消痈祛腐生肌汤联合胸腺肽α1治疗肺脾气虚型支气管扩张稳定期的临床研究

周敏华; 季兴祖; 陈灵勇

doi:10.16766/j.cnki.issn.1674-4152.003347

消痈祛腐生肌汤联合胸腺肽α1治疗肺脾气虚型支气管扩张稳定期的临床研究

doi: 10.16766/j.cnki.issn.1674-4152.003347

浙江中医药大学附属丽水中医院呼吸与危重症医学科，浙江丽水 323000

基金项目:

浙江省中医药科技计划项目 2023ZR058

详细信息

通讯作者:
季兴祖，E-mail：124354113@qq.com

中图分类号: R562.22 R242
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- 文章访问数: 72
- HTML全文浏览量: 21
- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2023-09-18
- 网络出版日期: 2024-03-09

Clinical study of Xiaoyong Qufu Shengji Decoction combined with thymosin α1 in the treatment of bronchodilation in stable stage of lung Qi deficiency type

Department of Respiratory and Critical Care Medicine, Lishui Traditional Chinese Medicine Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine, Lishui, Zhejiang 323000, China

摘要

摘要: 目的基于“治肺不远温”的中医理论，探讨消痈祛腐生肌汤联合胸腺肽α1治疗支气管扩张稳定期的效果，为增益临床疗效提供依据。方法选取2021年1月—2023年1月浙江中医药大学附属丽水中医院收治的88例肺脾气虚型支气管扩张稳定期患者，采用随机数表法分为对照组和研究组，各44例。在常规对症治疗基础上，对照组给予胸腺肽α1治疗，研究组给予消痈祛腐生肌汤联合胸腺肽α1治疗，均持续治疗和观察8周。观察2组中医证候积分、肺功能[第1秒用力呼气容积占预计值百分比(FEV₁%pred)、第1秒用力呼气量占用力肺活量的比值(FEV₁/FVC)]、T淋巴细胞亚群指标[CD4⁺、CD8⁺、CD4⁺/CD8⁺]，比较中医证候疗效和不良反应发生情况。结果研究组治疗后“咳嗽”“咳痰”积分和中医证候总积分均低于对照组(P＜0.05)，中医证候总有效率[90.91%(40/44)]高于对照组[72.73%(32/44), P＜0.05]。研究组治疗后FEV₁%pred、FEV₁/FVC、CD4⁺、CD4⁺/CD8⁺均高于对照组(P＜0.05)，CD8⁺低于对照组(P＜0.05)。2组间不良反应发生率比较差异无统计学意义(χ²=0.451，P=0.502)。结论消痈祛腐生肌汤联合胸腺肽α1能充分缓解肺脾气虚型支气管扩张稳定期的临床症状，改善肺功能和免疫功能，增益临床疗效且安全性较好。
- 支气管扩张 /
- 肺脾气虚型 /
- 稳定期 /
- 消痈祛腐生肌汤 /
- 胸腺肽α1
Abstract: Objective Based on the traditional Chinese medicine (TCM) theory of "treating the lung close to the temperature", the effect of Xiaoyong Qufu Shengji Decoction combined with thymosin α1 on the stable stage of bronchiectasis was discussed to provide evidence of clinical curative effect. Methods From January 2021 to January 2023, 88 patients with lung Qi deficiency type bronchodilation admitted to Lishui Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Chinese Medicine were selected and divided into control and study groups of 44 cases each by random number table method. On the basis of conventional symptomatic treatment, the control group was treated with thymosin α1, and the study group was treated with Xiaoyong Qufu Shengji Decoction combined with thymosin α1, all of which were continuously treated and observed for 8 weeks. The TCM syndrome score, lung function [percentage of forced expiratory volume in one second to expected value (FEV₁ % pred), ratio of forced expiratory volume in one second to forced vital capacity (FEV₁/FVC)], T lymphocyte subsets [CD4⁺, CD8⁺, CD4⁺/CD8⁺] of the two groups were observed, and the efficacy and adverse reactions of the TCM syndrome were compared. Results After treatment, the scores for "cough" and "expectoration" and the total score for TCM syndrome were lower in the study group than in the control group (P < 0.05), and the total efficacy rate for TCM syndrome [90.91% (40/44)] was higher than that in the control group [72.73% (32/44), P < 0.05]. After treatment, FEV₁ % pred, FEV₁/FVC, CD4⁺, CD4⁺/CD8⁺ in the study group were higher than those in the control group (P < 0.05) and CD8⁺ were lower than those in the control group (P < 0.05). There was no significant difference in the rate of side effects between groups (P>0.05). Conclusion Xiaoyong Qufu Shengji Decoction combined with thymosin α1 can completely relieve the clinical symptoms of bronchodilation of lung Qi deficiency type, improve lung function and immune function, and enhance clinical efficacy and safety.
- Bronchiectasis /
- Lung Qi deficiency type /
- Stable period /
- Xiaoyong Qufu Shengji Decoction /
- Thymosin alpha1

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表 1 2组支气管扩张患者中医证候积分比较(x±s，分)

Table 1. Comparison of TCM syndrome scores between the two groups of patients with bronchiectasis (x±s, points)

组别	例数	咳嗽		咳痰		总积分
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	44	2.23±0.34	1.61±0.32^a	2.21±0.37	1.68±0.34^a	13.53±2.83	8.12±2.37^a
研究组	44	2.20±0.37	1.32±0.29^a	2.23±0.36	1.29±0.31^a	13.49±2.86	6.05±1.96^a
t值		0.396	4.454	0.257	5.623	0.066	4.464
P值		0.693	＜0.001	0.798	＜0.001	0.948	＜0.001
注：与同组治疗前比较，^aP＜0.05。

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表 2 2组支气管扩张患者中医证候总有效率比较[例(%)]

Table 2. Comparison of total effective rate to TCM syndromes between the two groups of patients with bronchiectasis[cases (%)]

组别	例数	显效	有效	无效	总有效
对照组	44	8(18.18)	24(54.55)	12(27.27)	32(72.73)
研究组	44	13(29.55)	27(61.36)	4(9.09)	40(90.91)
注：2组总有效率比较，χ²=4.889，P=0.027。

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表 3 2组支气管扩张患者肺功能比较(x±s，%)

Table 3. Comparison of lung function between the two groups of patients with bronchiectasis(x±s, %)

组别	例数	FEV₁%pred		FEV₁/FVC
组别	例数	治疗前	治疗后	治疗前	治疗后
对照组	44	63.07±9.26	68.29±10.35^a	66.03±6.25	69.47±7.23^a
研究组	44	62.73±9.41	73.26±11.07^a	66.12±6.53	72.81±7.16^a
t值		0.171	2.175	0.066	2.243
P值		0.865	0.032	0.948	0.028
注：与同组治疗前比较，^aP＜0.05。

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表 4 2组支气管扩张患者免疫功能比较(x±s)

Table 4. Comparison of immune function between the two groups of patients with bronchiectasis(x±s)

组别	例数	CD4⁺(%)		CD8⁺(%)		CD4⁺/CD8⁺
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组	44	36.17±4.26	39.20±4.61^a	27.46±3.25	25.13±3.30^a	1.32±0.35	1.56±0.47^a
研究组	44	36.10±4.30	42.75±4.80^a	27.18±3.47	21.87±3.21^a	1.33±0.38	1.95±0.56^a
t值		0.077	3.538	0.391	4.697	0.128	3.538
P值		0.939	0.001	0.697	＜0.001	0.898	0.001
注：与同组治疗前比较，^aP＜0.05。

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参考文献(18)

[1]	王玲, 师一涵, 杨恒, 等. 支气管扩张症年度进展2021[J]. 中华结核和呼吸杂志, 2022, 45(6): 592-597. doi: 10.3760/cma.j.cn112147-20220111-00036 WANG L, SHI Y H, YANG H, et al. Annual review of bronchiectasis in 2021[J]. Chinese Journal of Tuberculosis and Respiratory Diseases, 2022, 45(6): 592-597. doi: 10.3760/cma.j.cn112147-20220111-00036
[2]	柯诗文, 岳学普, 朱伟, 等. 从肺间充质干细胞线粒体角度浅析全程温法治疗肺间质纤维化[J]. 中华中医药杂志, 2020, 35(5): 2491-2494. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY202005061.htm KE S W, YUE X P, ZHU W. Treatment of pulmonary fibrosis by whole course warming from the perspective of mitochondria of pulmonary mesenchymal stem cells[J]. China Journal of Traditional Chinese Medicine and Pharmacy, 2020, 35(5): 2491-2494. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY202005061.htm
[3]	支气管扩张症专家共识撰写协作组, 中华医学会呼吸病学分会感染学组. 中国成人支气管扩张症诊断与治疗专家共识[J]. 中华结核和呼吸杂志, 2021, 44(4): 311-321. doi: 10.3760/cma.j.cn112147-20200617-00717 Expert Consensus writing collaborative group on bronchiectasis, Infection Group, Respiratory Society, Chinese Medical Association. Expert consensus on the diagnosis and treatment of adult bronchiectasis in China[J]. Chinese Journal of Tuberculosis and Respiratory Diseases, 2021, 44(4): 311-321. doi: 10.3760/cma.j.cn112147-20200617-00717
[4]	中华中医药学会内科分会, 中国民族医药学会肺病分会, 中华中医药学会肺系病分会. 支气管扩张症中医证候诊断标准(2019版)[J]. 中医杂志, 2020, 61(15): 1377-1380. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ202015024.htm Chinese Society of Traditional Chinese Medicine Internal Medicine Branch, Chinese Society of Ethnic Medicine Lung Disease Branch, Chinese Society of Traditional Chinese Medicine Lung Disease Branch. Diagnostic Criteria of Bronchiectasis for Trditional Chinese Medicine Syndromes (2019 edition)[J]. Journal of Traditional Chinese Medicine, 2020, 61(15): 1377-1380. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ202015024.htm
[5]	郑筱萸. 中药新药临床研究指导原则: 试行[M]. 北京: 中国医药科技出版社, 2002: 394-396. ZHENG X Y. Guiding Principles of clinical research on new Chinese medicine: Trial[M]. Beijing: China Medical Science and Technology Press, 2002: 394-396.
[6]	O'DONNELL A E. Bronchiectasis: a clinical review[J]. N Engl J Med, 2022, 387(6): 533-545. doi: 10.1056/NEJMra2202819
[7]	舒郁平, 余丹琪, 荣越, 等. 基于孟德尔随机化法的溃疡性结肠炎与支气管扩张症的因果关系研究[J]. 中华全科医学, 2023, 21(6): 924-926, 1043. doi: 10.16766/j.cnki.issn.1674-4152.003016 SHU Y P, YU D Q, RONG Y, et al. Study on the causal relationship between ulcerative colitis and bronchiectasis based on Mendelian randomization[J]. Chinese Journal of General Practice, 2023, 21(6): 924-926, 1043. doi: 10.16766/j.cnki.issn.1674-4152.003016
[8]	吴宇, 武维屏. 武维屏诊治支气管扩张症临证思路[J]. 北京中医药, 2021, 40(6): 595-597. https://www.cnki.com.cn/Article/CJFDTOTAL-BJZO202106009.htm WU Y, WU W P (guidance). Clinical thinking of Wu Weiping's diagnosis and treatment of bronchiectasis[J]. Beijing Journal of Traditional Chinese Medicine, 2021, 40(6): 595-597. https://www.cnki.com.cn/Article/CJFDTOTAL-BJZO202106009.htm
[9]	陈金丽, 梁爱武, 黎云, 等. 支气管扩张症肺脾同调的治疗思路探讨[J]. 广西医学, 2022, 44(16): 1925-1927. https://www.cnki.com.cn/Article/CJFDTOTAL-GYYX202216023.htm CHEN JINLI, LIANG AIWU, LI YUN, et al. Exploration of therapeutic thoughts for concurrently regulating lung and spleen in bronchiectasis[J]. Guangxi Medical Journal, 2022, 44(16): 1925-1927. https://www.cnki.com.cn/Article/CJFDTOTAL-GYYX202216023.htm
[10]	何欣桥, 喻清和. 喻清和治疗支气管扩张症经验[J]. 广州中医药大学学报, 2022, 39(8): 1916-1920. https://www.cnki.com.cn/Article/CJFDTOTAL-REST202208033.htm HE X Q. YU Q H. YU Qing-He's Experience in Treating Bronchiectasis[J]. Journal of Guangzhou University of Traditional Chinese Medicine, 2022, 39(8): 1916-1920. https://www.cnki.com.cn/Article/CJFDTOTAL-REST202208033.htm
[11]	莫丽莎, 朱伟, 兰智慧, 等. 国医大师洪广祥治疗支气管扩张症经验探析[J]. 中华中医药杂志, 2020, 35(12): 6105-6107. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY202012050.htm MO L S, ZHU W, LAN Z H, et al. Analysis on TCM master HONG Guang-xiang's experience in the treatment of bronchiectasis[J]. China Journal of Traditional Chinese Medicine and Pharmacy, 2020, 35(12): 6105-6107. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY202012050.htm
[12]	赵媛, 丛晓东, 宗慧琪, 等. 支气管扩张症的治疗难点及中西医治疗策略[J]. 世界中医药, 2023, 18(5): 699-703. doi: 10.3969/j.issn.1673-7202.2023.05.020 ZHAO Y, CONG X D, ZONG H Q, et al. Difficulties and Strategies of Traditional Chinese and Western Medicine in the Treatment of Bronchiectasis[J]. World Chinese Medicine, 2023, 18(5): 699-703. doi: 10.3969/j.issn.1673-7202.2023.05.020
[13]	陈磊, 黄燕, 杨爽. 从肺脾论治支气管扩张症的研究进展[J]. 内蒙古中医药, 2020, 39(1): 157-158. https://www.cnki.com.cn/Article/CJFDTOTAL-NZYY202001091.htm CHEN L, HUANG Y, YANG S. Research progress of treating bronchiectasis from lung and spleen[J]. Nei Mongol Journal of Traditional Chinese Medicine, 2020, 39(1): 157-158. https://www.cnki.com.cn/Article/CJFDTOTAL-NZYY202001091.htm
[14]	吴梦菁, 黄东晖. 从瘀论治支气管扩张稳定期[J]. 山东中医药大学学报, 2021, 45(5): 585-589. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYX202105004.htm WU M J, HUANG D H. Treatment of stable bronchiectasis based on blood stasis[J]. Journal of Shandong University of Traditional Chinese Medicine, 2021, 45(5): 585-589. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYX202105004.htm
[15]	艾健, 王淑英, 姬晓辉, 等. 基于网络药理学探讨健脾祛湿化瘀膏对支气管扩张缓解期的作用机制[J]. 浙江中医药大学学报, 2020, 44(11): 1102-1112. https://www.cnki.com.cn/Article/CJFDTOTAL-BHON202011016.htm AI J, WANG S Y, JI X H, et al. Mechanism of Jianpi Qushi Huayu Ointment on the Relief Period of Bronchiectasis Based on Network Pharmacology[J]. Journal of Zhejiang Chinese Medical University, 2020, 44(11): 1102-1112. https://www.cnki.com.cn/Article/CJFDTOTAL-BHON202011016.htm
[16]	李霞, 刘洁净, 秦鸿. 健脾益肺汤对支气管扩张症(稳定期)的临床疗效及对血清炎症水平的影响[J]. 辽宁中医杂志, 2022, 49(5): 127-130. https://www.cnki.com.cn/Article/CJFDTOTAL-LNZY202205036.htm LI X, LIU J J, QIN H. Clinical Effect of Jianpi Yifei Decoction on Bronchiectasis(Stable Stage)and Its Influence on Serum Inflammatory[J]. Liaoning Journal of Traditional Chinese Medicine, 2022, 49(5): 127-130. https://www.cnki.com.cn/Article/CJFDTOTAL-LNZY202205036.htm
[17]	TAK A S, SATAPATHY J, JANA M, et al. Monogenic lupus with homozygous C4A deficiency presenting as bronchiectasis and immune-mediated thrombocytopenia[J]. Rheumatol Intl, 2022, 42(8): 1477-1482. doi: 10.1007/s00296-021-04943-y
[18]	王聪聪, 高永华, 张国俊. 原发性免疫缺陷病相关支气管扩张症患者的临床特征分析[J]. 检验医学与临床, 2022, 19(23): 3268-3270. doi: 10.3969/j.issn.1672-9455.2022.23.027 WANG C C, GAO Y H, ZHANG G J. Clinical characteristics of patients with primary immunodeficiency disease associated bronchiectasis[J]. Laboratory Medicine and Clinic, 2022, 19(23): 3268-3270. doi: 10.3969/j.issn.1672-9455.2022.23.027