参苓白术散加减治疗肺脾气虚证慢性鼻窦炎的疗效观察

目的:探讨参苓白术散加减治疗肺脾气虚证慢性鼻窦炎的临床疗效。方法:选取2016年6月-2019年3月收治的98例肺脾气虚证慢性鼻窦炎患者,按照随机数字表法随机分为对照组和研究组各49例,对照组给予鼻内窥镜手术治疗联合桉柠蒎肠溶软胶囊口服,研究组在此基础上给予参苓白术散加减治疗,疗程为8周。比较两组的临床疗效、中医证候积分、鼻腔鼻窦结局测试-20(the Sino-nasal Outcome Test-20,SNOT-20)生活质量评分、临床症状评分、鼻内镜Lund-Kennedy评分、鼻气道阻力、嗅觉功能、鼻黏膜纤毛输送率(Mucociliary Transport Rate,MTR)、鼻黏膜纤毛清除率(MTC)、血清总免疫球蛋白E(Total Immunoglobulin E,TIgE)、分泌型免疫球蛋白A(Secretory Immunoglobulin A,SIgA)、嗜酸性粒细胞阳离子蛋白(Eosinophil Cationic Protein,ECP)、肿瘤坏死因子(Tumor Necrosis Factor-ɑ,TNF-ɑ)、血清白介素(Interleukin,IL)-2、IL-6、IL-8、CD4^+、CD8^+、CD4^+/CD8^+水平。结果:治疗后,研究组的总有效率显著高于对照组(P<0.05);两组的中医证候积分、SNOT-20生活质量评分、临床症状(流涕、鼻塞、面颊胀痛、头痛、嗅觉减退)评分、鼻内镜Lund-Kennedy评分均较治疗前降低(P<0.05),且研究组低于对照组(P<0.05);两组的鼻气道阻力均较治疗前降低(P<0.05),且研究组低于对照组(P<0.05),两组的嗅觉功能、MTR、MTC均较治疗前升高(P<0.05),且研究组高于对照组(P<0.05);两组的TIgE、ECP、TNF-ɑ、IL-2、IL-6、IL-8、CD8^+水平均较治疗前降低(P<0.05),且研究组低于对照组(P<0.05),两组的SIgA、CD4^+、CD4^+/CD8^+均较治疗前升高(P<0.05),且研究组显著高于对照组(P<0.05)。结论:参苓白术散加减治疗肺脾气虚证慢性鼻窦炎可以改善临床症状,增强鼻黏膜纤毛功能,提高生活质量,改善免疫功能,抑制炎症反应。

Observation on treating chronic sinusitis of the Feipi Qixu syndrome with Shenling Baizhu San

Objective:To investigate Shenling Baizhu San(参苓白术散)on chronic sinusitis of the Feipi Qixu syndrome(肺脾气虚证).Methods:98 cases were randomly divided into two groups,49 cases in each.The control group was given nasal endoscopic surgery plus eucalyptus tincture enteric-coated soft capsule orally.The study group was given the Shenling Baizhu San more,for 8 weeks.Results:After treatment,the total efficiency in the study group was significantly higher than the control group(P﹤0.05).TCM syndrome scores,SNOT-20 quality of life score,clinical symptoms scores(runny nose,nasal congestion,cheek pain,headache,hyposmia)and nasal endoscopic Lund-Kennedy score were lower in both groups than before treatment(P﹤0.05),and those in the study group were lower than the control group(P﹤0.05).Nasal airway resistance was lower in both groups than before treatment(P﹤0.05),and that in the study group was lower than the control group(P﹤0.05).The olfactory function,MTR and MTC in two groups were higher than before treatment(P﹤0.05),and those in the study group were higher than the control group(P﹤0.05).The levels of TIgE,ECP,TNF-ɑ,IL-2,IL-6,IL-8 and CD8^+in groups were lower than before treatment(P﹤0.05),and those in the study group were lower than the control group(P﹤0.05).SIgA,CD4^+,CD4^+/CD8^+were higher in both groups than before treatment(P﹤0.05),and those in the study group were significantly higher than the control group(P﹤0.05).Conclusion:Shenling Baizhu San on chronic sinusitis of the Feipi Qixu syndrome shows good effects,can improve clinical symptoms,quality of life and immune function,enhance nasal mucosal ciliary function,and inhibit inflammatory response.