采用清肺排毒汤联合西药43例与单用西药46例的新型冠状病毒肺炎临床疗效比较

目的 回顾性评价清肺排毒汤加减治疗新型冠状病毒肺炎(COVID-19)的临床疗效,探讨可能的机制。 方法 选取 2020 年 2月 10 日至 4 月 1 日在武汉大学人民医院东院感染病区收治的符合 COVID-19 确诊标准的出院病历资料89例,根据是否使用清肺排毒汤加减,分为基础组46例和联合组43例,基础组根据国家卫生健康委员会制定的《新型冠状病毒肺炎诊疗方案(试行第六版)》中推荐的西医治疗方案,联合组在西医治疗方案基础上加用清肺排毒汤加减,比较两组治疗前后血常规、C反应蛋白(CRP)、白介素-6(IL-6)、细胞免疫、生化系列、凝血系列等表达变化,观察两组患者胸部CT变化情况、核酸转阴时间和住院天数。符合正态分布的数值型资料采用配对或非配对的t检验进行组间比较;计数资料采用相对数描述,组间差异采用卡方检验。 结果 (1)基础组和联合组患者治疗后中性粒细胞比例(NEU%)、CRP、IL-6、肌酸激酶(CK)、乳酸脱氢酶(LDH)、纤维蛋白原(Fib)、纤维蛋白原降解产物(FDP)表达水平均下降,差异有统计学意义(P均<0.05);治疗后的淋巴细胞比例(LYM%)、CD3、CD4、CD8细胞计数明显升高,差异有统计学意义(P均<0.05);联合组患者血清肌酐(SCr)及D-二聚体(DD)均降低,预估肾小球滤过率(eGFR)升高,差异有统计学意义(P均<0.05)。(2)与基础组相比,联合组CD3和IL-6治疗前后差值的差异有统计学意义(P均<0.05)。两组患者胸部CT改善程度无差异;与基础组相比,联合组患者住院天数明显缩短(P<0.01),核酸转阴时间缩短,但差异无统计学意义。 结论 (1)基础组和联合组都可以降低COVID-19患者炎症水平,增强细胞免疫,改善肾脏功能,减轻高凝状态。(2)与基础组相比,联合治疗可显著降低COVID-19患者IL-6的表达,升高细胞免疫中CD3水平,中西医结合治疗可显著抑制炎症反应,增强机体免疫力,缩短患者住院天数和核酸转阴时间,取得更好的临床疗效。

Comparison of clinical efficacy of Qingfei Paidu decoction combined with western medicine in 43 cases and single western medicine in 46 cases in the treatment of COVID-19

Objective To retrospectively evaluate the clinical efficacy of Qingfei Paidu decoction in the treatment of coronavirus disease 2019(COVID-19)and to explore the possible mechanism. Methods A total of 89 COVID-19 patiests whose date of discharge ranged from Feb. 10 to Apr. 1, 2020 were selected in the infection ward of the East Hospital of Renmin Hospital of Wuhan University. According to whether Qingfei Paidu decoction was used, 89 cases were divided into basic treatment group(n=46)and combined treatment group(n=43). The paitents in basic treatment group were only given western medicine treatment, while those in combined treatment group were treated with modified Qingfei Paidu decoction on the basis of western medicine treatment plan. The changes of blood routine, C reactive protein(CRP), interleukin-6(IL-6), cellular immunity, biochemical series and coagulation series were compared between the two groups before and after treatment. The changes of lung CT, the time of nucleic acid turning negative, and the patients hospitalization time were collected. A pairwise or non-paired t test was used to compare numerical data with normal distribution; the counting data were described by relative numbers, and the differences between groups were tested by chi-square test. Results (1) After the treatment, the expression levels of neutrophil ratio(NEU%), CRP, IL-6, creatine kinase(CK), lactate dehydrogenase(LDH), fibrinogen(Fib)and fibrinogen degradation product(FDP)were decreased in the two groups(P<0.05); the counts of lymphocyte ratio(LYM%), CD3, CD4 and CD8 T cells were significantly increased in the two groups(P<0.05); the levels of serum creatinine(SCr)and D-dimer(DD)were decreased while the estimated glomerular filtration rate(eGFR)was increased in the combined treatment group(P<0.05). (2) Compared with the basic treatment group, the difference of CD3 and IL-6 before and after treatment in the combination treatment group was statistically significant(P<0.05). There was no difference in the degree of improvement of chest CT between the two groups. The length of hospital stay in the combined treatment group was shorter than that in the basic treatment group(P<0.01), and the nucleic acid conversion time was shorter without statistical difference. Conclusion (1) The level of inflammation is reduced, cellular immunity is enhanced, renal function is improved, and hypercoagulability is reduced in both the basic treatment group and combined treatment group. (2) Compared with the basic treatment group, modified Qingfei Paidu decoction can significantly reduce the level of IL-6 and increase the level of CD3 of COVID-19 patients. The treatment of integrated traditional Chinese medicine and western medicine can significantly inhibit the inflammatory reaction, enhance the bodys immunity, and shorten the length of hospitalization and nucleic acid negative time, which help to get a better clinical efficacy.