小青龙汤加味联合西药治疗哮喘-慢性阻塞性肺疾病重叠的疗效及机制研究

目的观察小青龙汤加味联合噻托溴铵粉吸入剂(思力华)、布地奈德福莫特罗(信必可)吸入治疗哮喘-慢性阻塞性肺疾病重叠(ACOS)的短期疗效。方法将152例哮喘-慢性阻塞性肺疾病重叠患者按随机数字表法分为观察组(80例)和对照组(72例)。在一般治疗基础上,对照组给予思力华+信必可吸入;观察组实施思力华+信必可吸入+小青龙汤加味治疗,疗程均为4周。观察并比较两组临床疗效、肺功能指标(FEV1,FEV1/FVC)、免疫功能指标(CD4+、CD4+/CD8+、IgA、IgM、IgG)及ACT、CAT评分及急性加重次数的变化及不良反应。采用实时荧光定量PCR检测PPAR-γ和核因子-κBmRNA的表达,蛋白免疫印迹法检测PPAR-γ和核因子-κB蛋白的表达。酶联免疫吸附法检测炎性因子水平(TNF-α、IL-4及IL-5)水平变化。结果治疗2、4周,观察组临床总控制率与对照组相比较高(P<0.05);治疗后,两组肺功能指标均得到改善,与对照组同期相比,观察组治疗4周后FEV1、FEV1/FVC、一氧化碳弥散量(DLCO)水平较高,吸气分数(IC/TLC)、残总比(RV/TLC)水平较低(P<0.05);与同期对照组相比,观察组治疗4周后ACT评分较高,CAT评分及急性加重次数较低(P<0.05);观察组治疗后CD4+、CD4+/CD8+、IgA、IgM、IgG较对照组高,CD8+、IgE较对照组低(P<0.05);观察组PPAR-γmRNA及蛋白较对照组高,核因子-κB的mRNA、蛋白较对照组低(P<0.05);观察组TNF-α、IL-4及IL-5水平均较对照组低(P<0.05);两组治疗均未出现严重不良反应。结论在ACOS患者治疗中联用思力华、信必可吸入及小青龙汤加味治疗可取得确切疗效,利于提高肺功能及机体免疫力,调节炎症反应,控制病情进展,且用药安全性高。

Effect and Mechanism of modified Xiaoqinglong Decoction combined with western medicine on asthma-chronic obstructive pulmonary disease overlap syndrome

Objective To evaluate short-term effect of modified Xiaoqinglong Decoction combined with Tiotropium Bromide Powder for Inhalation(Spiriva)Budesonide-Fomoterol(Symbicort)on asthma-chronic obstructive pulmonary disease overlap syndrome(ACOS).Methods 152 patients with ACOS were randomly divided into the observation group(n=80)and the control group(n=72)by random number table.Based on conventional treatment,the control group was given inhaled Spiriva+Symbicort;the observation group was given inhaled Spiriva+Symbicort with modified Xiaoqinglong Decoction for 4 weeks.Clinical effect,lung function indexes(FEV1,FEV1/FVC),immune function indexes(CD4+,CD4+/CD8+,IgA,IgM,IgG),ACT,CAT score,number of acute exacerbation and adverse reactions were observed.mRNA expression of PPAR-γand nuclear factor-κB(NF-κB)was detected by real-time quantitative PCR.Protein expression of PPAR-γand NF-κB was detected by Western blot.TNF-α,IL-4 and IL-5 were measured by enzyme linked immunosorbent assay(ELISA).Results At the end of the 2 nd,4th week after treatment,the observation group had higher total control rate than the control group(P<0.05).After treatment,lung function was improved in both groups,however,the observation group had higher level of FEV1,FEV1/FVC,DLCO,and lower level of IC/TLC,RV/TLC than the control group at the end of the 4 th week after treatment(P<0.05).Compared with the control group at the same time point,the observation group had higher ACT score and lower CAT score and number of acute exacerbations at the 4 th week after treatment(P<0.05).After treatment,the observation group had higher level of CD4+,CD4+/CD8+,IgA,IgM,IgG and lower level of CD8+and IgE than the control group(P<0.05).The observation group had higher mRNA and protein expression of PPAR-γand lower mRNA and protein expression of NF-κB than the control group(P<0.05).The observation group had lower level of TNF-α,IL-4 and IL-5(P<0.05).No severe adverse reaction was found.Conclusion Modified Xiaoqinglong Decoction combined with Spiriva and Symbicort can effectively and safely improve lung function and body immunity alleviate inflammatory reactions and control the development for ACOS patients.