活血化瘀法治疗结核性胸膜炎胸膜增厚的疗效观察及对TNF-α和FIB的影响
发布时间：2018-08-28 20:27
【摘要】：目的： 观察活血化瘀法治疗结核性胸膜炎胸膜增厚的疗效以及对胸水中肿瘤坏死因子(TNF-α)和纤维蛋白原(FIB)的影响。 方法： 将60例符合条件的患者随机分为治疗组和对照组,住院期间治疗组用常规治疗(抗结核药物+胸腔穿刺抽液术)+活血化瘀的中药,对照组用常规治疗(抗结核药物+胸腔穿刺抽液术),疗程2周±7天,出院后治疗组用抗结核药物+活血化瘀成药(血府逐瘀冲剂1包,tid),对照组只用抗结核药物,疗程8周±7天,观察两组治疗前后胸水中肿瘤坏死因子TNF-α,纤维蛋白原(FIB)的变化,患者症状和肺功能改善情况以及胸膜厚度的改变。 成果： 1.中医证候疗效方面：治疗前两组患者各项主要中医症状比较,无显著性差异,(p0.05),具有可比性。治疗后,治疗组各项症状与治疗前相比,均有显著性差异,(p0.05),而对照组仅在咳嗽,气促,发热,咯血方面,同治疗前相比有显著差异,其余指标均无显著的差异,说明单纯常规的方法治疗仅能改善结核性胸膜炎部分症状,而联合活血化瘀的中药可明显改善患者主要中医症状,而且两组治疗后比较,治疗组在除气促,发热外,其余症状均较对照组明显改善(p0.05),且治疗后两组中医疗效比较,治疗组显效,有效的例数和总有效率明显高于对照组(p0.05),说明治疗组在改善结核性胸膜炎患者中医证候方面明显优于对照组。 2.肺功能检查：治疗前,两组患者FVC, FEV1/FVC%, VC, FEV1比较无显著性差异(p0.05),具有可比性。治疗2周±7天,8周±7天,两组患者FVC, VC,均较治疗前有显著的提高,而FEV1无明显变化(p0.05),FEV1/FVC%下降(p0.05)。两组治疗前后有显著的差异(p0.05),两组组间比较,治疗组VC较对照组有显著的提高,FEV1/FVC%下降(p0.05),而FEV1, FVC无显著的差异(p0.05),说明两组组间治疗有显著性的差异,治疗组在改善患者肺功能方面明显优于对照组。 3.胸水肿瘤坏死因子(TNF-α):治疗前两组患者的胸水中肿瘤坏死因子的含量比较无显著的差异(p0.05),经过相同疗程治疗后,2周±7天两组患者胸水中肿瘤坏死因子,较治疗前均有显著的减少(p0.05)。治疗后两组之间相比,具有显著性差异(p0.05),说明治疗组的疗效明显优于对照组。 4.胸水纤维蛋白原(FIB)：治疗前两组患者的胸水中纤维蛋白原比较无显著差异(p0.05),经过相同疗程治疗后,2周±7天两组患者胸水中纤维蛋白原,较治疗前均有显著的减少(p0.05)。治疗后两组之间相比,具有显著性差异(p0.05)说明治疗组的疗效明显优于对照组。 5.胸膜厚度：治疗前两组患者的胸膜厚度的比较无显著的差异(p0.05),经过相同疗程的治疗,2周±7天后治疗组与对照组患者胸膜的厚度相比,具有显著性差异(p0.05)：8周±7天后两组相比,具有显著性的差异(p0.05),说明治疗组的疗效明显优于对照组。 6.安全性指标：两组治疗前后血分析,大便检查,尿组合,ALT, AST,尿素氮及肌酐对比,两组治疗前无显著的差异(p0.05),两组治疗2周±7天,8周±7天与治疗前比较均无显著的差异(p0.05) 结论： 本病从“悬饮病”后期多以气滞水饮瘀血互结为主要证型的临床实际出发,以“津亏血瘀”的中医病理理论为指导,以结核性胸膜炎患者为受试对象,采用常规治疗(抗结核药物+胸腔穿刺术)+活血化瘀中药治疗,与常规治疗(抗结核药物+胸腔穿刺术)相比,能有效降低胸水中肿瘤坏死因子(TNF-α)和纤维蛋白原(FIB)的含量以及能够明显减少患者胸膜增厚的程度,改善患者肺功能的情况,从而改善患者临床症状,明显改善疾病的预后。
[Abstract]:Objective:
Objective To observe the effect of Huoxue Huayu method on pleural thickening in tuberculous pleurisy and the effect on tumor necrosis factor-alpha (TNF-alpha) and fibrinogen (FIB) in pleural effusion.
Method:
Sixty eligible patients were randomly divided into treatment group and control group. During hospitalization, the treatment group was treated with routine treatment (anti-tuberculosis drugs + pleural puncture aspiration) + traditional Chinese medicine for activating blood circulation and removing blood stasis. The control group was treated with routine treatment (anti-tuberculosis drugs + pleural puncture aspiration). The treatment course was 2 weeks (+ 7 days). After discharge, the treatment group was treated with anti-tuberculosis drugs + traditional Chinese medicine for activating blood circulation Xuefu Zhuyu Granule 1 pack, tid, the control group only used anti-tuberculosis drugs, course of treatment 8 weeks (+ 7 days), to observe the changes of tumor necrosis factor TNF-a, fibrinogen (FIB) in pleural effusion before and after treatment, the improvement of symptoms and lung function and pleural thickness.
Achievements:
1. TCM syndromes: before treatment, the two groups of patients with the main symptoms of TCM, no significant difference (p0.05), comparable. After treatment, the treatment group compared with before treatment, the symptoms have significant differences (p0.05), while the control group only in cough, shortness of breath, fever, hemoptysis, compared with before treatment, there is a significant difference, the rest of the fingers. There was no significant difference between the two groups, indicating that only routine treatment can improve some symptoms of tuberculous pleurisy, and the combination of traditional Chinese medicine can significantly improve the main symptoms of patients with tuberculous pleurisy, and two groups after treatment, the treatment group in addition to shortness of breath, fever, the other symptoms were significantly improved compared with the control group (p0.05), and after treatment in both groups. Compared with the control group, the number of effective cases and the total effective rate in the treatment group were significantly higher than those in the control group (p0.05), indicating that the treatment group was superior to the control group in improving the TCM syndrome of tuberculous pleurisy patients.
2. Pulmonary function examination: Before treatment, FVC, FEV1 / FVC, VC, FEV1 were not significantly different between the two groups (p0.05), with comparability. 2 weeks (+ 7 days), 8 weeks (+ 7 days), two groups of patients with FVC, VC, were significantly improved than before treatment, but no significant changes in FEV1 (p0.05), FEV1 / FVC% decreased (p0.05). There was a significant difference between the two groups before and after treatment (p0.05). Compared with the control group, VC in the treatment group was significantly improved, FEV1/FVC% decreased (p0.05), while FEV1 and FVC had no significant difference (p0.05), indicating that there was a significant difference between the two groups. The treatment group was significantly better than the control group in improving lung function.
3. Tumor necrosis factor-alpha in pleural effusion: There was no significant difference in the content of TNF-alpha in pleural effusion between the two groups before treatment (p0.05). After the same course of treatment, the level of TNF-alpha in pleural effusion of the two groups was significantly lower than that before treatment (p0.05). There was a significant difference between the two groups after treatment (p0.05). 05), indicating that the curative effect of the treatment group is obviously better than that of the control group.
4. Fibrinogen in pleural effusion (FIB): There was no significant difference between the two groups before treatment (p0.05). After the same course of treatment, the fibrinogen in pleural effusion of the two groups decreased significantly (p0.05). There was significant difference between the two groups after treatment (p0.05). The curative effect is obviously better than that of the control group.
5. Pleural thickness: before treatment, there was no significant difference in pleural thickness between the two groups (p0.05). After the same course of treatment, the pleural thickness between the treatment group and the control group after 2 weeks (+ 7 days) was significantly different (p0.05). After 8 weeks (+ 7 days), there was a significant difference between the two groups (p0.05), indicating that the treatment group had a significant effect. It was better than the control group.
6. Safety indicators: two groups before and after treatment blood analysis, stool examination, urine combination, ALT, AST, urea nitrogen and creatinine comparison, two groups before and after treatment no significant difference (p0.05), two groups of treatment 2 weeks (+ 7 days), 8 weeks (+ 7 days) compared with before treatment no significant difference (p0.05).
Conclusion:
Based on the clinical practice of Qi stagnation, water retention and blood stasis as the main syndromes in the late stage of "suspended drinking disease", and guided by the pathological theory of "Jin deficiency and blood stasis", the patients with tuberculous pleurisy were treated with routine treatment (anti-tuberculosis drugs + thoracic puncture) + traditional Chinese medicine for activating blood circulation and removing blood stasis, and routine treatment (anti-tuberculosis drugs) Compared with thoracentesis, it can effectively reduce the levels of tumor necrosis factor-alpha (TNF-alpha) and fibrinogen (FIB) in pleural effusion, significantly reduce the degree of pleural thickening and improve the pulmonary function of patients, thereby improving the clinical symptoms and prognosis of the disease.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R521.7
[Abstract]:Objective:
Objective To observe the effect of Huoxue Huayu method on pleural thickening in tuberculous pleurisy and the effect on tumor necrosis factor-alpha (TNF-alpha) and fibrinogen (FIB) in pleural effusion.
Method:
Sixty eligible patients were randomly divided into treatment group and control group. During hospitalization, the treatment group was treated with routine treatment (anti-tuberculosis drugs + pleural puncture aspiration) + traditional Chinese medicine for activating blood circulation and removing blood stasis. The control group was treated with routine treatment (anti-tuberculosis drugs + pleural puncture aspiration). The treatment course was 2 weeks (+ 7 days). After discharge, the treatment group was treated with anti-tuberculosis drugs + traditional Chinese medicine for activating blood circulation Xuefu Zhuyu Granule 1 pack, tid, the control group only used anti-tuberculosis drugs, course of treatment 8 weeks (+ 7 days), to observe the changes of tumor necrosis factor TNF-a, fibrinogen (FIB) in pleural effusion before and after treatment, the improvement of symptoms and lung function and pleural thickness.
Achievements:
1. TCM syndromes: before treatment, the two groups of patients with the main symptoms of TCM, no significant difference (p0.05), comparable. After treatment, the treatment group compared with before treatment, the symptoms have significant differences (p0.05), while the control group only in cough, shortness of breath, fever, hemoptysis, compared with before treatment, there is a significant difference, the rest of the fingers. There was no significant difference between the two groups, indicating that only routine treatment can improve some symptoms of tuberculous pleurisy, and the combination of traditional Chinese medicine can significantly improve the main symptoms of patients with tuberculous pleurisy, and two groups after treatment, the treatment group in addition to shortness of breath, fever, the other symptoms were significantly improved compared with the control group (p0.05), and after treatment in both groups. Compared with the control group, the number of effective cases and the total effective rate in the treatment group were significantly higher than those in the control group (p0.05), indicating that the treatment group was superior to the control group in improving the TCM syndrome of tuberculous pleurisy patients.
2. Pulmonary function examination: Before treatment, FVC, FEV1 / FVC, VC, FEV1 were not significantly different between the two groups (p0.05), with comparability. 2 weeks (+ 7 days), 8 weeks (+ 7 days), two groups of patients with FVC, VC, were significantly improved than before treatment, but no significant changes in FEV1 (p0.05), FEV1 / FVC% decreased (p0.05). There was a significant difference between the two groups before and after treatment (p0.05). Compared with the control group, VC in the treatment group was significantly improved, FEV1/FVC% decreased (p0.05), while FEV1 and FVC had no significant difference (p0.05), indicating that there was a significant difference between the two groups. The treatment group was significantly better than the control group in improving lung function.
3. Tumor necrosis factor-alpha in pleural effusion: There was no significant difference in the content of TNF-alpha in pleural effusion between the two groups before treatment (p0.05). After the same course of treatment, the level of TNF-alpha in pleural effusion of the two groups was significantly lower than that before treatment (p0.05). There was a significant difference between the two groups after treatment (p0.05). 05), indicating that the curative effect of the treatment group is obviously better than that of the control group.
4. Fibrinogen in pleural effusion (FIB): There was no significant difference between the two groups before treatment (p0.05). After the same course of treatment, the fibrinogen in pleural effusion of the two groups decreased significantly (p0.05). There was significant difference between the two groups after treatment (p0.05). The curative effect is obviously better than that of the control group.
5. Pleural thickness: before treatment, there was no significant difference in pleural thickness between the two groups (p0.05). After the same course of treatment, the pleural thickness between the treatment group and the control group after 2 weeks (+ 7 days) was significantly different (p0.05). After 8 weeks (+ 7 days), there was a significant difference between the two groups (p0.05), indicating that the treatment group had a significant effect. It was better than the control group.
6. Safety indicators: two groups before and after treatment blood analysis, stool examination, urine combination, ALT, AST, urea nitrogen and creatinine comparison, two groups before and after treatment no significant difference (p0.05), two groups of treatment 2 weeks (+ 7 days), 8 weeks (+ 7 days) compared with before treatment no significant difference (p0.05).
Conclusion:
Based on the clinical practice of Qi stagnation, water retention and blood stasis as the main syndromes in the late stage of "suspended drinking disease", and guided by the pathological theory of "Jin deficiency and blood stasis", the patients with tuberculous pleurisy were treated with routine treatment (anti-tuberculosis drugs + thoracic puncture) + traditional Chinese medicine for activating blood circulation and removing blood stasis, and routine treatment (anti-tuberculosis drugs) Compared with thoracentesis, it can effectively reduce the levels of tumor necrosis factor-alpha (TNF-alpha) and fibrinogen (FIB) in pleural effusion, significantly reduce the degree of pleural thickening and improve the pulmonary function of patients, thereby improving the clinical symptoms and prognosis of the disease.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R521.7
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