ACOS中医证候初步观察及阳和平喘颗粒对ACOS非缓解期患者干预作用

发布时间：2018-06-16 16:43

本文选题：哮喘-慢阻肺重叠综合征 + 阳和平喘颗粒　；参考：《安徽中医药大学》2016年硕士论文

【摘要】：目的初步观察ACOS中医证候分布特点;阳和平喘颗粒治疗ACOS非缓解期患者的临床疗效及对血清炎症因子IL-4、IFN-γ、IL-8、IL-10的影响。方法1采用横断面调查方法,填写ACOS中医证候观察表,对ACOS中医证候分布特点进行初步的临床观察。2收集符合纳入标准的40例ACOS患者,随机分配到治疗组和对照组,每组各20例。对照组以常规西医治疗为主,治疗组在对照组的基础上加用阳和平喘颗粒治疗。观察两组患者治疗前后中医证候积分、肺功能指标(FEV1、FVC、FEV1/FVC及FEV1%预计值)、血清炎症因子(IL-4、IFN-γ、IL-8及IL-10)和生活质量评分的变化。结果1 ACOS中医证候初步观察ACOS发病以男性居多,吸烟史较长,诱发本病发作的因素以气候变化为甚,肺功能分级在重度以上者占82.5%;以咳嗽、咳痰、胸闷所占频数最多是本病的主症;中医证型以热证居多,其中热夹痰证最多,其次是热夹瘀证,再者是寒夹虚证。2阳和平喘颗粒对ACOS非缓解期患者中医证候积分的影响两组治疗前中医证候积分比较差异无统计学意义(P0.05);两组治疗后中医证候积分较治疗前均明显降低(P0.01)。治疗组治疗后中医证候积分与对照组治疗后比较差异有统计学意义(P0.05)。治疗组中医证候疗效(85%)高于对照组(60%)差异有统计学意义(P0.05)。3阳和平喘颗粒对ACOS非缓解期患者肺功能的影响两组治疗前FVC、FEV1、FEV1%预计值及FEV1/FVC比较差异均无统计学意义(P0.05)。治疗后两组FVC、FEV1、FEV1%预计值及FEV1/FVC较治疗前均升高(P0.01或P0.05)。治疗组治疗后FVC、FEV1、FEV1%预计值及FEV1/FVC与对照组治疗后比较差异有统计学意义(P0.05)。4阳和平喘颗粒对ACOS非缓解期患者血清指标的影响两组治疗前血清IL-4、IFN-γ、IL-8及IL-10水平比较差异无统计学意义(P0.05)。治疗后两组血清IL-4、IL-8水平较治疗前均降低(P0.01或P0.05),血清IFN-γ、IL-10水平较治疗前均升高(P0.01或P0.05)。治疗组治疗后血清IL-4、IFN-γ、IL-8及IL-10水平与对照组治疗后比较差异有统计学差异(P0.05)。5阳和平喘颗粒对ACOS非缓解期患者生活质量评分的影响两组治疗前CAT评分比较差异无统计学意义(P0.05);两组治疗后CAT评分较治疗前均降低(P0.01);治疗组治疗后CAT评分与对照组治疗后比较差异无统计学意义(P0.05),但治疗组下降更明显。结论1在40例ACOS患者中,中医证型以热证居多,虚、瘀、痰是重要的兼证。2阳和平喘颗粒在西医治疗的基础上可提高ACOS非缓解期患者的中医证候积分、生活质量评分,改善患者的肺功能。3阳和平喘颗粒在西医治疗的基础上能降低ACOS非缓解期患者血清炎症因子IL-4、IL-8水平,升高IFN-γ、IL-10水平。
[Abstract]:Objective to observe the distribution of TCM syndromes of ACOS, the clinical effect of Yanghe Pingchuan granule on non-remission ACOS patients and the influence of IL-4, IFN- 纬, IL-8 and IL-10 on serum inflammatory factor IL-4, IFN- 纬, IL-8 and IL-10 in patients with ACOS. Methods 1 A cross-sectional investigation was used to fill out the observation form of TCM syndrome of ACOS. The clinical observation of the distribution of TCM syndromes of ACOS was carried out. 2. 40 ACOS patients who met the inclusion criteria were randomly assigned to the treatment group and the control group. There were 20 cases in each group. The control group was treated mainly by routine western medicine, and the treatment group was treated with Yang and Pingchuan granules on the basis of the control group. The scores of TCM syndromes, pulmonary function indexes, FEV1 / FVC and FEV1% predicted values, serum inflammatory factors (IL-4, IFN- 纬, IL-8 and IL-10) and quality of life (QOL) were observed before and after treatment in both groups. Results 1 Primary observation of TCM syndromes of ACOS showed that the incidence of ACOS was mostly male, smoking history was longer, the factors inducing ACOS attack were climate change, 82.5% of the patients with severe grade of lung function were cough, sputum, cough, phlegm, and so on. The frequency of chest tightness is the main symptom of the disease, heat syndrome is the most common type of TCM syndromes, among which heat clamping phlegm syndrome is the most, followed by heat and stasis syndrome. Furthermore, there was no significant difference in TCM syndromes score between the two groups before treatment (P 0.05N), and after treatment, the TCM syndrome score of the two groups were significantly lower than that of the control group (P 0.01). 2. The effect of Han Jia deficiency Syndrome on TCM syndromes integral in patients with ACOS during non-remission period was not statistically significant (P0.05N), and the scores of TCM syndromes after treatment in two groups were significantly lower than those before treatment. The scores of TCM syndrome in the treatment group were significantly different from those in the control group (P 0.05). The effect of TCM syndromes in the treatment group (85) was higher than that in the control group (60). There was no significant difference in the effect of P0.050.3-Yang and Pingchuan granule on lung function of patients with ACOS during non-remission period before treatment. There was no significant difference in the predicted value of FEV1 / FEV1 and FEV1 / FVC before treatment between the two groups. After treatment, the predicted FEV1 / FEV1% and FEV1 / FVC in both groups were significantly higher than those before treatment (P0.01 or P0.05). There was significant difference in the predicted value of FEV1 / FEV1% and the difference of FEV1 / FVC between the treatment group and the control group after treatment. The effect of P0.05.4 Yang and Pingchuan granule on serum indexes of patients with ACOS during non-remission period had no significant difference between the two groups before treatment. There was no significant difference in the levels of IL-4 IFN- 纬 -IL-8 and IL-10 between the two groups before treatment. After treatment, the serum levels of IL-4, IL-8 and IFN- 纬 -IL-10 in both groups were lower than those before treatment, respectively, and the levels of serum IFN- 纬 -IL-10 were higher than those before treatment (P0.01 or P0.05). Effect of serum IL-4, IFN- 纬 -IL-8 and IL-10 levels after treatment on quality of life score of non-remission ACOS patients in the treatment group and control group, there was no significant difference between the two groups in terms of cat score before treatment. The cat score of the treatment group was lower than that of the control group, but the cat score of the treatment group was lower than that of the control group, but the decrease of the cat score in the treatment group was more obvious than that in the control group. Conclusion (1) in 40 patients with ACOS, heat syndrome, deficiency, blood stasis and phlegm are the most important syndromes in 40 patients with ACOS. On the basis of western medicine treatment, the TCM syndromes integral and quality of life score of ACOS patients with non-remission period can be improved. On the basis of western medicine treatment, the improvement of pulmonary function in patients with ACOS can reduce the level of IL-4 and IL-8, and increase the level of IFN- 纬 -IL-10 in patients with ACOS.
【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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