目的 探讨清肺消炎丸联合沙丁胺醇治疗慢性阻塞性肺疾病急性加重期（AECOPD）的临床效果。方法 选取2019年3月—2020年10月天津市人民医院收治的106例AECOPD患者，使用随机数字表法将其随机分成对照组（n=53）和治疗组（n=53）。对照组给予氧气驱动雾化吸入硫酸沙丁胺醇雾化吸入溶液，2.5 mg/次，3次/d。治疗组在对照组基础上口服清肺消炎丸，60丸/次，3次/d。两组均连续治疗14 d。观察两组的临床疗效，比较两组典型症状缓解时间、改良版英国医学研究委员会呼吸问卷（mMRC）评分、慢性阻塞性肺疾病患者自我评估测试（CAT）评分、肺功能相关参数、中性粒细胞与淋巴细胞比值（NLR），血清淀粉样蛋白A（SAA）、基质金属蛋白酶（MMP）-9、基质金属蛋白酶抑制剂-1（TIMP-1）水平及MMP-9/TIMP-1比值。结果 治疗后，治疗组总有效率为94.3%，显著高于对照组的81.1%（P<0.05）。治疗组咳嗽、咳痰、喘息和肺部哮鸣音的缓解时间较对照组均显著缩短（P<0.05）。治疗后，两组mMRC评分及CAT评分均显著低于本组治疗前（P<0.05）；且治疗后治疗组以上评分的降低作用较对照组更显著（P<0.05）。治疗后，两组第1秒用力呼气容积（FEV₁）占预计值、FEV₁与用力肺活量比值（FEV₁/FVC）均较本组治疗前显著升高，但残气容积与肺总量比值（RV/TLC）则均显著降低（P<0.05）；且治疗后，治疗组肺功能参数改善优于对照组（P<0.05）。治疗后，两组NLR及血清SAA、MMP-9、TIMP-1水平和MMP-9/TIMP-1比值均较本组治疗前显著下降（P<0.05）；且治疗后，治疗组NLR和血清学指标改善优于对照组（P<0.05）。结论 清肺消炎丸联合沙丁胺醇治疗AECOPD的总体疗效满意，能安全有效且迅速地控制患者症状和体征，改善其肺通气功能，并可进一步减轻患者体内炎症反应、纠正其MMP-9/TIMP-1失衡。

Objective To investigate the clinical effect of Qingfei Xiaoyan Pills combined with salbutamol in treatment of acute exacerbation of chronic obstructive pulmonary disease. Methods A total of 106 AECOPD patients admitted to Tianjin People's Hospital from March 2019 to October 2020 were randomly divided into control group (n=53) and treatment group (n=53) by random number table method. Patients in the control group were given oxygen driven atomized inhalation of Salbutamol Sulfate Nebules Inhalation Solution, 2.5 mg/time, 3 times daily. Patients in the treatment group were po administered with Qingfei Xiaoyan Pills on the basis of the control group, 60 pills/time, 3 times daily. Both groups were treated for 14 d. The clinical efficacy of the two groups was observed. Typical symptom relief time of two groups, improved version of the medical research council respiratory questionnaire (mMRC), chronic obstructive pulmonary disease patients self assessment test (CAT) score, pulmonary function related parameters, neutrophils and lymphocytes ratio (NLR), serum amyloid A (SAA), matrix metalloproteinases (MMP)-9, matrix metalloproteinase-1 (TIMP-1) level and MMP-9/TIMP-1 ratio in two groups were compared. Results After treatment, the total effective rate in the treatment group was 94.3%, significantly higher than that in the control group (81.1%) (P< 0.05). The relief time of cough, expectoration, wheezing and pulmonary wheezing in treatment group was significantly shorter than that in control group (P < 0.05). After treatment, mMRC score and CAT score in two groups were significantly lower than before (P < 0.05). After treatment, the effect of above score in treatment group was more significant than that in control group (P < 0.05). After treatment, forced expiratory volume in the first second (FEV₁)% and the ratio of FEV₁ to forced vital capacity (FEV₁/FVC) in both groups were significantly increased compared with before treatment, but the ratio of residual gas volume to total lung volume (RV/TLC) was significantly decreased in both groups (P < 0.05). After treatment, the improvement of lung function parameters in the treatment group was better than that in the control group (P < 0.05). After treatment, NLR, serum SAA, MMP-9, TIMP-1 levels, and MMP-9/TIMP-1 ratio in two groups was significantly decreased compared with before treatment (P< 0.05). After treatment, NLR and serological indexes in the treatment group were improved better than those in the control group (P < 0.05). Conclusion Qingfei Xiaoyan Pills combined with salbutamol has satisfactory overall efficacy in the treatment of AECOPD, and can safely, effectively and quickly control the symptoms and signs of patients, improve their lung ventilation function, and can further reduce the inflammatory response in the patients' body and correct their MMP-9/TIMP-1 imbalance.

R974

天津市卫生和计划生育委员会科研基金资助项目（2017KZ009）