自拟活血清肺方对慢性阻塞性肺疾病患者C 反应蛋白水平及肺功能的影响

Effect of self-made Huoxue Qingfei decoction on CRP level and pulmonary function in COPD patients

摘要:

目的 探讨自拟活血清肺方对慢性阻塞性肺疾病（COPD）患者C反应蛋白（CRP）水平及肺功能 的影响。方法 选取2017年6月—2018年7月于北京中医医院顺义医院呼吸科收治的91例COPD稳定期患者，采 用随机数字表法分为研究组和对照组，常规治疗基础上研究组给予自拟活血清肺方和沙美特罗替卡松粉吸入剂治 疗，常规治疗基础上对照组给予沙美特罗替卡松粉吸入剂治疗。比较两组患者治疗前后中医证候积分、综合疗效、 肺功能、炎症因子水平及血液流变学指标，并进行安全性检测。结果 研究组治疗后中医证候积分较对照组低 （P <0.05），总有效率较对照组高（P <0.05）。研究组治疗后用力肺活量（FVC）、第一秒用力呼气容积（FEV1）、 FEV1/FVC较对照组高（P <0.05）。研究组治疗前后FVC、FEV1、FEV1/FVC差值较对照组高（P <0.05）。研究组 治疗后血清CRP、IL-6、IL-8及TNF-α水平较对照组低（P <0.05）。研究组治疗前后血清CRP、IL-6、IL-8 及TNF-α差值较对照组高（P <0.05），研究组治疗后全血高切黏度、全血低切黏度、纤维蛋白原及血细胞比容较 对照组低（P <0.05）。研究组治疗前后全血高切黏度、全血低切黏度、纤维蛋白原及血细胞比容差值较对照组高 （P <0.05）。两组患者治疗前后心电图、血常规、肝肾功能、尿常规检查均无异常，且研究期间未出现明显不良反 应。结论 自拟活血清肺汤联合沙美特罗替卡松粉吸入剂可有效改善COPD患者体内炎症反应状态，提高肺功能 且安全性较高，值得临床推广应用。

Abstract:

Objective To investigate the effect of self-made Huoxue Qingfei decoction combined with salmeterol and fluticasone powder inhalation on C-reactive protein (CRP) level and pulmonary function in chronic obstructive pulmonary disease (COPD) patients. Methods The data of 91 patients with stable COPD admitted to respiratory department of our hospital from June 2017 to July 2018 were selected and divided into two groups by random number table method, each with 49 cases, while 2 cases in the study group and 5 cases in the control group were lost to follow up. Thus 47 patients in the study group received the Huoxue Qingfei decoction combined with salmeterol and fluticasone powder inhalation. Meanwhile, 44 patients in the control group received the salmeterol and fluticasone powder inhalation. Then various indexes were compared between groups, including TCM syndrome scores, comprehensive efficacy, forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC, 25% forced expiratory flow rate (FEF25%), 50% forced expiratory flow rate (FEF50%), 75% forced expiratory flow rate (FEF75%), serum C-reactive protein (CRP), levels of inflammatory factors, such as interleukin- 6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor- α (TNF- α), hemorheological parameters, and safety test. Results Independent-sample t test showed that the scores of TCM syndromes had statistic difference between groups after treatment, and were lower in the study group than in the control group (P < 0.05). Chi-square test showed that the effective rate had statistic difference between groups after treatment, and was higher in the study group than that of the control group (P < 0.05). Independent-sample t test showed that the levels of FVC, FEV1, and FEV1/FVC had statistic difference between groups after treatment, and were higher in the study group than in the control group (P < 0.05). Independent-sample t test showed that the levels of FVC, FEV1, and FEV1/FVC had statistic difference between groups before and after treatment, and the difference was greater in the study group than in the control group (P < 0.05); Independent-sample t test showed that the serum levels of CRP, interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α) had statistic difference between groups after treatment, and were lower in the study group than in the control group (P < 0.05). Independent-sample t test showed that the levels of serum CRP, IL-6, IL-8, and TNF-α had statistic difference between groups before and after treatment, and the difference was greater in the study group than in the control group (P < 0.05); Independent-sample t test showed that the whole blood high shear viscosity, whole blood low shear viscosity, fibrinogen and hematocrit had statistic difference between groups after treatment, and were lower in the study group than in the control group (P < 0.05). Independent-sample t test showed that the whole blood high shear viscosity, whole blood low shear viscosity, fibrinogen, and hematocrit had statistic difference between groups before and after treatment, and the difference was greater in the study group than in the control group (P < 0.05); there was no obvious adverse reaction between the two groups during the treatment. Conclusion The application of self-made Huoxue Qingfei decoction combined with salmeterol and fluticasone powder inhalation can effectively and safely improve inflammatory reaction and pulmonary function in COPD patients, which is worthy of clinical application.