[关键词]
[摘要]
目的 探讨慢性阻塞性肺疾病急性加重期应用疏风解毒胶囊联合硫酸特布他林雾化液治疗的临床效果。方法 选取2017年1月-2018年12月北京市大兴区中西医结合医院收治的309例慢性阻塞性肺疾病急性加重期患者,采取随机数字表法将其随机分成对照组(n=154)和治疗组(n=155)。对照组雾化吸入硫酸特布他林雾化液(5 mg/次,3次/d),治疗组在此基础上口服疏风解毒胶囊(2.08 g/次,3次/d),所有患者均治疗14 d。比较两组临床疗效及主要症状、体征的缓解时间。治疗前后,使用改良版英国医学研究委员会呼吸问卷(mMRC)评估两组患者呼吸困难的严重程度,采用慢性阻塞性肺疾病患者自我评估测试问卷(CAT)对受试者综合症状进行评价,常规测定肺功能参数[第1秒用力呼气容积(FEV1)与用力肺活量(FVC)比值(FEV1/FVC)、FEV1占预计值百分比(FEV1占预计值%)]及呼出气一氧化氮(FeNO)浓度,分别选用酶联免疫法、免疫透射比浊法检测血清白介素(IL)-8、C反应蛋白(CRP)水平,再利用流式细胞仪测定外周血辅助性T细胞(Th)1、Th2占CD4+ T细胞的比例。并统计两组药物不良事件发生情况。结果 治疗组总有效率为95.5%,显著高于对照组(86.4%),两组比较差异有统计学意义(P<0.05)。治疗组主要症状(咳嗽、咳痰、喘息)及肺部哮鸣音的缓解时间较对照组均显著缩短(P<0.05)。两组治疗后mMRC、CAT评分均显著低于治疗前(P<0.05),而FEV1/FVC、FEV1占预计值%值均显著更高(P<0.05);且治疗后,治疗组以上问卷评分及肺功能指标的改善效果较对照组同期均更显著(P<0.05)。与治疗前对比,两组治疗后FeNO浓度及血清IL-8、CRP水平和外周血Th1、Th2细胞比例均显著降低(P<0.05);但治疗组上述指标的改善效果均更显著(P<0.05)。对照组和治疗组的不良反应发生率分别是2.6%、3.2%,两组比较差异无统计学意义。结论 疏风解毒胶囊联合特布他林治疗慢性阻塞性肺疾病急性加重期的整体疗效确切,可迅速稳定患者病情,缓解气流受限,减轻气道炎症与系统性炎症,抑制免疫过激,具有一定的临床推广应用价值。
[Key word]
[Abstract]
Objective To investigate the clinical effect of Shufeng Jiedu Capsules combined with terbutaline in treatment of acute exacerbation of chronic obstructive pulmonary disease. Methods A total of 309 patients with acute exacerbation of chronic obstructive pulmonary disease admitted to Beijing Daxing District Integrated Traditional Chinese and Western Medicine Hospital from January 2017 to December 2018 were randomly divided into control group (n=154) and treatment group (n=155). The control group was given Terbutaline Sulphate Solution for nebulization, 5 mg/time, three times daily. The treatment group was po administered with Shufeng Jiedu Capsules, 2.08 g/time, three times daily. All patients were treated for 14 d. The clinical efficacy and the relief time of the main symptoms and signs were compared between two groups. Before and after treatment, the modified British Medical Research Council Respiratory Questionnaire (mMRC) was used to assess the severity of dyspnea in both groups. The self-assessment test questionnaire (CAT) for patients with chronic obstructive pulmonary disease was used to evaluate the syndrome of the subjects. Pulmonary function parameters[1st forced expiratory volume (FEV1) and forced vital capacity (FVC) ratio (FEV1/FVC), FEV1 as a percentage of predicted value (FEV1 as predicted value)] and exhaled nitric oxide (FeNO) serum interleukin (IL)-8 and C-reactive protein (CRP) levels were determined by enzyme-linked immunosorbent assay and immunoturbidimetric assay, respectively. The proportion of helper T cells (Th) 1 and Th2 in CD4+ T cells in peripheral blood was determined by flow cytometry. And the incidence of adverse drug events in the two groups was calculated. Results The total effective rate of the treatment group was 95.5%, which was significantly higher than that of the control group (86.4%), and there were differences between two groups (P < 0.05). The remission time of the main symptoms (cough, cough, wheezing) and lung wheezing in the treatment group was significantly shorter than that in the control group (P < 0.05). The scores of mMRC and CAT were significantly lower in the two groups than before treatment (P < 0.05), while the values of FEV1/FVC and FEV1 were significantly higher (P < 0.05). After treatment, the above questionnaire scores and lung function indexes were more significant than those of the control group (P < 0.05). Compared with before treatment, the levels of FeNO, serum IL-8, CRP and the ratio of Th1 and Th2 cells in peripheral blood were significantly lower (P < 0.05). However, the improvement of the above indicators in the treatment group was more significant (P < 0.05). After treatment, the adverse reaction rates in the control and treatment group were 2.6% and 3.2%, respectively, and there was no difference between two groups. Conclusion Shufeng Jiedu Capsules combined with terbutaline has overall effect in treatment of acute exacerbation of chronic obstructive pulmonary disease, and can quickly stabilize the patients' condition, and relieve airflow limitation, reduce airway inflammation and systemic inflammation, and suppress immune hyperactivity, which has a certain clinical application value.
[中图分类号]
R974
[基金项目]