清金化痰汤治疗放射性肺炎的临床观察

发布时间：2018-05-09 13:13

本文选题：放射性肺炎 + 清金化痰汤　；参考：《辽宁中医药大学》2017年硕士论文

【摘要】：目的:观察清金化痰汤联合激素治疗急性放射性肺炎的临床疗效。急性放射性肺炎的中医病机为热邪郁肺气阴两虚,造成肺宣降失常,临床中可根据放射性肺炎患者的证型进行治疗。本试验应用清金化痰汤联合激素治疗热邪郁肺气阴两虚型急性放射性肺炎,探究并分析患者的生活质量评分、血TGF-β1水平、肺功能、影像学的变化。材料与方法:采用单盲前瞻性随机对照临床试验设计,鞍钢总医院2014年10月至2016年10月收治的急性放射性肺炎患者60例,中医辨证分型均为热邪郁肺气阴两虚型。将患者随机分为试验组和对照组,入组患者均符合纳入标准,不符合排除标准,病人自愿参加试验并签署知情同意书。对照组患者激素强的松30-50 mg/d口服,试验组使用强的松30-50 mg/d加清金化痰汤加减口服,两组患者均治疗4周。通过生活质量评分、肺功能、血中TGF-β水平(酶联免疫法)、胸部CT几个方面判定疗效。最后经SPSS 21.0进行统计分析并得出结果。结果:总有效率:治疗后,试验组符合有效标准的患者(28)例,无效(2例),总有效率93.33%。对照组符合有效标准的患者(22)例,无效(8)例,总有效率73.33%。试验组总有效率高于对照组,经χ2检验差异有统计学意义(P0.05);TGF-β1水平:治疗前试验组和对照组TGF-β1水平为(37.90±4.91)和(38.71±4.01);治疗后试验组和对照组TGF-β1水平(26.24±5.37)和(30.26±5.51)。试验组对TGF-β1水平的降低优于对照组,两组血TGF-β1的降低效果的差异有统计学意义(P0.05);KPS评分:治疗前试验组及对照组患者KPS评分为(67.00±5.96)和(65.00±5.72)。治疗后试验组及对照组KPS评分为(85.00±8.20)和(78.30±10.31)。两组患者治疗前后在KPS平分提高方面的差异有统计学意义(P0.05),相较对照组,试验组的KPS评分在治疗后提高更优(P0.05);肺功能:治疗前试验组和对照组的FEV1为(1.33±0.13)和(1.31±0.15),FEV1%为(64.03±2.10)和(63.11±1.68)。治疗后试验组和对照组FEV1为(1.86±0.28)和(1.57±0.25),FEV1%为(76.35±4.50)和(71.50±4.31)。治疗后试验组的肺功能的恢复情况明显优于对照组,两组在放射性肺炎造成的肺损伤恢复效果方面的差异有统计学意义(P0.05);。结论:1.放射性肺炎在使用清金化痰汤加减联合激素治疗后能够获得更显著的疗效,能够有效改善患者的生活质量,明显减轻患者胸部CT阴影、显著改善患者的肺功能,比单纯激素治疗放射性肺炎效果更好。2.清金化痰汤联合激素治疗能够显著的降低TGF-β1的水平,进一步抑制患者免疫因子的聚集和浸润,使患者肺组织炎症得到减轻,使患者的肺部损伤降到最低。
[Abstract]:Objective: to observe the clinical effect of Qingjin Huatan decoction combined with hormone in the treatment of acute radiation pneumonia. The TCM pathogenesis of acute radiation pneumonia is heat evil stagnation of lung qi and yin deficiency of both lung qi and yin, which results in abnormal declaration of the lung, which can be treated according to the syndromes of patients with radiation pneumonia. In this experiment, Qingjin Huatan decoction combined with hormone was used to treat acute radiation pneumonia with heat evil, stagnation of lung qi and yin deficiency. The quality of life score, blood TGF- 尾 1 level, pulmonary function and imaging changes were investigated and analyzed. Materials and methods: 60 patients with acute radiation pneumonia treated in Angang General Hospital from October 2014 to October 2016 were divided into two types: heat evil stagnation of lung qi and yin deficiency. Patients were randomly divided into experimental group and control group. The patients in the group met the inclusion criteria and did not meet the exclusion criteria. The patients volunteered to participate in the test and sign the informed consent. The patients in the control group were treated with prednisone for 30 to 50 mg/d, the test group was treated with prednisone 30-50 mg/d plus Qingjinhuatan decoction for 4 weeks. Quality of life score, lung function, blood TGF- 尾 level (enzyme linked immunosorbent assay, chest CT) were used to evaluate the curative effect. Finally, the statistical analysis was carried out by SPSS 21. 0 and the results were obtained. Results: total effective rate: after treatment, 28 patients in the test group met the effective standard, 2 patients were ineffective and the total effective rate was 93.33. In the control group, 22 patients met the effective standard and 8 patients failed. The total effective rate was 73.33. The total effective rate of the trial group was higher than that of the control group (蠂 2 test). The levels of TGF- 尾 1 in the test group and the control group were 37.90 卤4.91 and 38.71 卤4.01 respectively, and the TGF- 尾 1 levels in the experimental group and the control group were 26.24 卤5.37) and 30.26 卤5.51 respectively. The decrease of TGF- 尾 1 level in the trial group was better than that in the control group. There was significant difference in the effect of TGF- 尾 1 reduction between the two groups. The KPS scores of the patients in the trial group and the control group were 67.00 卤5.96 and 65.00 卤5.72 respectively before treatment. After treatment, the KPS scores of the experimental group and the control group were 85.00 卤8.20 and 78.30 卤10.31 respectively. There was significant difference between the two groups in improving the KPS score before and after treatment. Compared with the control group, the KPS score of the test group was better than that of the control group, and the pulmonary function of the experimental group and the control group was 1.33 卤0.13) and 1.31 卤0.15% (64.03 卤2.10) and 63.11 卤1.68%, respectively. After treatment, the FEV1 of the experimental group and the control group were 1.86 卤0.28) and 1.57 卤0.25% respectively. The FEV1% was 76.35 卤4.50) and the FEV1 was 71.50 卤4.31%. After treatment, the recovery of lung function in the experimental group was significantly better than that in the control group, and the difference between the two groups in the recovery effect of lung injury caused by radiation pneumonia was statistically significant (P 0.05). Conclusion 1. After using Qingjin Huatan decoction combined with hormone therapy, radiation pneumonia can obtain more significant curative effect, can effectively improve the quality of life of patients, obviously alleviate the chest CT shadow of patients, and significantly improve the pulmonary function of patients. Treatment of radiation pneumonia is better than hormone alone. 2. 2. Qingjinhuatan decoction combined with hormone therapy can significantly reduce the level of TGF- 尾 1, further inhibit the accumulation and infiltration of immune factors, reduce the inflammation of lung tissue and minimize the lung injury.
【学位授予单位】：辽宁中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R273

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