补中柴前连梅煎减少支气管扩张患者急性加重次数的临床疗效研究

发布时间：2018-04-25 06:35

本文选题：补中柴前连梅煎 + 稳定期　；参考：《中国中医科学院》2016年博士论文

【摘要】：支气管扩张是呼吸系统难治性疾病之一,继发性支气管扩张发病机制的关键环节为支气管感染和支气管阻塞,两者相互影响,形成恶性循环。大部分中医药专家认为在稳定期支气管扩张的病因病机以风、痰、热、毒、虚为主,虚主要以气虚为主。稳定期支气管扩张患者长期小剂量口服大环内脂类抗生素的研究引起大家关注,发现长期小剂量大环内酯类抗生素维持性治疗可显著减少急性加重的发生次数。中医药治疗在整体调节、改善机体状况、提高免疫力等方面具有一定优势,但在减少稳定期急性加重次数的研究相对较少,加强中医药治疗稳定期支气管扩张的研究,减少稳定期支气管扩张患者急性加重次数是一项重要研究课题。临床中发现柴前连梅煎治疗咳嗽日久,咳吐青绿痰病证,效果非常好,而稳定期支气管扩张患者反复咳吐青绿痰与之咳嗽日久,咳吐青绿痰病证非常相似。基于“火与元气不两立,一胜则一负”理论,同时根据稳定期支气管扩张肺脾气虚、痰热蕴肺的基本病机,组建了补中柴前连梅煎,从补元气,泻阴火,祛痰热方面治疗稳定期支气管扩张以减少急性加重次数。因此,我们开展了补中柴前连梅煎对稳定期支气管扩张急性加重次数影响的初步研究,为中医药治疗稳定期支气管扩张提供依据。目的：初步探讨补中柴前连梅煎对稳定期支气管扩张急性加重次数的影响,为中医药治疗稳定期支气管扩张提供依据。方法：采用随机对照的临床试验设计,选择70例稳定期无咯血患者,随机分为试验组及对照组,分别给与补中柴前连梅煎及阿奇霉素片治疗12周,随访12周。采用主要疗效指标(急性加重次数、症状评分、肺功能)及次要疗效指标(血清免疫球蛋白、L6, mMRC评分,FACED评分)进行评价分析。结果：1急性加重次数两组患者在3周、6周、9周、12周及随访12周急性加重次数组间比较无统计学差异(P0.05)。在治疗12周期间试验组的急性加重次数为0.49次／人,对照组为0.50次／人；随访12周内试验组的急性加重次数为0.48次／人,对照组为0.53次／人。两组在3周、6周、9周、12周及随访12周急性加重频次组间比较无统计学差异(P0.05)。2症状评分试验组总有效率为93.94%,对照组的总有效率为93.75%,两组之间疗效比较无统计学差异(P0.05),两组在0周、3周、6周及9周症状评分实测值组间比较无统计学差异(P0.05),在12周试验组症状评分明显小于对照组(P0.05)。两组症状评分组内前后比较都有显著差异(P0.01),两组在咳嗽、咯痰、胸闷气短、乏力、纳呆、自汗、腹胀及面色黄症状改善上无统计学差异(P0.05)。3肺功能两组治疗后VC、FEV1百分比组间比较无统计学差异(P0.05), FEV1/FVC百分比组间比较有显著统计学差异(P0.05),其中FEV1/FVC百分比试验组为74.30±11.046,对照组为61.40±14.377。两组患者肺功能组内前后比较无显著差异(P0.05)。4 FACED评分及mMRC评分治疗后两组患者FACED评分及mMRC评分组间比较无统计学差异(P0.05),两组患者mMRC评分组内前后比较有显著统计学差异(P0.01),FACED评分无统计学差异(P0.05)。5免疫球蛋白及IL6两组患者治疗后免疫球蛋白及IL6单项指标组间比较无统计学差异(P0.05),两组免疫球蛋白及IL6组内前后比较无统计学差异(P0.05)。结论：1补中柴前连梅煎能明显减少稳定期支气管扩张患者急性加重次数。2补中柴前连梅煎能减轻稳定期支气管扩张患者的呼吸困难严重程度,明显改善稳患者的临床症状。
[Abstract]:Bronchiectasis is one of the refractory diseases of the respiratory system. The key link of the pathogenesis of secondary bronchiectasis is bronchial infection and bronchial obstruction. Both of them affect each other and form a vicious cycle. Most Chinese medicine experts believe that the etiology and pathogenesis of bronchiectasis in the stable period are wind, phlegm, heat, poison, deficiency mainly, and asthenia mainly with Qi deficiency. The study of long term small dose oral macrocyclic lipid antibiotics in patients with stable bronchiectasis has caused attention. It is found that long-term small dose of macrolide antibiotics maintenance therapy can significantly reduce the incidence of acute aggravation. Chinese medicine treatment in the overall regulation, improve the body condition, improve immunity and so on. However, the study of acute exacerbation times in the stable period is relatively few. It is an important research topic to strengthen the study of bronchiectasis in the stable period of Chinese medicine and reduce the acute aggravation times of bronchiectasis in the stable period. Patients with periodic bronchiectasis cough and vomit green and green phlegm repeatedly and cough day long, cough and vomit green phlegm syndrome very similar. Based on the theory of "fire and Qi not two upright, one victory one negative" theory, according to the basic pathogenesis of bronchiectasis and spleen qi deficiency of the bronchiectasis in the stable period, the basic pathogenesis of phlegm heat accumulation is established, from supplementing qi, reducing Qi and eliminating phlegm heat from the Tonifying Qi, yin and Yin fire. To treat stable bronchiectasis in order to reduce the number of acute exacerbations. Therefore, we have carried out a preliminary study on the effect of the decoction of Chinese medicine of Bu Zhong Chai on the acute exacerbation of bronchiectasis in the stable period, to provide a basis for the treatment of bronchiectasis in stable period of Chinese medicine. The effect of acute aggravation times was provided for the treatment of bronchiectasis in stable period of Chinese medicine. Methods: 70 cases of stable and non hemoptysis were randomly divided into experimental group and control group by randomized controlled clinical trial design. The patients were randomly assigned to the test group and the control group for 12 weeks, respectively, and followed up for 12 weeks. The standard (acute aggravation, symptom score, lung function) and secondary curative effect index (serum immunoglobulin, L6, mMRC score, FACED score) were evaluated. Results there was no statistical difference between the two groups of 1 acute aggravation groups at 3 weeks, 6 weeks, 9 weeks, 12 weeks, and 12 weeks (P0.05). In the treatment group, the experimental group was treated for the period of 12 weeks. The times of acute aggravation were 0.49 times per person and 0.50 times in the control group; the acute aggravation times of the test group were 0.48 times in the 12 week follow-up group and 0.53 times in the control group. The two groups were in 3 weeks, 6 weeks, 9 weeks, 12 weeks and 12 weeks of follow-up (P0.05), the total effective rate of the.2 symptom score group was 93.94%, and the total effective rate was 93.94%. The total effective rate of the group was 93.75%. There was no statistical difference between the two groups (P0.05). There was no statistical difference between the two groups at 0 weeks, 3 weeks, 6 and 9 weeks (P0.05), and the symptom scores in the 12 week group were significantly smaller than those in the control group (P0.05). There were significant differences between the two groups before and after the symptom score group (P0.01), and two groups in the two groups. There was no statistical difference between coughing, phlegm, shortness of chest tightness, fatigue, fatigue, anathesis, self perspiration, abdominal distension and yellow symptoms (P0.05), there was no statistical difference between the two groups of.3 lung function after treatment (P0.05), and there was a significant statistical difference between the FEV1/FVC percentage groups (P0.05), and the percentage of FEV1/FVC percentage was 74.30 + 11.046 in the group of FEV1/FVC. In the control group, there was no significant difference in the pulmonary function group between the 61.40 + 14.377. two groups (P0.05), and there was no statistical difference between the FACED score and the mMRC score group in the two groups after the treatment of the mMRC score (P0.05). There was significant difference (P0.01) between the two groups before and after the mMRC score group (P0.01), and there was no statistical difference between the FACED scores (P0.01). P0.05) there was no statistical difference between.5 immunoglobulin and IL6 two groups after treatment (P0.05). There was no statistical difference between the two groups of immunoglobulin and IL6 group (P0.05). Conclusion: 1 Bu Zhong Chai Lian Mei decoction can significantly reduce the acute exacerbation times of stable bronchiectasis patients.2 complacation. Pre - Lian Mei decoction can relieve the severity of dyspnea in patients with bronchiectasis in stable stage, and improve the clinical symptoms of stable patients.

【学位授予单位】：中国中医科学院
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R259

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