温肺健脾汤治疗中-重度持续性变应性鼻炎(肺气虚寒证)的临床观察

目的:观察温肺健脾汤治疗中-重度持续性变应性鼻炎(AR)(肺气虚寒证)的疗效及对鼻腔分泌物P物质(SP和外周血促炎因子的影响。方法:将156例患者随机按数字表法分为对照组和观察组各78例。对照组采用布地奈德鼻喷雾剂,喷鼻,2次/d;口服盐酸西替利嗪片,10 mg·d^-1。观察组采用温肺健脾汤内服,1剂/d。两组疗程均为连续治疗4周。进行治疗前后4个鼻部症状(鼻塞、鼻痒、喷嚏、流涕)和2个眼部症状(眼痒、流泪)评分,进行治疗前后鼻腔体征评分和鼻气道阻力测量,进行治疗前后鼻结膜炎生命质量调查问卷(RQLQ)评分;检测治疗前后鼻腔分泌物SP水平,并进行嗜酸性粒细胞(EOS)计数,检测治疗前后外周血免疫球蛋白E(IgE),白细胞介素-4(IL-4),IL-5,IL-6和肿瘤坏死因子-α(TNF-α)水平。结果:经秩和检验,观察组临床疗效优于对照组(Z=2.073,P<0.05);治疗后观察组患者鼻部症状鼻塞、鼻痒、喷嚏、流涕,眼部症状眼痒、流泪及主观症状总分和鼻腔体征评分均低于对照组(P<0.05);观察组RQLQ量表除睡眠和情感外,其他维度评分和总分均低于对照组(P<0.05);观察组EOS计数低于对照组(P<0.05),IgE和SP水平均低于对照组(P<0.05);观察组外周血IL-4,IL-5,IL-6和TNF-α水平均低于对照组(P<0.01);治疗后观察组鼻阻力下降(P<0.05),并低于对照组(P<0.05)。结论:温肺健脾汤治疗肺气虚寒型中-重度持续性AR患者,可明显减轻患者的主观症状,改善体征,提高患者的生活质量,并能抑制促炎因子表达,减轻过敏反应,从而起到对AR的治疗作用。

Clinical Efficacy of Wenfei Jianpi Decoction on Moderate to Severe Persistent Allergic Rhinitis with Lung Qi Deficiency and Cold Syndrome

Objective: To observe the efficacy of Wenfei Jianpi decoction on moderate to severe persistent allergic rhinitis(AR) with Lung Qi deficiency and cold syndrome and its effect on substance P(SP) in nasal secretions and peripheral blood proinflammatory factors.Method: One hundred and sixty-six patients were randomly divided into control group and observation group by random number table.Patients in control group got budesonide nasal spray,2 times/days, and cetirizine hydrochloride tablets,10 mg/days.And patients in observation group got Wenfei Jianpi decoction for oral,1 dose/day.A course of treatment was 8 weeks.Before and after treatment,nasal obstruction,itching,sneezing,runny nose,itchy eyes,tears and nasal sign were scored,nasal airway resistance was detected,and rhinoconjunctivits quality of life questionnaire(RQLQ) were scored.Before and after treatment,levels of SP immunoglobulin E(IgE) in peripheral blood,interleukin-4(IL-4),interleukin-5(IL-5),interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) were detected,and eosinophil(EOS) were calculated.Result: By rank sum test,the clinical efficacy in observation group was better than that in control group(Z=2.073,P<0.05).Before and after treatment,scores of total score of nasal symptoms,ocular symptoms and subjective symptoms and nasal sign score were all lower than those in control group(P<0.05).Except sleep and emotion,scores of other dimensions and the total scores of RQLQ were all lower than those in control group(P<0.05).EOS in observation group was less than that in control group(P<0.05).And nasal resistance declined in observation group(P<0.05),and levels of IgE,SP,IL-4,IL-5,IL-6,TNF-α and nasal resistance were lower than those in control group(P<0.05,P<0.01).Conclusion: Wenfei Jianpi decoction can be used to treat moderate to severe persistent allergic rhinitis by relieving subjective symptoms and signs,improving quality of life,inhibiting inflammatory factors and reducing allergic reaction.