芩葶清肺汤联合双侧足三里穴位注射、穴位敷贴治疗痰热淤肺证AECOPD患者的疗效评价

doi:10.3760/cma.j.issn.1007-1245.2022.22.023

摘要/Abstract

摘要： 目的　研究芩葶清肺汤联合双侧足三里穴位注射、穴位敷贴治疗痰热淤肺证慢性阻塞性肺疾病急性加重期（acute exacerbation of chronic obstructive pulmonary disease，AECOPD）患者的疗效。方法　选取2018年6月至2021年6月于郑州市中医院就诊的136例痰热淤肺证AECOPD患者，简单随机分为对照组（68例）、联合组（68例）。对照组女30例，男38例；年龄（55.07±6.03）岁。联合组女31例，男37例；年龄（56.25±5.62）岁。对照组采用双侧足三里穴位注射（黄芪注射液）、穴位敷贴治疗，联合组采用芩葶清肺汤联合双侧足三里穴位注射、穴位敷贴治疗。比较2组临床疗效，治疗前及治疗14 d后中医证候积分、肺功能[用力肺活量（FVC）、第1秒用力呼气肺活量（FEV₁）、深吸气量（IC）]、红细胞免疫功能[红细胞免疫调节因子的C3b受体花环抑制率（RFIR）、红细胞免疫复合物花环（RBC-ICR）、红细胞C3b受体花环（RBC-C3bR）、红细胞免疫调节因子的C3b受体花环促进率（RFER）]、血清脂质运载蛋白-1（LCN-1）、LCN-2水平。行χ²检验、独立样本t检验。结果　联合组临床总有效率94.12%（64/68）高于对照组82.35%（56/68）（P<0.05）。治疗14 d后联合组中医证候积分低于对照组[（6.24±1.87）分比（8.03±2.16）分]（P<0.05）。治疗14 d后联合组FVC、FEV₁、IC高于对照组（均P<0.05）；治疗14 d后联合组RFER、RBC-C3bR高于对照组，RFIR、RBC-ICR低于对照组（均P<0.05）；治疗14 d后联合组血清LCN-1、LCN-2水平低于对照组（均P<0.05）。2组治疗期间均未发生严重不良反应。结论　芩葶清肺汤、双侧足三里穴位注射、穴位敷贴联合治疗痰热淤肺证AECOPD患者可有效改善临床症状，提高肺功能、红细胞免疫功能，减轻炎症状态，疗效显著，且安全性良好。

关键词: 芩葶清肺汤, 穴位注射, 穴位敷贴, 痰热淤肺证, AECOPD, LCN-1, LCN-2

Abstract: Objective　To study the efficacy of Qinting Qingfei decoction combined with bilateral Zusanli acupoint injection and acupoint application in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients with phlegm heat stasis lung syndrome. Methods　A total of 136 AECOPD patients with phlegm heat stasis lung syndrome in Zhengzhou Hospital of Traditional Chinese Medicine from June 2018 to June 2021 were selected and were simply randomly divided into a control group (68 cases) and a combined group (68 cases). There were 30 females and 38 males in the control group, aged (55.07±6.03) years; there were 31 females and 37 males in the combined group, aged (56.25±5.62) years. The control group was treated with bilateral Zusanli acupoint injection (Huangqi injection) and acupoint application, and the combined group was treated with Qinting Qingfei decoction combined with bilateral Zusanli acupoint injection and acupoint application. The clinical efficacy and TCM syndrome scores, pulmonary function [forced vital capacity (FVC), forced expiratory vital capacity in the first second (FEV₁), and inspiratory capacity (IC)], red blood cell immune function [red blood cell immunomodulator C3b receptor rosette inhibition rate (RFIR), red blood cell immune complex rosette (RBC-ICR), red blood cell C3b receptor rosette (RBC-C3bR), and red blood cell immune regulator C3b receptor rosette promotion rate (RFER)], and serum lipocalin-1 (LCN-1) and LCN-2 levels before treatment and after 14 days of treatment were compared between the two groups.χ² test and independent sample t test were used. Results　The total effective rate of the combined group was 94.12% (64/68), which was higher than that of the control group [82.35% (56/68)] (P<0.05). After 14 days of treatment, the TCM syndrome score of the combined group was lower than that of the control group [(6.24±1.87) vs. (8.03±2.16)] (P<0.05). After 14 days of treatment, the FVC, FEV₁, and IC of the combined group were higher than those of the control group (all P<0.05); the RFER and RBC-C3BR in the combined group were higher than those in the control group, and the RFIR and RBC-ICR were lower than those in the control group (all P<0.05); the serum levels of LCN-1 and LCN-2 in the combined group were lower than those in the control group (both P<0.05). No serious adverse reactions occurred in both groups during treatment. Conclusion　Qinting Qingfei decoction combined with bilateral Zusanli acupoint injection and acupoint application in the treatment of AECOPD patients with phlegm heat stasis lung syndrome can effectively improve the clinical symptoms, improve the lung function and red blood cell immune function, and reduce the inflammatory state, with significant curative effect and good safety.

Key words: Qinting Qingfei decoction, Acupoint injection, Acupoint application, Phlegm heat stasis lung syndrome, AECOPD, LCN-1, LCN-2

王海玲黄文通杨洁徐祉君王宗耀. 芩葶清肺汤联合双侧足三里穴位注射、穴位敷贴治疗痰热淤肺证AECOPD患者的疗效评价[J]. 国际医药卫生导报, 2022, 28(22): 3212-3216.

Wang Hailing, Huang Wentong, Yang Jie, Xu Zhijun, Wang Zongyao. Efficacy evaluation of Qinting Qingfei decoction combined with bilateral Zusanli acupoint injection and acupoint application in the treatment of AECOPD patients with phlegm heat stasis lung syndrome[J]. International Medicine and Health Guidance News, 2022, 28(22): 3212-3216.

参考文献

[1] 陈华萍,甘志新,刘刚,等.慢性阻塞性肺疾病的合并症/并发症的发病率和病死率分析[J/CD].中华肺部疾病杂志（电子版）,2021,14(4):417-421. DOI:10.3877/cma.j.issn.1674- 6902.2021.04.003.
[2] Gershon AS, McGihon RE, Luo J, et al. Trends in chronic obstructive pulmonary disease prevalence, incidence, and health services use in younger adults in Ontario, Canada, 2006-2016[J]. Am J Respir Crit Care Med, 2021, 203(9):1196-1199. DOI: 10.1164/rccm.202006-2495LE.
[3] 赵将勇.AECOPD患者血清炎症因子水平与肺功能的相关性研究[J].国际医药卫生导报,2020,26(11):1576-1578. DOI:10.3760/cma.j.issn.1007-1245.2020.11.026.
[4] 袁梦鑫,陈雨莎,欧雪梅,等.慢性阻塞性肺疾病急性加重期肺康复研究进展[J].中国呼吸与危重监护杂志,2020,19(1):92-95. DOI:10.7507/1671-6205.201810047.
[5] Kunadharaju R, Sethi S. Treatment of acute exacerbations in chronic obstructive pulmonary disease[J]. Clin Chest Med, 2020, 41(3):439-451. DOI: 10.1016/j.ccm.2020. 06.008.
[6] 陈云坤,王玮,王杰,等.中医药治疗慢性阻塞性肺疾病急性加重期研究进展[J].中国中医急症,2020,29(6):1125-1128. DOI:10.3969/j.issn.1004-745X.2020.06.052.
[7] 周仲瑛,薛博瑜.周仲瑛实用中医内科学[M]. 北京:中国中医药出版社,2013:120.
[8] 中华中医药学会内科分会肺系病专业委员会.慢性阻塞性肺疾病中医诊疗指南(2011版)[J].中医杂志,2012,53(1):80-84. DOI:10.13288/j.11-2166/r.2012.01.011.
[9] 万会平,曾杏生,喻建华,等.肺癌患者红细胞免疫功能、T细胞亚群和B细胞的检测及临床意义[J].中国肺癌杂志,2001,4(5):351-353.
[10] Zhang J, Liu J, Xu S, et al. Bioinformatics analyses of the pathogenesis and new biomarkers of chronic obstructive pulmonary disease[J]. Medicine (Baltimore), 2021, 100(46):e27737. DOI: 10.1097/MD.0000000000027737.
[11] 朱琳,高静,柏丁兮,等.慢性阻塞性肺疾病患者死亡危险因素队列研究的系统综述和荟萃分析[J].中华疾病控制杂志,2022,26(4):455-462. DOI:10.16462/j.cnki.zhjbkz.2022. 04.016.
[12] 罗冬强,邵莹,刘峰.中医外治法对COPD稳定期患者疗效的网状Meta分析[J].护士进修杂志,2022,37(2):151-158. DOI:10.16821/j.cnki.hsjx.2022.02.011.
[13] 冯超男,胡海殷,季昭臣,等.中成药治疗慢性阻塞性肺疾病的临床研究及评价[J].中国中药杂志,2022,47(9):2351-2357. DOI:10.19540/j.cnki.cjcmm.20210910.501.
[14] 樊长征,苗青,樊茂蓉,等.慢性阻塞性肺疾病稳定期中医临床实践指南(征求意见稿)[J].中国中药杂志,2020,45(22):5309-5322. DOI:10.19540/j.cnki.cjcmm.20200726.503.
[15] 张秀莲,危蕾,黄品贤,等.黄芪注射液穴位注射治疗肺脾气虚型慢性阻塞性肺疾病稳定期的临床研究[J].光明中医,2021,36(16):2722-2726. DOI:10.3969/j.issn.1003-8914. 2021.16.023.
[16] 赵立美.慢性阻塞性肺疾病急性发作期患者采取穴位敷贴联合中医护理干预的临床效果观察[J].中国药物与临床,2020,20(23):4054-4056. DOI:10.11655/zgywylc2020. 23.083.
[17] 章敏.外周血IFN-γ、IL-10水平及红细胞免疫功能对重症肺结核患者死亡预后的预测价值[J].标记免疫分析与临床,2020,27(7):1161-1165. DOI:10.11748/bjmy.issn.1006- 1703.2020.07.016.
[18] 胡光煦,张彩霞,程冰洁,等.痰热清注射液对急性加重期慢性阻塞性肺疾病痰热壅肺证中医症状及红细胞免疫功能的影响[J].现代中西医结合杂志,2020,29(8):802-806. DOI:10.3969/j.issn.1008-8849.2020.08.002.
[19] 林纯意,沈璐,李美婵.慢性阻塞性肺疾病患者血清FABP4、LCN2与肺功能及炎性因子的相关性分析[J].河北医药,2021,43(5):671-674,679. DOI:10.3969/j.issn.1002-7386. 2021.05.006.
[20] 梁新,李荣凯,胡晨阳.COPD患者不同时期血清LCN-1、LCN-2表达水平及临床意义[J].热带医学杂志,2020,20(2):217-221. DOI:10.3969/j.issn.1672-3619.2020.02.018.