益气温阳、通窍平喘法治疗成人过敏性鼻炎—哮喘综合征病例系列报告

发布时间：2018-02-27 23:22

  本文关键词： 过敏性鼻炎-哮喘综合征 中医药 观察性研究 病例系列报告　出处：《北京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的过敏性鼻炎-哮喘综合征(Combined Allergic Rhinitis and Asthma Syndrome,CARAS)是2004年由世界变态反应组织(World Allergy Organization,WAO)提出的医学诊断术语,其主要表现为同时发生的上、下呼吸道的慢性炎症和高反应性症状,包括鼻痒、喷嚏频频、流清鼻涕、鼻塞、咳嗽和喘息等[1]。流行病学调查表明,60%～78%的哮喘患者伴有过敏性鼻炎[16],20%～38%的过敏性鼻炎伴有哮喘[25]。目前本病的诊断采用过敏性鼻炎与支气管哮喘的联合诊断,治疗则按照相关指南推荐采取以吸入糖皮质激素为主的上、下呼吸道联合抗炎治疗。然而,临床实际中,由于未能建立鼻炎与哮喘的联合诊断,两种疾病常分科诊治,出现治疗重复和药物叠加等情况,导致患者经济负担加重、依从性和疗效差、副反应发生率增加等。因此,寻找安全、有效的中医药治疗方案成为当务之急。导师在长期的临床实践中发现成人CARAS具有"肺脾两虚、风痰犯肺、肺失宣降"的病机特点,提出了"益气温阳、祛风化痰、通窍平喘"的治疗大法,以参蛤苍龙汤为基础方加减进行分期治疗,初步结果显示可以改善患者上、下呼吸道的症状,减少急性发作次数。本研究拟在建立CARAS联合诊断模式的基础上,采用国内外公认的观察性研究的设计方法和报告规范,开展益气温阳、祛风化痰、通窍平喘法治疗成人CARAS的临床观察性研究,选用国际公认的疗效评价指标,初步评价中医药治疗本病的临床疗效,探讨可能的作用机制,有望为临床提供一种安全、有效的中医药治疗方案,也为下一步开展中医治疗CRARS的确证性研究提供依据。方法本研究采用前瞻性观察性设计(病例系列报告),选择2015年6月至2017年3月在东直门医院呼吸科门诊及耳鼻喉科门诊就诊的过敏性鼻炎-哮喘综合征患者(中医辨证属肺脾两虚、风痰犯肺)作为研究对象。对纳入研究的受试者予以参蛤苍龙汤为基础方加减的中医治疗方案,12周为一个疗程,连续治疗2个疗程。观察治疗前和治疗后各时点鼻炎和哮喘症状评分的变化及相关实验室指标检查结果的变化(包括疗效性指标和安全性指标)。结果1.受试者纳入情况:本研究共筛选45例患者,纳入24例,24例中完成全部疗程者15例,治疗期间脱落者9例。所有患者中,男性7例,女性17例。患者中年龄最大者68岁,最小者17岁,平均年龄43.79±12.29(岁)。鼻炎病程最长者37年,最短者4个月,平均病程141.67±97.88(月)。哮喘病程最长者25年,最短者1个月,平均病程60.92±70.432(月)。间歇性AR4例,持续性AR20例;轻度AR5例,中-重度AR 19例。哮喘发作期患者2例,慢性持续期患者22例;哮喘病情严重程度分级属于间断状态者3例,轻度持续者10例,中度持续者11例。2.疗效分析本次统计分析共纳入病例24例,经相关统计方法处理后发现:本治疗方案可以改善CARAS患者的主要疗效指标(包括过敏性鼻炎视觉模拟评分、过敏性鼻炎主要症状评分、哮喘症状评分、哮喘控制测试评分、成人哮喘生存质量评分、中医证候分级量化积分),同时可使部分合并使用西医治疗的患者减少西药用量,但对次要疗效指标中所有实验室指标(包括肺功能指标、血T细胞亚群、血总IgE、血EOS%)则无明显影响。具体如下:2.1主要疗效指标①治疗后患者的过敏性鼻炎视觉模拟评分、过敏性鼻炎主要症状评分、哮喘症状评分、中医证候分级量化积分均逐渐下降,且治疗后各时点与治疗前比较差异有统计学意义(P0.05)。表明本治疗方案可以改善患者的临床症状,包括鼻炎与哮喘的临床症状。②治疗后患者的ACT评分与AQLQ评分均较治疗前上升,治疗后各时点与治疗前比较差异有统计学意义(P0.05)。表明本治疗方案可以提高患者的哮喘控制水平,改善患者的生存质量。③将所有病例分为纯中医治疗与合并使用西医治疗两个亚组分析后发现:治疗后各亚组鼻炎与哮喘的各项症状评分均逐渐下降,且治疗后各时点与治疗前比较差异均有统计学意义(P0.05)。表明使用纯中医治疗与合并使用西医治疗均可改善患者鼻炎与哮喘的临床症状,提高哮喘的临床控制,改善患者生存质量。2.2次要疗效指标①治疗方案可使部分合并使用西医治疗的患者逐步减少西药的用量。②所有实验室指标治疗前后比较均无显著差异(P0.05),表明本治疗方案对患者的肺功能指标、血T细胞亚群、血总IgE、血EOS%均无明显影响。3.安全性分析所有受试者在研究期间均未发生严重不良事件,表明本治疗方案是安全的。结论本研究的结果表明,以参蛤苍龙汤为主方的中医治法"益气温阳、祛风化痰、通窍平喘"对成人CARAS "肺脾两虚、风痰犯肺"这一证型的临床治疗是安全有效的。中医治疗方案不仅可以改善患者的鼻炎与哮喘症状,提高患者的哮喘控制水平,改善患者生存质量,而且可使部分患者减少西药的用量;所有患者在研究期间均未发生严重不良事件。
[Abstract]:The purpose of allergic rhinitis and asthma syndrome (Combined Allergic Rhinitis and Asthma Syndrome, CARAS) is 2004 by the World Allergy Organization (World Allergy Organization, WAO) medical diagnostic terminology proposed, its main performance is to occur at the same time, chronic inflammation of the lower respiratory tract and hyperresponsiveness symptoms, including nasal itching, sneezing frequently, runny nose, stuffy nose, cough and wheezing [1]. survey of epidemiology, 60% ~ 78% of the patients with allergic rhinitis and asthma [16], 20% ~ 38% of the allergic rhinitis associated with asthma [25]. at diagnosis of the disease diagnosis with combined allergic rhinitis and bronchial asthma, the treatment is recommended in accordance with the relevant guidelines to take inhaled glucocorticoids. Corticosteroids based on lower respiratory tract with anti inflammation treatment. However, in clinical practice, because the combined diagnosis failed to establish rhinitis and asthma, two diseases often branch out treatment. The treatment of repetition and drug superposition, resulting in increased economic burden of the patients, compliance and curative effect, side reaction rate increased. Therefore, looking for safe and effective treatment of traditional Chinese medicine has become a pressing matter of the moment. The tutor in the long-term clinical practice found in adult CARAS with lung and spleen two deficiency, wind phlegm invading lung the pathogenesis, characteristics of lung dispersing and descending function ", put forward" Yiqiwenyang, dispelling wind and expelling phlegm, relieving asthma treatment method, Tongqiao "to ShenHa dragon soup based Decoction for staging treatment, preliminary results show that can improve the patients, lower respiratory tract symptoms, reduce the frequency of acute attack. This study based on the establishment of CARAS diagnosis model, the recognized at home and abroad observational study design methods and standards for reporting, carry out Yiqiwenyang, expelling wind and phlegm, relieving asthma clinical observational study of Tongqiao treatment of adult CARAS, using internationally accepted therapy Effect evaluation index, preliminary clinical efficacy evaluation of TCM treatment of this disease, to explore the possible mechanism of action, is expected to provide a safe and effective treatment for clinical medicine, also provides the basis for the research of Chinese medicine treatment of CRARS confirmed the next step. The design method was adopted in this study with prospective observational (series report from June 2015 to March 2017), the cases in Dongzhimen hospital outpatient department of respiration and Department of ENT outpatient treatment of allergic rhinitis and asthma syndrome patients (TCM is two lung spleen deficiency, wind phlegm invading the lung) as the research object. The TCM treatment plan of subjects included in the study of ShenHa dragon soup based decoction. 12 weeks for a course of treatment, continuous treatment of 2 courses. To observe the changes before and after treatment changes at each time point of rhinitis and asthma symptom score and laboratory indexes of examination results (including the effect 鎬ф寚鏍囧拰瀹夊叏鎬ф寚鏍，

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