泻白散合泻心汤加减治疗痰热壅肺证重症肺炎临床研究
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摘要
目的:观察泻白散合泻心汤加减治疗痰热壅肺证重症肺炎的临床疗效,探讨其对血清可溶性髓系细胞触发受体1(sTREM-1)和可溶性尿激酶型纤溶酶原激活物受体(suPAR)水平的影响。方法:将重症肺炎患者72例随机分为治疗组和对照组,各36例。对照组予常规康复综合疗法;治疗组在对照组基础上予泻白散合泻心汤加减治疗;2组连续治疗2周,比较2组患者痰热壅肺证积分、急性生理和慢性健康状况评分Ⅱ(APACHEⅡ)及临床疗效,检测2组患者血清sTREM-1、suPAR水平。结果:总有效率治疗组为97.22%,对照组为77.78%,2组比较,差异有统计学意义(P <0.05)。治疗后,2组壮热、咳嗽、气促胸痛、口渴、腹胀等痰热壅肺证候积分均较治疗前显著降低(P <0.05);且治疗组上述各项积分明显低于对照组(P <0.05)。治疗后,2组血清sTREM-1、suPAR水平较治疗前显著降低(P <0.05);且治疗组s TREM-1、suPAR水平明显低于对照组(P <0.05)。治疗后,2组APACHEⅡ评分均较治疗前显著降低(P <0.05);且治疗组APACHEⅡ评分明显低于对照组(P <0.05)。结论:在常规康复治疗基础上,泻白散合泻心汤加减治疗痰热壅肺证重症肺炎疗效确切,下调患者血清sTREM-1、suPAR水平可能是其疗效途径之一。
Objective:To observe the clinical effect of modified Xiebai powder combined with Xiexin tang for severe pneumonia with phlegm-heat obstructing lung syndrome, and discuss its effect on the levels of soluble triggering receptor expressed on myeloid cells-1(sT REM-1)and soluble urokinase-type plasminogen activator receptor(suPAR)in serum. Methods: Divided 72 cases of patients with severe pneumonia into the treatment group and the control group randomly,36 cases in each group. The control group received the routine comprehensive rehabilitation therapy, while the treatment group additionally received modified Xiebai powder combined with Xiexin tang. The treatment for both groups lasted for 2 weeks. Compared the scores of phlegm-heat obstructing lung syndrome,scores of acute physiology and chronic health evaluation(APACHE II)and clinical effect of patients in both groups, and detected the levels of sT REM-1 and suPAR in serum of patients in both groups. Results: The total effective rate was 97.22% in the treatment group and77.78% in the control group, difference being significant(P < 0.05). After treatment, the scores of such symptoms as cough, high fever,thirsty and abdominal distention in both groups were significantly lower than those before treatment(P < 0.05);each score above in the treatment group was significantly lower than that in the control group(P < 0.05). After treatment, the levels of sT REM-1 and suPAR in serum of patients in both groups were significantly lower than those before treatment(P < 0.05);the levels of sT REM-1 and suPAR in serum of patients in the treatment group were significantly lower than those in the control group(P < 0.05). After treatment,the scores of APACHE II in both groups were significantly lower than those before treatment(P < 0.05); the scores of APACHE II in the treatment group were significantly lower than those in the control group(P < 0.05). Conclusion: Based on the routine rehabilitation therapy, modified Xiebai powder combined with Xiexin tang has exact clinical effect in treating severe pneumonia with phlegm-heat obstructing lung syndrome. One of its approaches to the therapeutic effect may be down-regulating the levels of sT REM-1 and suPAR in serum.
Objective:To observe the clinical effect of modified Xiebai powder combined with Xiexin tang for severe pneumonia with phlegm-heat obstructing lung syndrome, and discuss its effect on the levels of soluble triggering receptor expressed on myeloid cells-1(sT REM-1)and soluble urokinase-type plasminogen activator receptor(suPAR)in serum. Methods: Divided 72 cases of patients with severe pneumonia into the treatment group and the control group randomly,36 cases in each group. The control group received the routine comprehensive rehabilitation therapy, while the treatment group additionally received modified Xiebai powder combined with Xiexin tang. The treatment for both groups lasted for 2 weeks. Compared the scores of phlegm-heat obstructing lung syndrome,scores of acute physiology and chronic health evaluation(APACHE II)and clinical effect of patients in both groups, and detected the levels of sT REM-1 and suPAR in serum of patients in both groups. Results: The total effective rate was 97.22% in the treatment group and77.78% in the control group, difference being significant(P < 0.05). After treatment, the scores of such symptoms as cough, high fever,thirsty and abdominal distention in both groups were significantly lower than those before treatment(P < 0.05);each score above in the treatment group was significantly lower than that in the control group(P < 0.05). After treatment, the levels of sT REM-1 and suPAR in serum of patients in both groups were significantly lower than those before treatment(P < 0.05);the levels of sT REM-1 and suPAR in serum of patients in the treatment group were significantly lower than those in the control group(P < 0.05). After treatment,the scores of APACHE II in both groups were significantly lower than those before treatment(P < 0.05); the scores of APACHE II in the treatment group were significantly lower than those in the control group(P < 0.05). Conclusion: Based on the routine rehabilitation therapy, modified Xiebai powder combined with Xiexin tang has exact clinical effect in treating severe pneumonia with phlegm-heat obstructing lung syndrome. One of its approaches to the therapeutic effect may be down-regulating the levels of sT REM-1 and suPAR in serum.
引文
[1]田佳.早期营养支持联合谷氨酰胺和低分子肝素对老年重症肺炎患者的疗效研究[J].重庆医学,2016,45(19):2648-2651.
[2]刘德智,周霞,高尚兰.清肺承气汤辅助治疗重症肺炎痰热壅肺证临床分析[J].中国实验方剂学杂志,2016,22(8):191-195.
[3]管奕婷.泻白散加减治疗痰热蕴肺型社区获得性肺炎疗效观察[J].吉林医学,2014,35(12):2565.
[4]梁锐中.泻心汤随证加减治疗慢性胃炎、消化性溃荡90例临床观察[J].中医临床研究,2017,9(26):51-52.
[5]DEY S,KARIM H M R,YUNUS M,et al.Relationship of on admission hypocalcaemia and illness severity as measured by APACHE-Ⅱand SOFA score in intensive care patients[J].J Clin Diagn Res,2017,11(3):UC01-UC03.
[6]MANDELL L A,WUNDERINK R G,ANZUETO A,et al.Infectious diseases society of American/American thoracic society consensus guidelines on the management of communityacquired pneumonia in adults[J].Clin Infect Dis,2007,44(Suppl 2):27-72.
[7]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:53-58.
[8]国家中医药管理局.ZY/T001.1~001.9-94中医病证诊断疗效标准[S].南京:南京大学出版社,1994:286-287.
[9]黄婧文,李冬玲.自拟宣壅清肺汤辅助西医治疗重症肺炎(痰热壅肺证)临床观察[J].中国中医急症,2017,26(1):155-157.
[10]孙印,韦海燕,何士杰.重症肺炎患者血清suPAR、s TREM-1水平变化及意义[J].山东医药,2017,57(22):59-60.
[2]刘德智,周霞,高尚兰.清肺承气汤辅助治疗重症肺炎痰热壅肺证临床分析[J].中国实验方剂学杂志,2016,22(8):191-195.
[3]管奕婷.泻白散加减治疗痰热蕴肺型社区获得性肺炎疗效观察[J].吉林医学,2014,35(12):2565.
[4]梁锐中.泻心汤随证加减治疗慢性胃炎、消化性溃荡90例临床观察[J].中医临床研究,2017,9(26):51-52.
[5]DEY S,KARIM H M R,YUNUS M,et al.Relationship of on admission hypocalcaemia and illness severity as measured by APACHE-Ⅱand SOFA score in intensive care patients[J].J Clin Diagn Res,2017,11(3):UC01-UC03.
[6]MANDELL L A,WUNDERINK R G,ANZUETO A,et al.Infectious diseases society of American/American thoracic society consensus guidelines on the management of communityacquired pneumonia in adults[J].Clin Infect Dis,2007,44(Suppl 2):27-72.
[7]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:53-58.
[8]国家中医药管理局.ZY/T001.1~001.9-94中医病证诊断疗效标准[S].南京:南京大学出版社,1994:286-287.
[9]黄婧文,李冬玲.自拟宣壅清肺汤辅助西医治疗重症肺炎(痰热壅肺证)临床观察[J].中国中医急症,2017,26(1):155-157.
[10]孙印,韦海燕,何士杰.重症肺炎患者血清suPAR、s TREM-1水平变化及意义[J].山东医药,2017,57(22):59-60.
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