对哮喘-慢阻肺重叠综合征(ACOS)缓解期患者肺功能和血清白三烯B_4(LTB_4)水平的影响。方法将100例ACOS缓解期患者按照随机数字表法分为2组。对照组50例予西医治疗;治疗组50例在对照组治疗基础上加补肾化痰、祛瘀通络膏治疗。2组疗程3个月。观察2组治疗前后哮喘控制测试(ACT)评分及慢阻肺症状测试(CAT)评分变化,肺功能指标第1 s用力呼气容积占预计值百分比(FEV_1%)、FEV_1/用力肺活量(FVC)、呼气高峰流量(PEFR)变化,LTB_4水平变化;观察2组治疗期间及治疗后6个月内急性加重次数,并进行安全性评价。结果 2组治疗后ACT评分均较本组治疗前升高(P<0.05),CAT评分降低(P<0.05);且治疗组治疗后ACT评分高于对照组(P<0.05),CAT评分低于对照组(P<0.05)。2组治疗后FEV_1/FVC、FEV_1%及PEFR均较本组治疗前升高(P<0.05),且治疗组升高更明显(P<0.05)。2组治疗后血清LTB_4水平均较本组治疗前降低(P<0.05),且治疗组降低更明显(P<0.05)。治疗组治疗期间、治疗后6个月内急性加重次数均较对照组少(P<0.05)。治疗组不良反应发生率8.0%,对照组不良反应发生率12.0%,治疗组不良反应发生率低于对照组(P<0.05)。结论补肾化痰、祛瘀通络膏联合西医治疗ACOS缓解期,可显著改善患者临床症状及肺功能,降低血清LTB_4水平,减少急性加重次数,降低不良反应发生率。
Objective To observe the clinical effect of Bushen Huatan-Quyu Tongluo ointment on pulmonary function and serum leukotriene B_4(LTB_4)level in patients with asthma-COPD overlap syndrome(ACOS) in remission stage. Methods 100 ACOS patients in remission stage were divided into two groups according to random number table method. 50 cases in the control group were treated by western medicine. 50 cases in treatment group were treated by Bushen Huatan-Quyu Tongluo ointment on the basis of the control group. Both groups were treated for 3 months. The changes of asthma control test(ACT) score, chronic obstructive pulmonary symptom test(CAT) score, the percentage of forced expiratory volume(FEV_1%), FEV_1/forced vital capacity(FVC), peak expiratory flow(PEFR) and LTB_4 level before and after treatment in two groups were observed. The times of acute exacerbation was observed during treatment period and within 6 months after treatment, and the safety was evaluated. Results After treatment, the ACT score in two groups were higher than those in the group before treatment(P<0.05), and the CAT score were decreased(P<0.05). The ACT score of the treatment group was higher than that of the control group(P<0.05), the CAT score was lower than the control group(P<0.05). After treatment, FEV_1/FVC, FEV_1% and PEFR in two groups were higher than those in the group before treatment(P<0.05), and the increase in the treatment group was more obvious(P<0.05). After treatment, the serum LTB_4 level in two groups were lower than that in the group before treatment(P<0.05), and the decrease in the treatment group was more obvious(P<0.05). The times of acute exacerbation in the treatment group was less than that in the control group during the treatment period and within 6 months after treatment(P<0.05). The incidence of adverse reactions was 8.0% in treatment group and 12.0% in the control group. The incidence of adverse reactions in the treatment group was lower than that in the control group(P<0.05). Conclusion Bushen Huatan-Quyu Tongluo ointment combined with western medicine can significantly improve the clinical symptoms and lung function of patients with ACOS in remission stage, reduce the level of serum LTB4, reduce the number of acute exacerbations, and reduce the incidence of adverse reactions.
Objective To observe the clinical effect of Bushen Huatan-Quyu Tongluo ointment on pulmonary function and serum leukotriene B_4(LTB_4)level in patients with asthma-COPD overlap syndrome(ACOS) in remission stage. Methods 100 ACOS patients in remission stage were divided into two groups according to random number table method. 50 cases in the control group were treated by western medicine. 50 cases in treatment group were treated by Bushen Huatan-Quyu Tongluo ointment on the basis of the control group. Both groups were treated for 3 months. The changes of asthma control test(ACT) score, chronic obstructive pulmonary symptom test(CAT) score, the percentage of forced expiratory volume(FEV_1%), FEV_1/forced vital capacity(FVC), peak expiratory flow(PEFR) and LTB_4 level before and after treatment in two groups were observed. The times of acute exacerbation was observed during treatment period and within 6 months after treatment, and the safety was evaluated. Results After treatment, the ACT score in two groups were higher than those in the group before treatment(P<0.05), and the CAT score were decreased(P<0.05). The ACT score of the treatment group was higher than that of the control group(P<0.05), the CAT score was lower than the control group(P<0.05). After treatment, FEV_1/FVC, FEV_1% and PEFR in two groups were higher than those in the group before treatment(P<0.05), and the increase in the treatment group was more obvious(P<0.05). After treatment, the serum LTB_4 level in two groups were lower than that in the group before treatment(P<0.05), and the decrease in the treatment group was more obvious(P<0.05). The times of acute exacerbation in the treatment group was less than that in the control group during the treatment period and within 6 months after treatment(P<0.05). The incidence of adverse reactions was 8.0% in treatment group and 12.0% in the control group. The incidence of adverse reactions in the treatment group was lower than that in the control group(P<0.05). Conclusion Bushen Huatan-Quyu Tongluo ointment combined with western medicine can significantly improve the clinical symptoms and lung function of patients with ACOS in remission stage, reduce the level of serum LTB4, reduce the number of acute exacerbations, and reduce the incidence of adverse reactions.
引文
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[22] Celli BR,Halbert RJ,Isonaka S,et al.Population impact of different definitions of airway obstruction[J].Eur Respir J,2003,22(2):268-273.
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[24] Csoma Z,Kharitonov SA,Balint B,et al.Increased leukotrienes in exhaled breath condensate in childhood asthma[J].Am J Respir Crit Care Med,2002,166(10):1345-1349.
[25] Hacievliyagil SS,Gunen H,Mutlu LC,et al.Association between cytokines in induced sputum and severity of chronic obstructive pulmonary disease[J].Respir Med,2006,100(5):846-854.
[2] Shaya FT,Dongyi D,Akazawa MO,et al.Burden of concomitant asthma and COPD in a Medicaid population[J].Chest,2008,134(1):14-19.
[3] de Marco R,Pesce G,Marcon A,et al.The coexistence of asthma and chronic obstructive pulmonary disease(COPD):prevalence and risk factors in young,middle-aged and elderly people from the general population[J].PLoS One,2013,8(5):e62985.
[4] 刘晓芳,孙永昌,金建敏,等.慢性阻塞性肺疾病合并变应性支气管肺曲霉病三例临床分析[J].中华结核和呼吸杂志,2013,36(10):741-745.
[5] Soler-Catalua JJ,Cosío B,Izquierdo JL,et al.Consensus document on the overlap phenotype COPD-asthma in COPD[J].Arch Bronconeumol,2012,48(9):331-337.
[6] 国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:4-5.
[7] 李为民,刘伦旭.呼吸系统疾病基础与临床[M].北京:人民卫生出版社,2017:804.
[8] Nathan RA,Sorkness CA,Kosinski M,et al.Development of the asthma control test:a survey for assessing asthma control [J].J Allergy Clin Immunol,2004,113(1):59-65.
[9] Jones PW,Harding G,Berry P,et al.Development and first validation of the COPD Assessment Test[J].Eur Respir J,2009,34(3):648-654.
[10] Zeki AA,Schivo M,Chan A,et al.The Asthma-COPD Overlap Syndrome:A Common Clinical Problem in the Elderly[J].J Allergy(Cairo),2011:861-926.
[11] Vogelmeier CF,Criner GJ,Martinez FJ,et al.Global Strategy for the Diagnosis,Management,and Prevention of Chronic Obstructive Lung Disease 2017 Report[J].Am J Respir Crit Care Med,2017,195(5):557-582.
[12] Magnussen H,Bugnas B,van Noord J,et al.Improvements with tiotropium in COPD patients with concomitant asthma[J].Respir Med,2008,102(1):50-56.
[13] Chung JW,Kong KA,Lee JH,et al.Characteristics and self-rated health of overlap syndrome[J].Int J Chron Obstruct Pulmon Dis,2014,9:795-804.
[14] 董竞成,张红英,魏颖,等.基于气道慢性炎症性疾病之肺肾气虚证型内涵的现代认识与实践[J].中国中西医结合杂志,2015,35(5):521-528.
[15] 孙子凯,陈玉超,董筠,等.周仲瑛辨治慢性阻塞性肺疾病经验[J].辽宁中医杂志,2013,40(5):881-882.
[16] 陈维志,张治,陈路光,等.化痰活血降气方联合西药治疗哮喘-慢阻肺重叠综合征急性发作期临床观察[J].新中医,2017,49(5):35-37.
[17] 杨红梅,梁爱武,陆彩云,等.扶肺固肾饮治疗稳定期慢性阻塞性肺疾病[J].中医学报,2018,33(10):1882-1886.
[18] 甄绍先.鹿角胶平喘偶得[J].浙江中医杂志,2010,45(7):515.
[19] 夏庆华,路千里.熟地黄药理研究进展[J].江西中医学院学报,2008,20(6):96-97.
[20] 郑素玉,陈健.巴戟天有效成分及其药理作用实验研究进展[J].世界中西医结合杂志,2012,7(9):823-825,828.
[21] Zhou X,Ding FM,Lin JT,et al.Validity of Asthma Control Test in Chinese patients[J].Chin Med J(Engl),2007,120(12):1037-1041.
[22] Celli BR,Halbert RJ,Isonaka S,et al.Population impact of different definitions of airway obstruction[J].Eur Respir J,2003,22(2):268-273.
[23] 丁艳苓,姚婉贞.白三烯B4与肺部疾病[J].临床内科杂志,2005,22(11):790-792.
[24] Csoma Z,Kharitonov SA,Balint B,et al.Increased leukotrienes in exhaled breath condensate in childhood asthma[J].Am J Respir Crit Care Med,2002,166(10):1345-1349.
[25] Hacievliyagil SS,Gunen H,Mutlu LC,et al.Association between cytokines in induced sputum and severity of chronic obstructive pulmonary disease[J].Respir Med,2006,100(5):846-854.