目的 探讨补肺活血胶囊治疗慢性阻塞性肺疾病合并肺动脉高压的效果及对T淋巴细胞亚群的影响。方法 选取2021年1月—2023年6月在山西省中医院、山西省人民医院、山西省中西医结合医院收治的慢性阻塞性肺疾病合并肺动脉高压患者82例，随机分为试验组和对照组。试验组患者给予口服补肺活血胶囊治疗，对照组患者给予口服补肺活血胶囊安慰剂治疗。观察两组患者的临床疗效，比较两组治疗前后的免疫功能指标、肺通气功能指标水平及肺总量（total lung capacity，TLC）、一氧化碳弥散量（carbon monoxide diffusing capacity，DLCO）、肺动脉收缩压（pulmonary artery systolic pressure，PASP）、中医证候积分。采用6 min步行试验（6 min walking test，6MWT）评估运动耐量，采用慢性阻塞性肺疾病评估量表（chronic obstructive pulmonary disease assessment test scale，CAT）评估患者生活质量，采用WHO功能分级预测生存能力。结果 脱落4例，纳入分析78例。试验组患者的总有效率（69.23%）明显高于对照组（10.26%），差异有统计学意义（P<0.001）。治疗后，试验组患者T淋巴细胞亚群CD4⁺、CD4⁺/CD8⁺、第1秒用力呼气量（forced expiratory volume in the first second，FEV1）、用力肺活量（forced vital capacity，FVC）、FEV1/FVC、TLC、DLCO水平均高于治疗前，且试验组改善程度明显高于对照组，差异均有统计学意义（P<0.05）。治疗后，试验组患者的CD8^＋和PASP水平均低于治疗前，且试验组改善程度明显低于对照组，差异均有统计学意义（P<0.05）。治疗后，试验组患者6MWT距离、WHO功能分级均得到改善，且试验组改善程度好于对照组，差异均有统计学意义（P<0.05）。治疗后，两组患者CAT评分、中医证候积分均得到改善，且试验组改善程度好于对照组，差异均有统计学意义（P<0.05）。两组不良反应发生率比较差异无统计学意义。结论 补肺活血胶囊治疗慢性阻塞性肺疾病合并肺动脉高压患者，可有效改善患者肺功能，降低肺动脉压力，并可提高免疫功能、改善患者生活质量和中医证侯表现，临床治疗效果显著。

Objective To investigate the effect of Bufei Huoxue Capsules (补肺活血胶囊) on chronic obstructive pulmonary disease complicated with pulmonary arterial hypertension and its effect on T lymphocyte subsets. Methods From January 2021 to June 2023, 82 patients with chronic obstructive pulmonary disease complicated with pulmonary arterial hypertension admitted to Shanxi Hospital of Traditional Chinese Medicine, Shanxi People's Hospital and Shanxi Provincial Integrated TCM and WM Hospital were randomly divided into experimental group and control group. Patients in the experimental group were treated with oral Bufei Huoxue Capsules and patients in the control group were treated with oral Bufei Huoxue Capsules placebo. The clinical efficacy of the two groups was observed, and the immune function indexes, pulmonary ventilation index levels and total lung capacity (TLC), carbon monoxide diffusing capacity (DLCO), pulmonary artery systolic pressure (PASP), TCM syndrome scores were compared between the two groups before and after treatment. Exercise tolerance was evaluated by 6-minute walking test (6MWT), quality of life of patients was assessed using the chronic obstructive pulmonary disease assessment scale (CAT), survival ability was predicted by WHO functional classification. Results A total of 82 cases were included, four cases fell off and 78 cases were included. The total effective rate of the experimental group (69.23%) was significantly higher than that of the control group (10.26%) (P < 0.001) The levels of CD4⁺, CD4⁺/CD8⁺, forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), FEV1/FVC, TLC and DLCO in the experimental group were significantly higher than those in the control group after treatment (P < 0.05). After treatment, the levels of CD8⁺ and PASP in the experimental group were lower than those in the control group, and the improvement degree was significantly lower than that in the control group (P< 0.05). After treatment, 6MWT distance, WHO functional classification, CAT scores and TCM syndrome scores in both groups were decreased, and the improvement degree in the experimental group was higher than that in the control group (P < 0.05). Conclusion Bufei Huoxue Capsules can effectively improve pulmonary function, reduce pulmonary artery pressure, improve immune function, improve quality of life and TCM syndromes in patients with acute exacerbation of chronic obstructive pulmonary disease complicated with pulmonary arterial hypertension.

R285.64

山西省中医药研究院院级课题创新骨干人才专项（2021CXGG-01）