血府逐瘀汤联合西医常规疗法治疗结核性胸膜炎胸膜增厚临床研究
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摘要
目的观察血府逐瘀汤联合西医常规疗法治疗结核性胸膜炎(TBP)胸膜增厚的临床疗效,探讨可能的作用机制。方法采用随机数字表法将150例TBP胸膜增厚患者分为试验组和对照组各75例,共脱落11例,最终试验组71例,对照组68例。对照组予常规短程强化抗结核化疗方案+胸腔穿刺抽中-大量积液,试验组在对照组治疗基础上予血府逐瘀汤,每次150m L,每日3次口服。2组均连续治疗2个月。观察2组中医症状评分、胸水引流量、胸膜厚度、胸水消失时间、胸水指标及临床疗效。结果试验组胸水引流量、胸膜厚度、胸水消失时间均低于对照组(P<0.05)。与本组治疗前比较,2组治疗后发热、咳嗽、气促、胸胁痛评分明显改善(P<0.05);试验组治疗后发热、咳嗽、气促、胸胁痛评分低于对照组(P<0.05)。与本组治疗前比较,2组治疗后胸水肿瘤坏死因子-α(TNF-α)、纤维蛋白原(FIB)、转化生长因子-β1(TGF-β1)、腺苷脱氨酶(ADA)水平下降(P<0.05);试验组治疗后胸水TNF-α、FIB、TGF-β1、ADA水平低于对照组(P<0.05)。试验组总有效率为97.2%(69/71),对照组为88.2%(60/68),2组比较差异有统计学意义(P<0.05)。结论血府逐瘀汤联合西医常规疗法可有效缓解TBP胸膜增厚患者的临床症状,提高临床疗效,其机制可能与降低胸腔积液中TNF-α、FIB、TGF-β1水平相关。
Objective To observe the clinical efficacy of Xuefu Zhuyu Decoction combined with conventional Western medicine for tuberculous pleurisy(TBP) and pleura thickness; To explore the possible mechanism. Methods Totally 150 cases of TBP and pleura thickness were divided into the experiment group and control group according to random number table method, with 75 cases in each group. 11 cases were lost. In the end, 71 cases were treated in the experiment group and 68 cases in the control group. The control group received conventional short-course intensive anti-tuberculosis chemotherapy + thoracentesis medium to large amount of effusion, while the experiment group was given Xuefu Zhuyu Decoction on the basis of the control group, 150 mL each time, three times a day, orally. The treatment for both groups lasted for two months. TCM syndrome scores, pleural drainage volume, pleural thickness, pleural effusion duration, pleural effusion index and clinical efficacy of the two groups were observed. Results The pleural drainage volume, pleural thickness and pleural effusion duration in the experiment group were lower than those in the control group(P<0.05). Compared with before treatment, the scores of fevers, cough, shortness of breath and thoracicgia were significantly improved after treatment in the two groups(P<0.05); The scores of fevers, cough, shortness of breath and thoracicgia in the experiment group were lower than those in the control group(P<0.05). Compared with before treatment, the levels of pleural effusion tumor necrosis factor-α(TNF-α), fibrinogen(FIB), transforming growth factor-β1(TGF-β1) and adenosine deaminase(ADA) decreased after treatment in both groups(P<0.05); The levels of TNF-α, FIB, TGF-β1 and ADA in the pleural effusion of the experiment group were lower than those of the control group(P<0.05). The total effective rate was 97.2%(69/71) in the experiment group and 88.2%(60/68) in the control group, with statistical significance(P<0.05). Conclusion Xuefu Zhuyu Decoction combined with conventional Western medicine can effectively alleviate the clinical symptoms of patients with TBP and pleural thickness and improve clinical efficacy. The mechanism may be related to reducing the levels of TNF-α, FIB and TGF-β1 in pleural effusion of patients.
Objective To observe the clinical efficacy of Xuefu Zhuyu Decoction combined with conventional Western medicine for tuberculous pleurisy(TBP) and pleura thickness; To explore the possible mechanism. Methods Totally 150 cases of TBP and pleura thickness were divided into the experiment group and control group according to random number table method, with 75 cases in each group. 11 cases were lost. In the end, 71 cases were treated in the experiment group and 68 cases in the control group. The control group received conventional short-course intensive anti-tuberculosis chemotherapy + thoracentesis medium to large amount of effusion, while the experiment group was given Xuefu Zhuyu Decoction on the basis of the control group, 150 mL each time, three times a day, orally. The treatment for both groups lasted for two months. TCM syndrome scores, pleural drainage volume, pleural thickness, pleural effusion duration, pleural effusion index and clinical efficacy of the two groups were observed. Results The pleural drainage volume, pleural thickness and pleural effusion duration in the experiment group were lower than those in the control group(P<0.05). Compared with before treatment, the scores of fevers, cough, shortness of breath and thoracicgia were significantly improved after treatment in the two groups(P<0.05); The scores of fevers, cough, shortness of breath and thoracicgia in the experiment group were lower than those in the control group(P<0.05). Compared with before treatment, the levels of pleural effusion tumor necrosis factor-α(TNF-α), fibrinogen(FIB), transforming growth factor-β1(TGF-β1) and adenosine deaminase(ADA) decreased after treatment in both groups(P<0.05); The levels of TNF-α, FIB, TGF-β1 and ADA in the pleural effusion of the experiment group were lower than those of the control group(P<0.05). The total effective rate was 97.2%(69/71) in the experiment group and 88.2%(60/68) in the control group, with statistical significance(P<0.05). Conclusion Xuefu Zhuyu Decoction combined with conventional Western medicine can effectively alleviate the clinical symptoms of patients with TBP and pleural thickness and improve clinical efficacy. The mechanism may be related to reducing the levels of TNF-α, FIB and TGF-β1 in pleural effusion of patients.
引文
[1] KIM M C, KIM S M, LEE S O, et al. A diagnostic algorithm for tuberculous pleurisy using the ELISPOT assay on peripheral blood and pleural effusion[J]. Infect Dis(Lond),2016,48(9):688-694.
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[3]唐先梅,赵英仁,江自成,等.新方法初治结核性胸膜炎的疗效观察[J].中国感染控制杂志,2018,17(1):52-55.
[4]王涛,田彦卿,王岫峥,等.加味升降散对饮停胸胁型结核性胸膜炎的疗效及对患者胸腔积液ADA,免疫功能,T淋巴细胞及炎症因子水平的影响[J].中国实验方剂学杂志,2018,24(1):169-173.
[5]龚惠莉,张燕玲,吴国强,等.逐饮活血方剂联合西药治疗结核性胸膜炎的临床研究[J].中国医药导报,2016,13(12):173-176.
[6]张伟,董洪珍,肖曼,等.活血化瘀法对结核性胸膜炎患者中医证候疗效及肺功能的影响[J].中国中医急症,2013,22(10):1763-1764.
[7]中华人民共和国卫生部.肺结核门诊诊疗规范(2012年版)[J].中国医学前沿杂志(电子版),2013,5(3):73-75.
[8]屈清,黄毅.结核性胸膜炎脏层胸膜增厚的超声表现及临床价值[J].延安大学学报:医学科学版,2017,15(1):46-48.
[9]国家中医药管理局.中医病证诊断疗效标准[M].北京:中国医药科技出版社,2012:1005-1041.
[10]中国疾病控制中心.中国结核病防治规划实施工作指南[M].北京:人民卫生出版社,2008:26-37.
[11]中华人民共和国卫生部.中药新药临床研究指导原则:第一辑[M].北京:1993:54-58.
[12]张艳,郑建,黄捷晖,等.胸腔镜下结核性胸膜炎胸膜粘连程度的判定及相关因素分析[J].南京医科大学学报:自然科学版,2012,32(10):1422-1425.
[13]廖红保,陈芳.腹水型晚期血吸虫病合并结核性胸膜炎15例临床分析[J].中国血吸虫病防治杂志,2016,28(3):343-344.
[14] XIE S S, LU L, LI M, et al. The efficacy and safety of adjunctive corticosteroids in the treatment of tuberculous pleurisy:a systematic review and meta-analysis[J]. Oncotarget,2017,8(47):83315-83322.
[15]张伟,肖曼,董洪珍,等.结核性胸膜炎中医证候分布与胸水B超相关性探讨[J].辽宁中医药大学学报,2013,15(12):35-36.
[16]张志杰,曹培谦.中西医结合治疗结核性胸膜炎胸膜增厚临床研究[J].中医学报,2017,32(8):1547-1550.
[17] LEE M H, NAHM C H, CHOI J W. Thrombin-antithrombin Ⅲ complex,proinflammatory cytokines,and fibrinolytic indices for assessing the severity of inflammation in pleural effusions[J].Ann Clin Lab Sci,2010,40(4):342-347.
[18]陈敏,赖天文,陈衡华,等.结核性胸膜炎内科胸腔镜下表现及其诊断价值[J].临床肺科杂志,2013,18(6):1064-1065.
[19]张伟,董洪珍,谢慧文,等.活血化瘀法治疗结核性胸膜炎患者胸膜增厚的疗效观察[J].广州中医药大学学报,2013,30(3):302-304.
[20]彭卫平,王小娟.胸腔积液ADA、IFN-γ联合检测在结核性胸膜炎诊断中的意义[J].山东医药,2015,55(25):56-57.
[2] KAWAGUCHI T, ODA K, KIDO T, et al. Bilateral tuberculous pleurisy with subsequent upper lobe predominant pulmonary fibrosis mimicking pleuroparenchymal fibroelastosis[J]. Intern Med,2018,57(1):85-89.
[3]唐先梅,赵英仁,江自成,等.新方法初治结核性胸膜炎的疗效观察[J].中国感染控制杂志,2018,17(1):52-55.
[4]王涛,田彦卿,王岫峥,等.加味升降散对饮停胸胁型结核性胸膜炎的疗效及对患者胸腔积液ADA,免疫功能,T淋巴细胞及炎症因子水平的影响[J].中国实验方剂学杂志,2018,24(1):169-173.
[5]龚惠莉,张燕玲,吴国强,等.逐饮活血方剂联合西药治疗结核性胸膜炎的临床研究[J].中国医药导报,2016,13(12):173-176.
[6]张伟,董洪珍,肖曼,等.活血化瘀法对结核性胸膜炎患者中医证候疗效及肺功能的影响[J].中国中医急症,2013,22(10):1763-1764.
[7]中华人民共和国卫生部.肺结核门诊诊疗规范(2012年版)[J].中国医学前沿杂志(电子版),2013,5(3):73-75.
[8]屈清,黄毅.结核性胸膜炎脏层胸膜增厚的超声表现及临床价值[J].延安大学学报:医学科学版,2017,15(1):46-48.
[9]国家中医药管理局.中医病证诊断疗效标准[M].北京:中国医药科技出版社,2012:1005-1041.
[10]中国疾病控制中心.中国结核病防治规划实施工作指南[M].北京:人民卫生出版社,2008:26-37.
[11]中华人民共和国卫生部.中药新药临床研究指导原则:第一辑[M].北京:1993:54-58.
[12]张艳,郑建,黄捷晖,等.胸腔镜下结核性胸膜炎胸膜粘连程度的判定及相关因素分析[J].南京医科大学学报:自然科学版,2012,32(10):1422-1425.
[13]廖红保,陈芳.腹水型晚期血吸虫病合并结核性胸膜炎15例临床分析[J].中国血吸虫病防治杂志,2016,28(3):343-344.
[14] XIE S S, LU L, LI M, et al. The efficacy and safety of adjunctive corticosteroids in the treatment of tuberculous pleurisy:a systematic review and meta-analysis[J]. Oncotarget,2017,8(47):83315-83322.
[15]张伟,肖曼,董洪珍,等.结核性胸膜炎中医证候分布与胸水B超相关性探讨[J].辽宁中医药大学学报,2013,15(12):35-36.
[16]张志杰,曹培谦.中西医结合治疗结核性胸膜炎胸膜增厚临床研究[J].中医学报,2017,32(8):1547-1550.
[17] LEE M H, NAHM C H, CHOI J W. Thrombin-antithrombin Ⅲ complex,proinflammatory cytokines,and fibrinolytic indices for assessing the severity of inflammation in pleural effusions[J].Ann Clin Lab Sci,2010,40(4):342-347.
[18]陈敏,赖天文,陈衡华,等.结核性胸膜炎内科胸腔镜下表现及其诊断价值[J].临床肺科杂志,2013,18(6):1064-1065.
[19]张伟,董洪珍,谢慧文,等.活血化瘀法治疗结核性胸膜炎患者胸膜增厚的疗效观察[J].广州中医药大学学报,2013,30(3):302-304.
[20]彭卫平,王小娟.胸腔积液ADA、IFN-γ联合检测在结核性胸膜炎诊断中的意义[J].山东医药,2015,55(25):56-57.