玉屏风颗粒联合厚朴排气合剂治疗气虚腑实型稳定期COPD疗效及对免疫功能、CX3CL1与MFAP-4的影响

目的探讨玉屏风颗粒联合厚朴排气合剂治疗气虚腑实型稳定期慢性阻塞性肺疾病(COPD)患者的疗效及对免疫功能、CX3CL1和微纤丝相关蛋白-4(MFAP-4)的影响。方法将2015年1月—2017年12月在延安大学附属医院治疗的98例气虚腑实型稳定期COPD患者随机分为中药组和对照组各49例。对照组给予氧疗、解痉平喘等常规西医治疗,中药组在对照组治疗基础上给予玉屏风颗粒和厚朴排气合剂口服,2组疗程均为4周。观察2组治疗前后肺功能指标第1秒用力呼气容积(FEV1)、FEV1占预计值百分比(FEV1%)、第一秒用力呼气末容积/用力肺活量(FEV1/FVC)]、主要症状及体征评分及血清免疫球蛋白(IgM、IgG、IgA)、T淋巴细胞(CD4+、CD8+、CD4+/CD8+)、CX3CL1、MFAP-4水平变化情况,对比2组临床疗效。结果2组治疗4周后FEV1、FEV1%和FEV1/FVC均较治疗前明显升高(P均<0.05),且中药组FEV1、FEV1%和FEV1/FVC均明显高于对照组(P均<0.05);2组治疗4周后气短、咳嗽、咳痰和双肺喘鸣音评分均较治疗前明显降低(P均<0.05),且中药组均明显低于对照组(P均<0.05);中药组治疗4周后血清IgM、IgG、IgA、CD4+水平及CD4+/CD8+均明显高于治疗前及对照组(P均<0.05),CX3CL1、MFAP-4与CD8+水平均明显低于治疗前及对照组(P均<0.05),对照组治疗4周后上述指标与治疗前比较差异均无统计学意义(P均>0.05)。治疗4周后,中药组和对照组总有效率分别为83.7%(41/49)和73.5%(36/49),中药组明显高于对照组(P<0.05)。结论玉屏风颗粒联合厚朴排气合剂治疗气虚腑实型稳定期COPD患者疗效优于单纯西医治疗,能够明显减轻临床症状,改善肺功能,增强机体抵抗力,减轻炎症反应。

Clinical efficacy of Yupingfeng granule combined with Houpu exhaust mixture in the treatment of stable COPD and its effect on immune function,CX3CL1 and MFAP-4

Objective It is to investigate the efficacy of Yupingfeng granules combined with Houpu exhaust mixture in the treatment of patients with stable chronic obstructive pulmonary disease(COPD),and its effects on the immune function,CX3CL1 and micro-fibrillar-associated protein 4(MFAP-4).Methods 98 stable COPD patients treated in Yan'an University Affiliated Hospital from January 2015 to December 2017 were randomly divided into Chinese medicine group and control group,49 cases in each group.Both groups were given normal western medical therapy such as oxygen therapy,antispasmodic and antiasthmatic treatment.The Chinese medicine group was treated with Yupingfeng granules and Houpu exhaust mixture by oral administration.Both groups were treated for 4 weeks.The pulmonary function indicators(FEV1,FEV1%,FEV1/FVC),the scores of main symptoms and signs,the levels of serum immunoglobulin(IgM,IgG,IgA),T lymphocytes(CD4+,CD8+,CD4+/CD8+),CX3CL1,and MFAP-4 before and after treatment were observed in the two groups.The clinical efficacy of the two groups was compared.Results After 4 weeks of treatment,FEV1,FEV1%,and FEV1/FVC were significantly higher than those before treatment in the two groups(all P<0.05),and FEV1,FEV1%,and FEV1/FVC in the Chinese medicine group were significantly higher than those in the control group(P<0.05).After 4 weeks of treatment,the scores of shortness of breath,cough,sputum and double lung wheezing were significantly lower than those before treatment in both groups(P<0.05),and the Chinese medicine group was significantly lower than the control group(P<0.05).The levels of serum IgM,IgG,IgA,CD4+and CD4+/CD8+in the Chinese medicine group were significantly higher while the levels of CX3CL1,MFAP-4 and CD8+were significantly lower than those before treatment and in the control group(all P<0.05),there was no significant difference in the above indexes after treatment for 4 weeks compared with those before treatment in the control group(all P>0.05).After 4 weeks of treatment,the total effective rates of the Chinese medicine group and the control group were 83.7%(41/49)and 73.5%(36/49),respectively.The Chinese medicine group was significantly higher than the control group(P<0.05).Conclusion Yupingfeng granules combined with Houpu exhaust mixture which can significantly relive clinical symptoms,improve lung function,enhance body resistance,and reduce inflammation,are more effective than simple western medicine in treating patients with stable COPD of type of Qi deficiency and fu-viscera excess.