辨证治疗慢性阻塞性肺疾病稳定期的疗效及对全身炎症反应的影响
|
摘要
背景:慢性阻塞性肺疾病(Chronic Obstructive Pulmonary Disease,COPD)是一种严重危害人类身体健康的重大疾病。由于其发病率高、致残率高、死亡率高以及疾病严重的经济负担,已引起各国的极大关注和重视。近10年来,西医对COPD作出了大量研究和不懈探索,无论从流行病学、发病机制,诊断、治疗和评价,还是新的、多维的管理模式都已取得长足、实质性的进步,但COPD的发病机制尚未完全明了,目前普遍认为COPD是以气道、肺实质和肺血管的慢性炎症为特征,气道炎症是疾病发病过程中的一个关键环节,对COPD的治疗仍然没有有效的防治措施。COPD运用中医药治疗具有较好的疗效,可以明显缩短病程,改善生活质量,减少并发症,尤其是缓解期患者,但对其作用机制的探讨方面研究不多。因此,科学评价辨证治疗COPD稳定期患者的疗效,并探讨中医药防治COPD稳定期的作用机制,对于提高中医药辨证治疗的水平具有重要意义。
目的:通过对COPD稳定期患者的肺功能、临床症状与体征、急性加重次数、六分钟步行距离(6 min walk distance,6MWD)、呼吸困难分级、体重指数(body mass index,BMI)等评价指标的观察和COPD稳定期患者外周血清C反应蛋白(C reactive protein,CRP)、白细胞介素8(interleukin 8,IL-8)和肿瘤坏死因子α(Tumor necrosis Factor alpha,TNF-α)水平的变化,评价辨证治疗COPD稳定期的疗效及其对外周血清CRP、IL-8和TNF-α水平的影响,探讨中医药防治COPD稳定期的作用机制。
方法:采用随机、对照的临床试验方法,选取符合纳入标准的慢性阻塞性肺疾病稳定期患者216例,随机分为试验组和对照组。试验组采用中医辨证治疗联合西医规范治疗方案,对照组采用西医规范治疗方案,两组治疗期各为6个月。观察两组患者治疗前,治疗3个月和治疗6个月时的肺功能、临床症状与体征、急性加重次数、呼吸困难分级、运动能力(6分钟步行距离)和体重指数的变化
情况;同时从216例患者中随机抽取70例患者,检测上述时段的外周血清CRP、IL-8和TNF-α水平。
结果:
1辨证治疗对COPD稳定期患者的疗效评价共纳入COPD稳定期患者216例,剔除资料不全、未按规定服药等21例,符合研究要求的共195例。从以下七个方面评价辨证治疗COPD稳定期患者的临床疗效,结果如下:
1.1肺功能治疗前两组用力肺活量(Forced vital capacity,FVC)、第一秒用力活量(the Forced expiratory volume in one second,FEV1)、第一秒用力肺活量占预计值百分比(FEV1%)均无统计学差异(P>0.05);治疗后两组FVC与治疗前相比无统计学差异(P>0.05),FEV1、FEV1%均较前治疗前明显升高(P<0.05);治疗6个月后试验组FEV1、FEV1%均高于对照组(P<0.05);经重复测量方差分析显示不同治疗点之间两组FEV1、FEV1%差异均有显著意义(P<0.05),两组间FEV1、FEV1%有显著性差异(P<0.05)。
1.2临床症状与体征治疗前两组症状体征总分无统计学差异(P>0.05);治疗后两组症状体征总分均持续下降,且试验组明显低于对照组(P<0.05);经重复测量方差分析显示不同治疗点之间两组症状体征总分差异均有显著意义(P<0.001),两组间有显著性差异(P<0.05)。
1.3急性加重次数及程度治疗前两组急性加重次数无明显差异(P>0.05),治疗期间对照组明显高于试验组(P<0.05);治疗期间两组急性加重程度无明显差异(P>0.05)。
1.4呼吸困难分级治疗前、3个月两组呼吸困难分级无明显差异(P>0.05),6个月时试验组患者呼吸困难分级改善状况较对照组改善明显(P<0.001)。
1.5 6MWD治疗前、3个月、6个月时两组6MWD均无统计学差异(P>0.05);治疗后两组均较前增高(P<0.05);经重复测量方差分析显示不同治疗点之间两组6MWD差异均有显著意义(P<0.001),两组间无显著差异(P>0.05)。
1.6 BMI治疗前、3个月、6个月时两组BMI均无显著差异(P>0.05);两组内各时间点相比均无显著差异(P>0.05);经重复测量方差分析显示不同治疗点之间两组BMI差异均无显著意义(P>0.05),两组间无显著差异(P>0.05)。
2辨证治疗对COPD稳定期患者全身炎症反应的影响从收集病例中随机选取70例,后脱落1例,平均年龄(62.78±10.87)岁,检测外周血清CRP、IL-8和TNF-α水平,观察辨证治疗对COPD稳定期患者全身炎症反应的影响。
2.1 CRP水平治疗前、3个月、6个月后两组血清CRP水平均显著高于健康组(P<0.01);治疗前两组无显著差异(P>0.05),治疗后两组均较治疗前降低(P<0.01,P<0.05),且治疗3个月、治疗6个月试验组明显低于对照组(P<0.01);经重复测量方差分析显示不同治疗点之间两组血清CRP水平差异均有显著意义(P<0.001),两组间有显著性差异(P<0.05)。
2.2 IL-8水平治疗前、3个月、6个月两组血清IL-8水平均高于健康组(P<0.05);治疗前两组无显著差异(P>0.05),治疗后两组均较治疗前降低,试验组降低显著(P<0.01),第3个月、第6个月时试验组低于对照组(P<0.05);经重复测量方差分析显示不同治疗点之间试验组血清IL-8水平差异有显著意义(P<0.001),两组间有显著性差异(P<0.05)。
2.3 TNF-α水平治疗前两组TNF-α水平均高于健康组(P<0.01),治疗后对照组明显高于健康组(P<0.05),试验组亦高于健康组但无统计学意义(P>0.05);治疗后两组均较前降低,试验组(P<0.01),对照组(P<0.05);治疗6个月试验组明显低于对照组(P<0.05);经重复测量方差分析显示不同治疗点之间两组血清TNF-α水平差异均有显著意义(P<0.05);两组组间差异不显著(P>0.05)。
结论:
1辨证治疗对COPD稳定期患者的疗效评价基于西医规范治疗基础上的中医辨证治疗COPD稳定期较单纯西医治疗具有更好的疗效,表现在提高肺通气功能、改善症状体征、减少急性加重次数、改善呼吸困难方面。
2辨证治疗对COPD稳定期患者全身炎症反应的影响中医辨证治疗COPD稳定期患者具有更好的疗效,其作用机制可能与显著降低血清IL-8、TNF-α和CRP水平有待进一步深入研究。
Background The Chronic obstructive pulmonary disease (COPD) is a serious disease that is harm to human’s health. Because of its high incidence, morbidity, mortality and economic burden, COPD has caught the great attention of scholars around the world. In the past 10 years, western medicine has made a lot of research and exploration on COPD not only in epidemiology, pathogenesis, diagnosis, treatment and evaluation, also the new and multi-dimensional management model which have made quiet great and substantial progress, but the mechanism of COPD was not fully understood. Now it is widely recognized that COPD is characterized by chronic inflammation in airway, lung parenchyma and lung vessels.Airway inflammation is a key step in the process of the disease. There is still no effective prevention or treatment of COPD. Chinese medicine therapy has better efficacy on COPD which includes significantly shortening the course and improving life quality and decreasing complications especially in patients with stable COPD but few researches on its mechanism. Therefore, it’s of important significance to evaluate scientifically the efficacy of patients with stable COPD, explore the mechanism of prevention and treatment on patients with stable COPD and improve the level of TCM Syndrome Differentiation.
Objective The main aim of this study was to observe the changes of pulmonary function ,clinical symptoms and signs, exacerbation frequency, the six-minute walking distance(6MWD), dyspnea grading, the body-mass index (BMI) and Serum C-reactive protein(CRP), interleukin-8(IL-8) and tumor necrosis factor-alpha(TNF-α) levels of the stable phase of COPD patients,and to evaluate the efficacy of these patients and response of Serum CRP ,IL-8 and TNF-α,exploring the mechanism of prevention an- treatment of the stable phase of COPD by Traditional Chinese Medicine.
Methods Through a randomized, controlled clinical trial, we selected 216 patients with stable COPD randomly divided into the test group and the control group. The test group are used fixed prescription of TCM therapy combined with Western standard treatment; the control group receives standard Western treatment.Both groups are observed for 6 months. The patients are observed of pulmonary function, clinical symptoms and signs, acute exacerbation frequency, dyspnea grade, six-minute walking distance, body mass index changes before treatment and after 3 months and 6 months treatment. Meanwhile we also test the levels of Serum CRP, IL-8 and TNF-α.
Results
1 Evaluation of the effect of differentiation treatment on patients with stable COPD.Patients with stable COPD included 216 cases, excluding 21 cases with incomplete information and no prescribed medication and 195 cases met the study requirements. The clinical efficacy of differential treatments in patients with stable COPD were evaluated in the following seven aspects.The results are as follows:
1.1 Pulmonary Function: before treatment, FVC (Forced vital capacity), FEV1 (the forced expiratory volume in one second), and FEV1%(forced vital capacity in one second percentage of predicted value percentage) in either groups were not statistically different (P>0.05); After treatments, FVC in two groups were not statistically different (P>0.05), while FEV1 and FEV1% were significant higher than before (P<0.05);the FEV1 and FEV1% of the text group after treatments for 6 months are all higher than the control group (P<0.05);the repeated measure analysis of variance showed that the FEV1 and FEV1% of different points of treatment were significantly different with the text group (P<0.001), it was significantly different between the two groups indicators (P<0.05).
1.2 Clinical symptoms and signs: there wan no significant difference in total score of symptoms and signs before treatment(P>0.05);after treatment, the total score of symptoms and signs was declining, and the text group was significantly lower than the control group (P<0.05);the repeated measures analysis of variance between two groups showed the total score of symptoms and signs between different treatment point were significantly different (P<0.001), there was significant difference between the two groups (P<0.05).
1.3 The number and the extent of acute exacerbation: two groups had no significant differences before treatment(P>0.05) ; the number of acute exacerbation of the control group after treatment was significantly higher than the text group (P <0.05); the extent of acute exacerbation before or after treatment had no differences between two groups(P>0.05).
1.4 Dyspnea grade: two groups had no significant differences before treatment and after 3 months of treatment (P> 0.05), but the control group was significantly higher than the text group after 6 months of treatment (P<0.001).
1.5 6MWD: before treatment and 3 months, 6 months of treatment there were no significant differences between two groups (P>0.05); two groups increased after treatment(P<0.05); the repeated measures analysis of variance showed that 6MWD of different treatment points between two groups was significantly different(P <0.001)and no significant difference between the two groups (P>0.05).
1.6 BMI: before treatment and 3 months, 6 months of treatment there were no significant differences between two groups (P>0.05);BMI at either time point were not significantly different (P>0.05);the repeated measure analysis of variance between the two groups showed the BMI of different treatment points were no significantly different (P>0.05)and there’s no significant difference between two groups ( P>0.05).
2 Influence of systemic inflammatory response on stable COPD patients affected by differentiation therapy.70 patients, one of which was lost to follow up. were randomly selected from 216 patients. the average age was 62.78±10.87. Serum CRP, IL-8 and TNF-αwere tested to observate the influence of Systemic Inflammatory Response on stable COPD patients affected by Differentiation treatment.
2.1 CRP: before and after treatment, the serum CRP levels of two groups were higher than the healthy group (P<0.01), before treatment, there was no significant difference between two groups (P>0.05); after treatment,the CRP levels of two groups were lower than before (P<0.01, P<0.05),and the text group after treatment was significantly lower than the control group (P<0.01); the repeated measures analysis of variance between the two groups showed the CRP levels of different treatment points had significant difference (P<0.001), and there was significant difference between the two groups (P<0.05).
2.2 IL-8: before and after treatment the serum IL-8 levels of two groups were higher than the healthy group (P<0.05), before treatment, there was no significant difference (P>0.05);after treatment, IL-8 levels of two groups were declining,and the text group were statistically different (P<0.01).After 3 months and 6 months of treatment, the IL-8 levels of the text group were lower than the control group (P <0.05); the repeated measures analysis of variance showed IL-8 levels of different treatment points had significant difference with the text groups (P<0.001), between two groups there was significant difference (P<0.05).
2.3 TNF-α:before treatment, the TNF-αlevels of each group were higher than healthy group (P<0.001); the control group after treatment was significantly higher than the healthy group (P<0.01); the serum TNF-αlevels were higher in the text group than the healthy group,but there was no statistical difference(P>0.05). After treatment, TNF-αlevels of two groups were declining, including the text group(P<0.01) and the control group (P<0.05);after 6 months of treatment, the TNF-αlevel of the text group was lower than the control group (P<0.05); the repeated measures analysis of variance showed the TNF-αlevels of different treatment points had significant difference (P<0.05);between the two groups there was no significant difference (P>0.05).
Conclusion
1 Evaluation of the effect of differentiation treatment on patients with stable COPD. Western medicine conventional treatment based on differential treatment for stable COPD patients is more effective than simple western medicine conventional treatment,performance in improving pulmonary function、clinical symptoms and signs、dyspnea grade and reduce the frequency of acute exacerbation.
2 Influence of systemic inflammatory response on stable COPD patients affected by differentiation treatment. Differential treatment of TCM on patients with stable COPD has better efficacy, its mechanism may be associated with significantly reduce levels of the serum IL-8, TNF-αand CRP to be further study.
目的:通过对COPD稳定期患者的肺功能、临床症状与体征、急性加重次数、六分钟步行距离(6 min walk distance,6MWD)、呼吸困难分级、体重指数(body mass index,BMI)等评价指标的观察和COPD稳定期患者外周血清C反应蛋白(C reactive protein,CRP)、白细胞介素8(interleukin 8,IL-8)和肿瘤坏死因子α(Tumor necrosis Factor alpha,TNF-α)水平的变化,评价辨证治疗COPD稳定期的疗效及其对外周血清CRP、IL-8和TNF-α水平的影响,探讨中医药防治COPD稳定期的作用机制。
方法:采用随机、对照的临床试验方法,选取符合纳入标准的慢性阻塞性肺疾病稳定期患者216例,随机分为试验组和对照组。试验组采用中医辨证治疗联合西医规范治疗方案,对照组采用西医规范治疗方案,两组治疗期各为6个月。观察两组患者治疗前,治疗3个月和治疗6个月时的肺功能、临床症状与体征、急性加重次数、呼吸困难分级、运动能力(6分钟步行距离)和体重指数的变化
情况;同时从216例患者中随机抽取70例患者,检测上述时段的外周血清CRP、IL-8和TNF-α水平。
结果:
1辨证治疗对COPD稳定期患者的疗效评价共纳入COPD稳定期患者216例,剔除资料不全、未按规定服药等21例,符合研究要求的共195例。从以下七个方面评价辨证治疗COPD稳定期患者的临床疗效,结果如下:
1.1肺功能治疗前两组用力肺活量(Forced vital capacity,FVC)、第一秒用力活量(the Forced expiratory volume in one second,FEV1)、第一秒用力肺活量占预计值百分比(FEV1%)均无统计学差异(P>0.05);治疗后两组FVC与治疗前相比无统计学差异(P>0.05),FEV1、FEV1%均较前治疗前明显升高(P<0.05);治疗6个月后试验组FEV1、FEV1%均高于对照组(P<0.05);经重复测量方差分析显示不同治疗点之间两组FEV1、FEV1%差异均有显著意义(P<0.05),两组间FEV1、FEV1%有显著性差异(P<0.05)。
1.2临床症状与体征治疗前两组症状体征总分无统计学差异(P>0.05);治疗后两组症状体征总分均持续下降,且试验组明显低于对照组(P<0.05);经重复测量方差分析显示不同治疗点之间两组症状体征总分差异均有显著意义(P<0.001),两组间有显著性差异(P<0.05)。
1.3急性加重次数及程度治疗前两组急性加重次数无明显差异(P>0.05),治疗期间对照组明显高于试验组(P<0.05);治疗期间两组急性加重程度无明显差异(P>0.05)。
1.4呼吸困难分级治疗前、3个月两组呼吸困难分级无明显差异(P>0.05),6个月时试验组患者呼吸困难分级改善状况较对照组改善明显(P<0.001)。
1.5 6MWD治疗前、3个月、6个月时两组6MWD均无统计学差异(P>0.05);治疗后两组均较前增高(P<0.05);经重复测量方差分析显示不同治疗点之间两组6MWD差异均有显著意义(P<0.001),两组间无显著差异(P>0.05)。
1.6 BMI治疗前、3个月、6个月时两组BMI均无显著差异(P>0.05);两组内各时间点相比均无显著差异(P>0.05);经重复测量方差分析显示不同治疗点之间两组BMI差异均无显著意义(P>0.05),两组间无显著差异(P>0.05)。
2辨证治疗对COPD稳定期患者全身炎症反应的影响从收集病例中随机选取70例,后脱落1例,平均年龄(62.78±10.87)岁,检测外周血清CRP、IL-8和TNF-α水平,观察辨证治疗对COPD稳定期患者全身炎症反应的影响。
2.1 CRP水平治疗前、3个月、6个月后两组血清CRP水平均显著高于健康组(P<0.01);治疗前两组无显著差异(P>0.05),治疗后两组均较治疗前降低(P<0.01,P<0.05),且治疗3个月、治疗6个月试验组明显低于对照组(P<0.01);经重复测量方差分析显示不同治疗点之间两组血清CRP水平差异均有显著意义(P<0.001),两组间有显著性差异(P<0.05)。
2.2 IL-8水平治疗前、3个月、6个月两组血清IL-8水平均高于健康组(P<0.05);治疗前两组无显著差异(P>0.05),治疗后两组均较治疗前降低,试验组降低显著(P<0.01),第3个月、第6个月时试验组低于对照组(P<0.05);经重复测量方差分析显示不同治疗点之间试验组血清IL-8水平差异有显著意义(P<0.001),两组间有显著性差异(P<0.05)。
2.3 TNF-α水平治疗前两组TNF-α水平均高于健康组(P<0.01),治疗后对照组明显高于健康组(P<0.05),试验组亦高于健康组但无统计学意义(P>0.05);治疗后两组均较前降低,试验组(P<0.01),对照组(P<0.05);治疗6个月试验组明显低于对照组(P<0.05);经重复测量方差分析显示不同治疗点之间两组血清TNF-α水平差异均有显著意义(P<0.05);两组组间差异不显著(P>0.05)。
结论:
1辨证治疗对COPD稳定期患者的疗效评价基于西医规范治疗基础上的中医辨证治疗COPD稳定期较单纯西医治疗具有更好的疗效,表现在提高肺通气功能、改善症状体征、减少急性加重次数、改善呼吸困难方面。
2辨证治疗对COPD稳定期患者全身炎症反应的影响中医辨证治疗COPD稳定期患者具有更好的疗效,其作用机制可能与显著降低血清IL-8、TNF-α和CRP水平有待进一步深入研究。
Background The Chronic obstructive pulmonary disease (COPD) is a serious disease that is harm to human’s health. Because of its high incidence, morbidity, mortality and economic burden, COPD has caught the great attention of scholars around the world. In the past 10 years, western medicine has made a lot of research and exploration on COPD not only in epidemiology, pathogenesis, diagnosis, treatment and evaluation, also the new and multi-dimensional management model which have made quiet great and substantial progress, but the mechanism of COPD was not fully understood. Now it is widely recognized that COPD is characterized by chronic inflammation in airway, lung parenchyma and lung vessels.Airway inflammation is a key step in the process of the disease. There is still no effective prevention or treatment of COPD. Chinese medicine therapy has better efficacy on COPD which includes significantly shortening the course and improving life quality and decreasing complications especially in patients with stable COPD but few researches on its mechanism. Therefore, it’s of important significance to evaluate scientifically the efficacy of patients with stable COPD, explore the mechanism of prevention and treatment on patients with stable COPD and improve the level of TCM Syndrome Differentiation.
Objective The main aim of this study was to observe the changes of pulmonary function ,clinical symptoms and signs, exacerbation frequency, the six-minute walking distance(6MWD), dyspnea grading, the body-mass index (BMI) and Serum C-reactive protein(CRP), interleukin-8(IL-8) and tumor necrosis factor-alpha(TNF-α) levels of the stable phase of COPD patients,and to evaluate the efficacy of these patients and response of Serum CRP ,IL-8 and TNF-α,exploring the mechanism of prevention an- treatment of the stable phase of COPD by Traditional Chinese Medicine.
Methods Through a randomized, controlled clinical trial, we selected 216 patients with stable COPD randomly divided into the test group and the control group. The test group are used fixed prescription of TCM therapy combined with Western standard treatment; the control group receives standard Western treatment.Both groups are observed for 6 months. The patients are observed of pulmonary function, clinical symptoms and signs, acute exacerbation frequency, dyspnea grade, six-minute walking distance, body mass index changes before treatment and after 3 months and 6 months treatment. Meanwhile we also test the levels of Serum CRP, IL-8 and TNF-α.
Results
1 Evaluation of the effect of differentiation treatment on patients with stable COPD.Patients with stable COPD included 216 cases, excluding 21 cases with incomplete information and no prescribed medication and 195 cases met the study requirements. The clinical efficacy of differential treatments in patients with stable COPD were evaluated in the following seven aspects.The results are as follows:
1.1 Pulmonary Function: before treatment, FVC (Forced vital capacity), FEV1 (the forced expiratory volume in one second), and FEV1%(forced vital capacity in one second percentage of predicted value percentage) in either groups were not statistically different (P>0.05); After treatments, FVC in two groups were not statistically different (P>0.05), while FEV1 and FEV1% were significant higher than before (P<0.05);the FEV1 and FEV1% of the text group after treatments for 6 months are all higher than the control group (P<0.05);the repeated measure analysis of variance showed that the FEV1 and FEV1% of different points of treatment were significantly different with the text group (P<0.001), it was significantly different between the two groups indicators (P<0.05).
1.2 Clinical symptoms and signs: there wan no significant difference in total score of symptoms and signs before treatment(P>0.05);after treatment, the total score of symptoms and signs was declining, and the text group was significantly lower than the control group (P<0.05);the repeated measures analysis of variance between two groups showed the total score of symptoms and signs between different treatment point were significantly different (P<0.001), there was significant difference between the two groups (P<0.05).
1.3 The number and the extent of acute exacerbation: two groups had no significant differences before treatment(P>0.05) ; the number of acute exacerbation of the control group after treatment was significantly higher than the text group (P <0.05); the extent of acute exacerbation before or after treatment had no differences between two groups(P>0.05).
1.4 Dyspnea grade: two groups had no significant differences before treatment and after 3 months of treatment (P> 0.05), but the control group was significantly higher than the text group after 6 months of treatment (P<0.001).
1.5 6MWD: before treatment and 3 months, 6 months of treatment there were no significant differences between two groups (P>0.05); two groups increased after treatment(P<0.05); the repeated measures analysis of variance showed that 6MWD of different treatment points between two groups was significantly different(P <0.001)and no significant difference between the two groups (P>0.05).
1.6 BMI: before treatment and 3 months, 6 months of treatment there were no significant differences between two groups (P>0.05);BMI at either time point were not significantly different (P>0.05);the repeated measure analysis of variance between the two groups showed the BMI of different treatment points were no significantly different (P>0.05)and there’s no significant difference between two groups ( P>0.05).
2 Influence of systemic inflammatory response on stable COPD patients affected by differentiation therapy.70 patients, one of which was lost to follow up. were randomly selected from 216 patients. the average age was 62.78±10.87. Serum CRP, IL-8 and TNF-αwere tested to observate the influence of Systemic Inflammatory Response on stable COPD patients affected by Differentiation treatment.
2.1 CRP: before and after treatment, the serum CRP levels of two groups were higher than the healthy group (P<0.01), before treatment, there was no significant difference between two groups (P>0.05); after treatment,the CRP levels of two groups were lower than before (P<0.01, P<0.05),and the text group after treatment was significantly lower than the control group (P<0.01); the repeated measures analysis of variance between the two groups showed the CRP levels of different treatment points had significant difference (P<0.001), and there was significant difference between the two groups (P<0.05).
2.2 IL-8: before and after treatment the serum IL-8 levels of two groups were higher than the healthy group (P<0.05), before treatment, there was no significant difference (P>0.05);after treatment, IL-8 levels of two groups were declining,and the text group were statistically different (P<0.01).After 3 months and 6 months of treatment, the IL-8 levels of the text group were lower than the control group (P <0.05); the repeated measures analysis of variance showed IL-8 levels of different treatment points had significant difference with the text groups (P<0.001), between two groups there was significant difference (P<0.05).
2.3 TNF-α:before treatment, the TNF-αlevels of each group were higher than healthy group (P<0.001); the control group after treatment was significantly higher than the healthy group (P<0.01); the serum TNF-αlevels were higher in the text group than the healthy group,but there was no statistical difference(P>0.05). After treatment, TNF-αlevels of two groups were declining, including the text group(P<0.01) and the control group (P<0.05);after 6 months of treatment, the TNF-αlevel of the text group was lower than the control group (P<0.05); the repeated measures analysis of variance showed the TNF-αlevels of different treatment points had significant difference (P<0.05);between the two groups there was no significant difference (P>0.05).
Conclusion
1 Evaluation of the effect of differentiation treatment on patients with stable COPD. Western medicine conventional treatment based on differential treatment for stable COPD patients is more effective than simple western medicine conventional treatment,performance in improving pulmonary function、clinical symptoms and signs、dyspnea grade and reduce the frequency of acute exacerbation.
2 Influence of systemic inflammatory response on stable COPD patients affected by differentiation treatment. Differential treatment of TCM on patients with stable COPD has better efficacy, its mechanism may be associated with significantly reduce levels of the serum IL-8, TNF-αand CRP to be further study.
引文
1.程显声,李景周.慢性阻塞性肺疾病、肺心病人群防治的研究基线资料分析[J].中华结核和呼吸杂志,1998,21(12):749-752.
2. Nanshan Zhong, ChenWang, WanzhenYao,et al. Prevalence of chronic obstructive pulmonary disease in China: a large, population-based survey.Am J Respir Crit Care Med. 2007 ,176(8):753-760.
3.单淑香,陈宝元.慢性阻塞性肺疾病流行病学研究进展[J].国外医学呼吸系统分册.2005,25(6)440-442.
4. Petty TL.Definition,epidemiology,course,and prognosis of COPD[J]. Clin Cornerstone,2003,5(1):1-10.
5. Pauwels RA, Buist AS, Calverley, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Golbal Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med, 2001;163(5):1256-1276.
6.中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2007年修订版)[J].中华结核和呼吸杂志,2007,30(1):8-17.
7.吴大玮.抗炎治疗在COPD治疗中的地位.中华医学信息报,2007,22(1):21-22.
8. Hogg JC, Chu F, Utokaparch S, et al. The nature of small airway obstruction in chronic obstructive pulmonary disease. N Engl J Med. 2004,350(26):2645-2653.
9.张海龙,曹帆,李建生,等.慢性阻塞性肺疾病炎症反应研究进展[J].国际呼吸杂志,2009,29(19):1191-1195.
10.苏瑾,姜智海,卢伟.慢性阻塞性肺疾病的综合防治研究进展[J].上海预防医学杂志,2005,17(5):213-214.
11.李建生,李素云,马利军,等.通塞颗粒治疗老年慢性阻塞性肺疾病(COPD)急性加重期的临床疗效评价[J].2003,18(5):35-38.
12.张颖,李廷谦,王刚,等.痰热清注射液治疗慢性阻塞性肺疾病急性加重期(痰热阻肺证)的随机对照试验[J].中国循证医学杂志,2004,4(5):300-336.
13.骆仙芳,柴秀娟,陈益民,等.保肺定喘冲剂治疗COPD 36例临床研究[J].中医杂志,2002,43(4):268-270.
14.周庆伟,李素云,吴纪珍.缓肺颗粒对慢性阻塞性肺疾病患者缓解期肺通气功能的影响[J].中国中西医结合杂志,2005,25(7):649.
15.李素云,李建生,马利军,等.益气养阴活血化痰法对慢性阻塞性肺疾病稳定期免疫功能的影响[J].河北中医,2001,23(12):899-901.
16.张颖,高鹏飞,方忠宏,等.中药治疗慢性阻塞性肺病的疗效观察[J].上海中医药杂志,2004,38(6):6-7.
17.黄东晖,吴蕾,何德平,等.中西医综合治疗慢性阻塞性肺疾病稳定期临床观察[J].第四军医大学学报,2005,26(17):1611-1613.
18. Global Initiative for COPD(GOLD).Global strategy for the diagnosis ,magement,and prevention of chronic obstructive pulmonary disease.Revised 2006,www.goldcopd.org
19.王永炎,晁恩祥主编.今日中医内科[M].北京:人民卫生出版社,2000.
20.王永炎,鲁兆麟主编.中医内科学[M].北京:人民卫生出版社,1999.
21.张伯臾主编.中医内科学[M] .上海:上海科学技术出版社,2002.
22.国家中医药管理局.中华人民共和国中医药行业标准.中医病证诊断疗效标准.南京:南京大学出版社,1994.
23.中华医学会老年医学学会.中华医学会老年医学会对健康老年人标准的建议(修订草案,1995年).中华老年医学杂志,1996,15(1):9.
24.国家药典委员会.中国药典,Ⅰ部[S].北京:化学工业出版社,2005.
25. Ferris BG.Epidemiology Standardization Project (American Thoracic Society). Am Rev Respir Dis, 1978 ,118(6 Pt 2):1-120.
26.要全保.慢阻肺从脾论治初探[J].中医研究,1999,12(6):4-6.
27.黄礼明.试论痰、瘀、虚在慢性阻塞性肺病辨治中的重要性[J].贵阳中医学院学报,2000,22(1):5-7.
28.孙子凯,曹世宏.262例慢性阻塞性肺病证治规律探讨[J].南京中医药大学学报,1998,14(1):13-15.
29.余学庆,李建生,李力.慢性阻塞性肺疾病(COPD)中医证候分布规律研究[J].河南中医学院学报,2003,18(4):44-46.
30.喻清和,邱志楠.慢性阻塞性肺疾病的辨证治疗浅析[J].中医药学刊,2003,21(7):1190.
31.张洪春,昆恩祥.调补肺肾胶囊治疗慢性阻塞性肺疾病稳定期临床研究[J].北京中医药大学学报,2003,26(2):53-56.
32.尚景盛,王玉光.应用对应分析研究CODP中医证候与病情分级的相关性[J].上海中医药大学学报,2004,18(4):29-30.
33.李素云,吴其标.曹世宏教授论治慢性阻塞性肺疾病经验选粹[J].中医药学刊,2002,20(l):28-29.
34.尹新中,刘贵颖,张慧琪,等.中西医结合治疗慢性阻塞性肺疾病急性加重期30例临床分析[J].天津中医药,2005,22(2):117-118.
35.徐毓华.中西医结合治疗慢性阻塞性肺疾病急性加重期临床观察[J].湖北中医杂志,2005,27(6):22-23.
36.王胜,季红燕,张念志,等.益肺健脾方对炎症细胞计数和慢性阻塞性肺疾病患者痰液IL-8、TNF-α、水平的影响[J].中国中西医结合杂志,2005,25(2):111-113.
37.钱冬梅.生脉注射液改善慢性阻塞性肺病患者免疫功能疗效观察[J].湖南中医药导报,2002,8(7):402-408.
38.刘洪,陈风云.温肾纳气、健脾利水法对慢性阻塞性肺疾病缓解期肺功能的影响[J].中国中医急症,2006,15(2):116-117.
39. Agusti AG.COPD:a multicomponent disease:implications for management.Respiratory Mdeicine.2005,99(6):670-682.
40.钟小宁,柳广南,慢性阻塞性肺疾病气道炎症研究进展[J].国外医学内科学分册,2000,27(1):32-34.
41. David G Parr,Andrew J White,Darren L Bayley ,et al.Inflammation in sputum relates to progression of disease in subjects with COPD:a prospective descriptive study.Respiratory Research .2006,18(7):136-146.
42. Barnes NC, Qiu YS, Pavord ID, et al. Antiin flammatory effects of salmeterol/fluticasone propionate in chronic obstructive lung disease.Am J Respir Crit Care Med. 2006,173(7):736-743.
43. Calverey P.Combined salmeterol and fluticasone in the treatment of chronic obstructive pulmonary disease:a randomized controlled trial .Lancet .2003,361:449-453.
44. Mahler DA, Wire P, Horstman D, et al. Effectiveness of fluticasone propionate and salmeterol combination delivered via the Diskus device in the treatment of chronic obstructive pulmonary disease.Am J Respir Crit Care Med. 2002,166(8):1084-1091.
45. Hanania NA, Darken P, Horstman D, et al. The efficacy and safety of fluticasone propionate (250 microg)/salmeterol (50 microg) combined in the Diskus inhaler for the treatment of COPD.Chest. 2003,124(3):834-843.
46. Soriano JB, Vestbo J, Pride NB, et al. Survival in COPD patients after regular use of fluticasone propionate and salmeterol in general practice.Eur Respir J. 2002,20(4):819-825.
47.李建生.老年医学概论[M].北京:人民卫生出版社,2003.
48.李建生.中医药治疗慢性阻塞性肺疾病研究的实践与若干思考[J].河南中医,2005,25(5):13-15.
49.李建生.慢性阻塞性肺疾病中医辨证治疗概要[J].河南中医学院学报,2009,24(4):9-11.
50.程先宽,李建生,李素云.中医药治疗慢性阻塞性肺疾病研究概况[J].中国中医急症,2002,11(6):485-487.
51.李鸿超.慢性阻塞性肺疾病中BODE评分的临床价值[J].现代医院,2008, 8(8):8-10.
52. Johnson M.Interactions between corticosteroids and beta 2 agonists in asthma and chronic obstructive pulmonary disease,2004, 1(3):200-206.
53. Adcock IM, Maneechotesuwan K, et al.Molecular interactions between glucocorticoids and long-acting beta2-agonists. J Allergy Clin Immunol. 2002 ,110(6 ):S261 -S268.
54.李艳,祝庆华.补肺益肾法对慢性阻塞性肺疾病稳定期肺功能的影响[J].长春中医药大学学报,2007,23(4):37-38.
55.刘德频,洪华金.补肾健脾化瘀法治疗慢性阻塞性肺疾病稳定期疗效观察[J].中国中医急症,2007,16(2):152-197.
56.王耀峰.补肺益肾胶囊治疗COPD临床研究[J].山东医药,2007,47(13):30-31.
57.邵长荣,陈凤鸣.阻塞性肺气肿培补肺肾后α1抗胰蛋白酶及纤维结合蛋白的观察[J].中医杂志,2002,25(8):451-460.
58.刘惠芳.补肾健脾清肺平喘法治疗慢支炎和肺气肿65例[J].黑龙江中医药,1992,28(5):16.
59.陈文彬,潘祥林.诊断学(第六版)[M].北京:人民卫生出版社,2004.
60.陈宪海,王经武,等.慢性阻塞性肺疾病稳定期中医治法述要[J].山东中医药大学学报,2003,27(6):413-414.
61. Murphy TF,Sethi S.Chronic obstructive pulmonary disease.Drugs Aging.2002,19(10):761-763.
62.包红,李清华,罗百灵.营养支持对慢性阻塞性肺疾病急性加重期患者免疫和肺功能的影响[J].中华急诊医学杂志,2003,12(11):730-733.
63.吴纪珍,张罗献,马利军,等.老年人慢性阻塞性肺病患者免疫功能测定及其意义[J].医药论坛杂志,2004,25(23):10-12.
64.张石安,高兴林,张珍萍,等.老年慢性阻塞性肺病患者细胞免疫功能变化的研究[J].现代临床医学生物工程学杂志,2004,10(5):402-404.
65.冯健,陆鸿雁,黄卫峰.慢性阻塞性肺疾病26例免疫功能检测分析[J].南通医学院学报,2001:21(2)145-146.
66.沈自尹.中医药与免疫[J].中国免疫学杂志,2004,20(1):8-10.
67.沈自尹.从肾本质研究到证本质研究的思考与实践[J].上海中医药杂志,2000,34(4):4-7.
68.李素云,周庆伟,吴纪珍.补肺益肾颗粒对COPD缓解期患者肺通气功能和免疫功能的影响[J].山东中医杂志,2003,22(6):333-335.
69.刘刚,张贻雯,马晓东.补肺益肾汤改善慢性阻塞性肺疾病患者细胞免疫研究[J].实用中西医结合临床,2007,7(3):18-19.
70.李素云,李建生.慢性阻塞性肺疾病中医药研究进展[J].中国中医药信息杂志,2002,9(6):83-85.
71. Katsura H,Yamada K,Kida K.Both generic and disease specific health-related quality of life are deteriorated in patients with underweight COPD.Respir Med,2005,99(5):624-630.
72. Nishimura K, Izumi T, Tsukino M,et al. Dyspnea is a better predictor of 5 year survival than airway obstruction in patients with COPD.Chest 2002;121(5):1434-1440.
73.李建生,王明航,李素云.慢性阻塞性肺疾病呼吸困难的评估研究进展[J].河南中医学院学报,2007,22(2):79-82.
74. American Thoracic Society. Dyspnea: mechanisms, assessment, and management: a consensus statement[J]. Am J Respir Crit Care Med,1999,159(1):321-340.
75. Gosker HR,Engelen MP,van Mameren H,et al.Muscle Fiber type IIX atrophy is involved in the loss of fat free mass in chronic obstructive pulmonary disease.Am J Clin Nutr 2002,76(1):113-119.
76. Casanova C, Cote CG, Marin JM, et al.The 6min walking distance: longterm follow up in patients with COPD. Eur Respir J. 2007 ,29(3):535-540.
77. Paulin E,Yamaguti WP,Chammas MC,et al.Influence of diaphragmatic mobility on exercise tolerance and dyspnea in patients with COPD.Respir Med 2007,101(10):2113-2118.
78. Montes de Oca M,Torres SH,González Y, et al.Changes in Exercise Tolerance,Health Related Quality of Life,and Peripheral Muscle Characteristics of Chronic Obstructive Pulmonary Disease Patients After 6 Weeks Training.Arch Bronconeumol 2005,41(8):413-418.
79.吕探云,马敏芝.社区老年人抑郁症状及其影响因素的研究[J].护理学杂志,2001,16(7):387-389.
80.蔡映云.当代呼吸病研究的两个特征[J].中华结核和呼吸杂志,1999,22(7):445-446.
81. Debigare R,Marquis K,Cote CH,et al.Catabolic/anabolic balance and muscle wasting in patients with COPD.Chest.2003.124(1):83-89.
82. Wilson DO, Rogers RM, Wright EC, et al.Body weight in chronic obstructive pulmonary disease. The National Institutes of Health Intermittent Positive-Pressure Breathing Trial. Am Rev Respir Dis. 1989,139(6):1435-1438.
83. Laaban JP.Nutrition and chronic respiratory failure. Ann Med Interne (Paris). 2000 ,151(7):542-548.
84. Ezzell L, Jensen GL.Malnutrition in chronic obstructive pulmonary disease. Am J Clin Nutr. 2000 ,72(6):1415-1416.
85. Nagaya N,Kojima M,Kangawa K.Ghrelin,a Novel Growth Hormonereleasing Peptide,in the Treatment of Cardiopulmonary-associated Cachexia.Intern Med.2006 ;45(3):127-134.
86. Landbo C,Prescott E,lange P,et al.Prognostic value of nutritional status in chronic obstructive pulmonary disease.Am J RespirCrit Car Med, 1999 Dec;160(6):1856-1861.
87. Schols AM,Shangen J,Volovics L,et al.Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease.Am J Respir Crit Care Med, 1998 ,157(6 Pt 1):1791-1797.
88. Nocturnal Oxygen Therapy Trial Group.Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive pulmonary disease:a clinical trial.Ann Intern Med.1980,93:391-398.
89. Celli BR, Cote CG, Marin JM, et al.The bodymass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004,350(10):1005-1012.
90. Landbo C,Prescott E,Lange P, et al.Prognostic value of nutritional status in chronic obstructive pulmonary disease.Am J Respir Crit Care Med . 1999 ,160(6):1856-1861.
91.杜月君,罗怡,霍震.慢性阻塞性肺疾病体重指数与再住院关系分析[J].医学理论与实践,2007,(20)2:183-184.
92. Sin DD,Man SF.Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases?The potential role of systemicinflammation in chronic obstructive pulmonary disease.Circulation 2003,107(11):1514–1519.
93. De Torres JP,Cordoba-Lanus E,Lopez-Aguilar C,et al.C-reactive protein levels and clinically important predictive outcomes in stable COPD patients.Eur Respir J 2006;27(5):902–907.
94. Gan WQ,Man SF,Senthilselvan A,Sin DD.Association between chronic obstructive pulmonary disease and systemic inflammation:a systematic review and a metaanalysis.Thorax 2004;59:574–580.
95. Schneider A,Dinant GJ,Maag I, et al.The added value of Creactive protein to clinical signs and symptoms in patients with obstructive airway disease:results of a diagnostic study in primary care.BMC Fam Pract.2006;7:28.
96. Pepys MB.C-reactive protein fifty years on.Lancet.1981:1(8221):653–657.
97.杜迎雪,李素敏.110例急性呼吸道感染C反应蛋白检测的分析[J].中国民康医学,2003,15(1):34-35.
98. Eid AA,Ionescu AA,Nixon LS.et al.Inflammatory response and body composition in chronic obstructive pulmonary disease[J].Am J Respir Crit Care Med.2001.164(7):1414-1418.
99.何宪章,严明生,郭晓兰,等. CRP检测在慢性阻塞性肺疾病中的应用[J].川北医学院学报,2003,18(4):96.
100.卿克勤,张锐. C反应蛋白与慢性阻塞性肺疾病的急性加重期关系的探讨[J].四川省卫生管理干部学院学报,2004, 23(1): 2-3.
101. Malo O,Sauleda J,Busquets X, et al.Systemic inflammation during exacerbations of chronic obstructive pulmonary disease.Arch Bronconeumol 2002,38(4):172–176.
102.熊曙光,陈余思. C反应蛋白在慢性阻塞性肺疾病急性加重期的应用评价[J].临床肺科杂志,2007,12(6):608-610.
103.张冰,王丹琪,夏国光.白细胞介素6及C反应蛋白在慢性阻塞性肺疾病患者急性加重中的意义[J].中国呼吸与危重监护杂志,2003,2(2):85-86.
104. Karadag F, Kirdar S, Karul AB, et al. The value of Creactive protein as a marker of systemic inflammation in stable chronic obstructive pulmonary disease. Eur J Intern Med. 2008 Mar,19(2):104-108.
105. J.P.de Torres,E.CordobaLanus,C.Lo′pezAguilar, et al.Creactive protein levels and clinically important predictive outcomes in stable COPD patients. Eur Respir J. 2006,27(5):902-907.
106. PintoPlata VM, Müllerova H, Toso JFThorax. et al.Creactive protein in patients with COPD, control smokers and nonsmokers. 2006 Jan;61(1):23-28.
107. Yoshikawa T,Dent G,Ward J,et al.Impaired Neutrophil Chemotaxis in Chronic Obstructive Pulmonary Disease[J].Am J Respir Crit Care Med,2007,175(5):473-479.
108. Larsson K.Inflammatory markers in COPD. Clin Respir J. 2008,2(1):84-87.
109. Facchinetti F,Amadei F,Geppetti P,et al. Alpha,beta-unsaturated aldehydes in cigarette smoke release inflammatory mediators from human macrophages.[J].Am J Respir Cell Mol Biol,2007,37(5):617-623.
110.林美玲,张宏斌,许珏.慢性阻塞性肺疾病患者血清IL-8检测及其临床意义[J].实用医技杂志,2006,13(13):2237-2238.
111. Wang HY,Liu JK,Huang HX, et al.Relationship among bacterial colonization,airway inflammation,and bronchodilator response in patients with[J].Chin Medi J,2006,119(8):684-687.
112. Hu XR, Han SX, Wang T, et al.Association between interleukin-8 in lung tissues and stages of chronic obstructive pulmonary diseases. Sichuan Da Xue Xue Bao Yi Xue Ban. 2009 ,40(5):885-888.
113.秦兴国,肖平,陈风华,等.已酮可可碱吸入对慢性阻塞性肺疾病患者的疗效观察[J].中国临床医学,2000,7(3):289-291.
114. DouradoVZ, Tanni SE, Vale SA,et al. Systemic manifestations in chronic obstructive pulmonary disease. J Bras Pneumol,2006, 32(2):161-171.
115. Aarson SD, Angel JB, Lnnau M, et al. Granulocyte inflammatory markers and airway infection during acute exacerbation of chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2001,163(2):349-355.
116. KeatingsVM, Collins PD, ScottDM, et al.Differences in interleukin-8 and tumor necrosis factor-αin induced sputum From patients with chronic obstructive pulmonary disease or asthma [J].Am J Respir Cirt Care Med,1996, 153:530-534.
117. Patuzzo C, Gile LS, ZorzettoM, et al.Tumor necrosis factor gene complex in COPD and disseminated bronchiectasis[ J].Chest, 2000, 117(5): 13-53.
118. AmraniY, PanettieriRA, FrossardN, et al.Activation of the TNFa-p55 receptor inducesmyocyte proliferation andmodulates agonistevoked calcium transients in cultured human tracheal smooth muscle cells[J].Am J Respir Cell MolBio,l 1996, 15: 55-63.
119. Emala CW,Kuhl J,HungerFold CL, et al.TNFa inhibits isoproterenolstimulated adenylyl cyclase activity in cultured airway smoothmuscle cells[J].Am J Physio,l 1997, 272:L644-L650.
120. Sun G,StaceyMA,Vittori E,et al.Cellular andmolecular characteristics of inflammation in chronic bronchitis.Eur J Clin Invest,1998,28:364-372.
121. Nguyen LT,Bedu M,Caillaud D,et al.Increased resting energy expenditure isrelated to plasmaTNF-αconcentration in stable COPD patients.Clin Nutr,1999,18:269-274.
122. Di SteFano A,Capelli A,Lusuardi M,et al.Severity of airflow limitation is associated with severity of airway inflammation in smokers.Am J Respir Crit Care Med,1998,158:1277-1285.
123. MeyerPA,ManninoDM, Redd SC,et al. Characteristics of adults dying with COPD[J].Chest,2002,122(6):2003-3008.
124.杨玲,徐卫国,林建海.精氨酸辅助治疗COPD合并营养不良[J].上海第二医科大学学报,2004,24(1):49-51.
125. Wouters EF, Creutzberg EC, Schols AM. Systemic effects in COPD [J].Chest,2002,121(5Suppl):127S-130S.
126.詹娟,孙圣华.COPD患者缺氧对TNF-α系统的激活及与营养不良的相关性[J].医学临床研究,2003,20(12):881-884.
127. Kenji M,Toshiyuki T. Elevated Production of Tumor Necrosis factor-αby Monocytes in Patients With Obstructive Sleep Apnea Syndrome.Chest, 2004, 126(5): 1473-1479.
128.李振坤,张涛,李其皓,等.肿瘤坏死因子α在OSAHS COPD重叠综合症及OSAHS中的血清水平研究[J].临床肺科杂志,2007,12(9):955-957.
129.张双胜,程荣健,程道胜.健脾补肺法和固肾益肺法对稳定期慢性阻塞性肺疾病患者营养状况、TNF-α及肺功能影响的临床研究[J] .中国中医药科技,2007, 14(2):70-71.
1.中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2007年修订版).中华结核和呼吸杂志,2007,30( 1):8-17.
2.傅曙华.慢性阻塞性肺疾病病因病机及治法探讨.湖南中医杂志,2003,19(4):34.
3.田正鉴,徐幼明,李亚清.慢性阻塞性肺疾病中医病机探微〔J〕.湖北中医学院学报,2001,3(1):29-30.
4.张峻斌,罗侃.“下虚上实”是慢阻肺病机特点和临床表现的高度概括.中国中医基础医学杂志.2004,10(5):30-32.
5.陈晓东.慢性阻塞性肺病稳定期从脾虚血癖论治探析.中医函拦通讯,2000,19(6):20-21.
6.尚景盛,王玉光.应用对应分析研究COPD中医证候与病情分级的相关性[J].上海中医药大学学报,2004,18(4),29-30.
7.何军强,黄广平.中医对COPD病因病机的认识及中医固本治疗.陕西中医学院学报,2005,28(3):12-13.
8.李建生.中医药治疗慢性阻塞性肺疾病研究的实践与若干思考[J].河南中医,2005,25(5),13-15.
9.余学庆,李建生.慢性阻塞性肺疾病中医证候文献分析.辽宁中医杂志,2006,33(7):794-795.
10.徐雯洁,王天芳,王智瑜,等.基于现代文献的慢性阻塞性肺疾病中医证候及证候要素的研究.中华中医药杂志,2008,23(1):19-22.
11.李素云,吴其标.曹世宏教授论治慢性阻塞性肺疾病经验选粹.中医药学刊,2002,20(l):28-29.
12.陈凯佳,梁直英,等.500例慢性阻塞性肺疾病中医证型规律探讨.现代中西医结合杂志,2002,11(18):1755-1757.
13.喻清和,邱志楠.慢性阻塞性肺疾病的辨证治疗浅析.中医药学刊,2003,21(7):11-90.
14.谢健,黄明霞.赵淳教授治疗慢性肺心病急性期经验述要[J].中医药学刊,2004,22(3) :398-399.
15.周苛.慢性阻塞性肺病发作期的辨证治疗.南京中医药大学学报,1995,(4):1.
16.周庆伟,李素云《金匮要略》皂荚丸治疗慢性阻塞性肺病痰浊阻肺型的临床研究[J].中国医药学报,1997,4(12):35-36.
17.吕英,张慧琪.化痰合剂对慢性阻塞性肺疾病急性加重期化痰作用的研究[J].中国中医急症,2005,14(3):213-214.
18.李泽庚,彭波,孙敬.化痰降气胶囊对慢性阻塞性肺疾病模型大鼠影像学的影响[J].安徽中医学院学报,2004,23(1):46-48.
19.崔焱,梁直英,董竞成.活血化瘀方治疗慢性阻塞性肺疾病急性加重期的临床观察[J].中国中西医结合杂志,2005,25(4):327-329.
20.白敬华,王惠兰.益气活血对慢性阻塞性肺疾病血液流变学及血瘀证的影响[J].甘肃中医学院学报,1996,13(4):46.
21.林育华.活血化淤法治疗慢阻肺95例临床观察[J].新中医,1998, 30(2):33-34.
22.陈宪海,王经武,刘春红.慢性阻塞性肺疾病稳定期中医治法述要.山东中医药大学学报,2003,27(6) :413-414.
23.李艳,祝庆华.补肺益肾法对慢性阻塞性肺疾病稳定期肺功能的影响.长春中医药大学学报,2007,23(4) :37-38.
24.陈云凤,扈晓宇,刘洪,等.培本宁肺法对慢性阻塞性肺病稳定期患者临床疗效及肺功能的影响.成都中医药大学学报,2007,30(2) :19-21.
25.焦丽杰.慢性阻塞性肺病继发低氧性肺动脉高压的中医治疗思路与方法[J].中国中西医结合杂志,2000,20(11):867-868.
26.耿宏伟,胡秀红.金水宝胶囊治疗慢性阻塞性肺疾病60例〔J〕.中医研究,2000,13(4):40.
27.王耀峰.补肺益肾胶囊治疗COPD临床研究.山东医药,2007,47(13):30.
28.钱冬梅.生脉注射液改善慢性阻塞性肺病患者免疫功能的疗效观察〔J〕.华西药学杂志,2002,17(4):315.
29.刘明.温补脾肾汤治疗慢性支气管炎117例[J].河南中医, 1997,17(4):222.
30.王真,张泓,宓雅珠.温补脾肾方治疗慢性阻塞性肺病稳定期23例[J].浙江中医杂志, 1999: 234-235.
31.杨素娟,杨绍俊,杨斐斐.健脾固肾丸治疗慢性阻塞性肺病稳定期56例[J].陕西中医,2003,24(4):299.
32.赵文,罗凤鸣,何成奇.肺康复与补肾中药对COPD稳定期患者肺功能及生活质量的影响[J].现代中西医结合杂志,2003,24(12):26-43.
33.单丽囡,刘小虹,钟亮环.培土生金法配合西药治疗慢性阻塞性肺疾病稳定期的临床观察[J].湖北中医杂志,2007,29(4) :26-27.
34.冯学祯,姚惠青.健脾补肺法结合西药治疗慢性阻塞性肺病稳定期36例临床观察[J].青海医药杂志,2006,36(9):82-83.
35.刘小虹,刘琼.培土生金法在慢性阻塞性肺疾病缓解期的床用研究[J].新中医,2002,34(10):18.
36.王平.补脾益肺丸治疗慢性阻塞性肺病86例[J].四川中医,2003,21(10):40.
37.涂晓龙.慢性阻塞性肺疾病肺肾传变规律探讨.辽宁中医杂志,2007,34(10):13-93.
38.张铭熙.健脾益肺补肾法治疗慢性阻塞性肺疾病稳定期临床研究[J].中国中医药信息杂志,2006,13(7):64-65.
39.郑彩霞,王洪刚,刘振安.穴位贴敷为主治疗慢性阻塞性肺疾病90例[J].中医研究,2005,18(10):36-37.
40.彭明松,龚新全,谢六安.中药穴位贴敷治疗慢性阻塞性肺疾病的临床观察[J].湖北中医杂志,2006,28(7):44-45.
41.曾飞球,刘建新,林夏飞.经络导平佐治慢性阻塞性肺疾病的临床研究[J].中国老年学杂志,2004,7(24):605.
42.万文蓉.针灸治疗慢性阻塞性肺疾病36例[J].Chinese A cupuncture&Moxibustion, 2006,26(9): 672.
43.陈钦,钟力炜,刘洪波,等.推拿治疗慢性阻塞性肺疾病的疗效[J].中国临床康复,2006,10(7):10-12.
44.刘小红.点按肺腧结合缩唇呼气在慢性阻塞性肺病中的临床研究[J].按摩与导引,2005,21(6):78.
45. Hogg JC, Chu F, Utokaparch S, et al. The nature of smallairway obstruction in chronic obstructive pulmonary disease. N Engl J Med. 2004;350:2645-2653.
46.岳圆圆,李永春.丹参对慢性阻塞性肺疾病大鼠模型气道保护作用的实验研究[J].中国全科医学,2007,10(7):549-551.
47.张朝宁,吴立文,孙杰,等.益肾通肺汤对COPD大鼠血清IL-8、TNF-α的影响[J].甘肃中医学院学报,2006,23(1):23-25.
48.张炳填,易亚乔,李鑫辉,等.栝蒌薤白半夏汤对COPD大鼠IL-8、TNF-α水平影响的实验研究[J].湖南中医杂志,2006,22(5):79-80.
49.王胜,季红燕,等.益气健脾方对慢性阻塞性肺疾病患者痰液炎症细胞计数和IL-8、TNFa水平的影响.中国中西医结合杂志,2005,25 (2):111-113.
50.李素云,李建生,马利军,等.补肺益肾颗粒对慢性阻塞性肺疾病患者缓解期黏附分子的影响[J].中国医药学报,2003,18(8):500-502.
51.张双胜,程荣健,程道胜.健脾补肺法和固肾益肺法对稳定期慢性阻塞性肺疾病患者营养状况、TNF-α及肺功能影响的临床研究.中国中医药科技,2007,14(2):70-71.
2. Nanshan Zhong, ChenWang, WanzhenYao,et al. Prevalence of chronic obstructive pulmonary disease in China: a large, population-based survey.Am J Respir Crit Care Med. 2007 ,176(8):753-760.
3.单淑香,陈宝元.慢性阻塞性肺疾病流行病学研究进展[J].国外医学呼吸系统分册.2005,25(6)440-442.
4. Petty TL.Definition,epidemiology,course,and prognosis of COPD[J]. Clin Cornerstone,2003,5(1):1-10.
5. Pauwels RA, Buist AS, Calverley, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Golbal Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med, 2001;163(5):1256-1276.
6.中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2007年修订版)[J].中华结核和呼吸杂志,2007,30(1):8-17.
7.吴大玮.抗炎治疗在COPD治疗中的地位.中华医学信息报,2007,22(1):21-22.
8. Hogg JC, Chu F, Utokaparch S, et al. The nature of small airway obstruction in chronic obstructive pulmonary disease. N Engl J Med. 2004,350(26):2645-2653.
9.张海龙,曹帆,李建生,等.慢性阻塞性肺疾病炎症反应研究进展[J].国际呼吸杂志,2009,29(19):1191-1195.
10.苏瑾,姜智海,卢伟.慢性阻塞性肺疾病的综合防治研究进展[J].上海预防医学杂志,2005,17(5):213-214.
11.李建生,李素云,马利军,等.通塞颗粒治疗老年慢性阻塞性肺疾病(COPD)急性加重期的临床疗效评价[J].2003,18(5):35-38.
12.张颖,李廷谦,王刚,等.痰热清注射液治疗慢性阻塞性肺疾病急性加重期(痰热阻肺证)的随机对照试验[J].中国循证医学杂志,2004,4(5):300-336.
13.骆仙芳,柴秀娟,陈益民,等.保肺定喘冲剂治疗COPD 36例临床研究[J].中医杂志,2002,43(4):268-270.
14.周庆伟,李素云,吴纪珍.缓肺颗粒对慢性阻塞性肺疾病患者缓解期肺通气功能的影响[J].中国中西医结合杂志,2005,25(7):649.
15.李素云,李建生,马利军,等.益气养阴活血化痰法对慢性阻塞性肺疾病稳定期免疫功能的影响[J].河北中医,2001,23(12):899-901.
16.张颖,高鹏飞,方忠宏,等.中药治疗慢性阻塞性肺病的疗效观察[J].上海中医药杂志,2004,38(6):6-7.
17.黄东晖,吴蕾,何德平,等.中西医综合治疗慢性阻塞性肺疾病稳定期临床观察[J].第四军医大学学报,2005,26(17):1611-1613.
18. Global Initiative for COPD(GOLD).Global strategy for the diagnosis ,magement,and prevention of chronic obstructive pulmonary disease.Revised 2006,www.goldcopd.org
19.王永炎,晁恩祥主编.今日中医内科[M].北京:人民卫生出版社,2000.
20.王永炎,鲁兆麟主编.中医内科学[M].北京:人民卫生出版社,1999.
21.张伯臾主编.中医内科学[M] .上海:上海科学技术出版社,2002.
22.国家中医药管理局.中华人民共和国中医药行业标准.中医病证诊断疗效标准.南京:南京大学出版社,1994.
23.中华医学会老年医学学会.中华医学会老年医学会对健康老年人标准的建议(修订草案,1995年).中华老年医学杂志,1996,15(1):9.
24.国家药典委员会.中国药典,Ⅰ部[S].北京:化学工业出版社,2005.
25. Ferris BG.Epidemiology Standardization Project (American Thoracic Society). Am Rev Respir Dis, 1978 ,118(6 Pt 2):1-120.
26.要全保.慢阻肺从脾论治初探[J].中医研究,1999,12(6):4-6.
27.黄礼明.试论痰、瘀、虚在慢性阻塞性肺病辨治中的重要性[J].贵阳中医学院学报,2000,22(1):5-7.
28.孙子凯,曹世宏.262例慢性阻塞性肺病证治规律探讨[J].南京中医药大学学报,1998,14(1):13-15.
29.余学庆,李建生,李力.慢性阻塞性肺疾病(COPD)中医证候分布规律研究[J].河南中医学院学报,2003,18(4):44-46.
30.喻清和,邱志楠.慢性阻塞性肺疾病的辨证治疗浅析[J].中医药学刊,2003,21(7):1190.
31.张洪春,昆恩祥.调补肺肾胶囊治疗慢性阻塞性肺疾病稳定期临床研究[J].北京中医药大学学报,2003,26(2):53-56.
32.尚景盛,王玉光.应用对应分析研究CODP中医证候与病情分级的相关性[J].上海中医药大学学报,2004,18(4):29-30.
33.李素云,吴其标.曹世宏教授论治慢性阻塞性肺疾病经验选粹[J].中医药学刊,2002,20(l):28-29.
34.尹新中,刘贵颖,张慧琪,等.中西医结合治疗慢性阻塞性肺疾病急性加重期30例临床分析[J].天津中医药,2005,22(2):117-118.
35.徐毓华.中西医结合治疗慢性阻塞性肺疾病急性加重期临床观察[J].湖北中医杂志,2005,27(6):22-23.
36.王胜,季红燕,张念志,等.益肺健脾方对炎症细胞计数和慢性阻塞性肺疾病患者痰液IL-8、TNF-α、水平的影响[J].中国中西医结合杂志,2005,25(2):111-113.
37.钱冬梅.生脉注射液改善慢性阻塞性肺病患者免疫功能疗效观察[J].湖南中医药导报,2002,8(7):402-408.
38.刘洪,陈风云.温肾纳气、健脾利水法对慢性阻塞性肺疾病缓解期肺功能的影响[J].中国中医急症,2006,15(2):116-117.
39. Agusti AG.COPD:a multicomponent disease:implications for management.Respiratory Mdeicine.2005,99(6):670-682.
40.钟小宁,柳广南,慢性阻塞性肺疾病气道炎症研究进展[J].国外医学内科学分册,2000,27(1):32-34.
41. David G Parr,Andrew J White,Darren L Bayley ,et al.Inflammation in sputum relates to progression of disease in subjects with COPD:a prospective descriptive study.Respiratory Research .2006,18(7):136-146.
42. Barnes NC, Qiu YS, Pavord ID, et al. Antiin flammatory effects of salmeterol/fluticasone propionate in chronic obstructive lung disease.Am J Respir Crit Care Med. 2006,173(7):736-743.
43. Calverey P.Combined salmeterol and fluticasone in the treatment of chronic obstructive pulmonary disease:a randomized controlled trial .Lancet .2003,361:449-453.
44. Mahler DA, Wire P, Horstman D, et al. Effectiveness of fluticasone propionate and salmeterol combination delivered via the Diskus device in the treatment of chronic obstructive pulmonary disease.Am J Respir Crit Care Med. 2002,166(8):1084-1091.
45. Hanania NA, Darken P, Horstman D, et al. The efficacy and safety of fluticasone propionate (250 microg)/salmeterol (50 microg) combined in the Diskus inhaler for the treatment of COPD.Chest. 2003,124(3):834-843.
46. Soriano JB, Vestbo J, Pride NB, et al. Survival in COPD patients after regular use of fluticasone propionate and salmeterol in general practice.Eur Respir J. 2002,20(4):819-825.
47.李建生.老年医学概论[M].北京:人民卫生出版社,2003.
48.李建生.中医药治疗慢性阻塞性肺疾病研究的实践与若干思考[J].河南中医,2005,25(5):13-15.
49.李建生.慢性阻塞性肺疾病中医辨证治疗概要[J].河南中医学院学报,2009,24(4):9-11.
50.程先宽,李建生,李素云.中医药治疗慢性阻塞性肺疾病研究概况[J].中国中医急症,2002,11(6):485-487.
51.李鸿超.慢性阻塞性肺疾病中BODE评分的临床价值[J].现代医院,2008, 8(8):8-10.
52. Johnson M.Interactions between corticosteroids and beta 2 agonists in asthma and chronic obstructive pulmonary disease,2004, 1(3):200-206.
53. Adcock IM, Maneechotesuwan K, et al.Molecular interactions between glucocorticoids and long-acting beta2-agonists. J Allergy Clin Immunol. 2002 ,110(6 ):S261 -S268.
54.李艳,祝庆华.补肺益肾法对慢性阻塞性肺疾病稳定期肺功能的影响[J].长春中医药大学学报,2007,23(4):37-38.
55.刘德频,洪华金.补肾健脾化瘀法治疗慢性阻塞性肺疾病稳定期疗效观察[J].中国中医急症,2007,16(2):152-197.
56.王耀峰.补肺益肾胶囊治疗COPD临床研究[J].山东医药,2007,47(13):30-31.
57.邵长荣,陈凤鸣.阻塞性肺气肿培补肺肾后α1抗胰蛋白酶及纤维结合蛋白的观察[J].中医杂志,2002,25(8):451-460.
58.刘惠芳.补肾健脾清肺平喘法治疗慢支炎和肺气肿65例[J].黑龙江中医药,1992,28(5):16.
59.陈文彬,潘祥林.诊断学(第六版)[M].北京:人民卫生出版社,2004.
60.陈宪海,王经武,等.慢性阻塞性肺疾病稳定期中医治法述要[J].山东中医药大学学报,2003,27(6):413-414.
61. Murphy TF,Sethi S.Chronic obstructive pulmonary disease.Drugs Aging.2002,19(10):761-763.
62.包红,李清华,罗百灵.营养支持对慢性阻塞性肺疾病急性加重期患者免疫和肺功能的影响[J].中华急诊医学杂志,2003,12(11):730-733.
63.吴纪珍,张罗献,马利军,等.老年人慢性阻塞性肺病患者免疫功能测定及其意义[J].医药论坛杂志,2004,25(23):10-12.
64.张石安,高兴林,张珍萍,等.老年慢性阻塞性肺病患者细胞免疫功能变化的研究[J].现代临床医学生物工程学杂志,2004,10(5):402-404.
65.冯健,陆鸿雁,黄卫峰.慢性阻塞性肺疾病26例免疫功能检测分析[J].南通医学院学报,2001:21(2)145-146.
66.沈自尹.中医药与免疫[J].中国免疫学杂志,2004,20(1):8-10.
67.沈自尹.从肾本质研究到证本质研究的思考与实践[J].上海中医药杂志,2000,34(4):4-7.
68.李素云,周庆伟,吴纪珍.补肺益肾颗粒对COPD缓解期患者肺通气功能和免疫功能的影响[J].山东中医杂志,2003,22(6):333-335.
69.刘刚,张贻雯,马晓东.补肺益肾汤改善慢性阻塞性肺疾病患者细胞免疫研究[J].实用中西医结合临床,2007,7(3):18-19.
70.李素云,李建生.慢性阻塞性肺疾病中医药研究进展[J].中国中医药信息杂志,2002,9(6):83-85.
71. Katsura H,Yamada K,Kida K.Both generic and disease specific health-related quality of life are deteriorated in patients with underweight COPD.Respir Med,2005,99(5):624-630.
72. Nishimura K, Izumi T, Tsukino M,et al. Dyspnea is a better predictor of 5 year survival than airway obstruction in patients with COPD.Chest 2002;121(5):1434-1440.
73.李建生,王明航,李素云.慢性阻塞性肺疾病呼吸困难的评估研究进展[J].河南中医学院学报,2007,22(2):79-82.
74. American Thoracic Society. Dyspnea: mechanisms, assessment, and management: a consensus statement[J]. Am J Respir Crit Care Med,1999,159(1):321-340.
75. Gosker HR,Engelen MP,van Mameren H,et al.Muscle Fiber type IIX atrophy is involved in the loss of fat free mass in chronic obstructive pulmonary disease.Am J Clin Nutr 2002,76(1):113-119.
76. Casanova C, Cote CG, Marin JM, et al.The 6min walking distance: longterm follow up in patients with COPD. Eur Respir J. 2007 ,29(3):535-540.
77. Paulin E,Yamaguti WP,Chammas MC,et al.Influence of diaphragmatic mobility on exercise tolerance and dyspnea in patients with COPD.Respir Med 2007,101(10):2113-2118.
78. Montes de Oca M,Torres SH,González Y, et al.Changes in Exercise Tolerance,Health Related Quality of Life,and Peripheral Muscle Characteristics of Chronic Obstructive Pulmonary Disease Patients After 6 Weeks Training.Arch Bronconeumol 2005,41(8):413-418.
79.吕探云,马敏芝.社区老年人抑郁症状及其影响因素的研究[J].护理学杂志,2001,16(7):387-389.
80.蔡映云.当代呼吸病研究的两个特征[J].中华结核和呼吸杂志,1999,22(7):445-446.
81. Debigare R,Marquis K,Cote CH,et al.Catabolic/anabolic balance and muscle wasting in patients with COPD.Chest.2003.124(1):83-89.
82. Wilson DO, Rogers RM, Wright EC, et al.Body weight in chronic obstructive pulmonary disease. The National Institutes of Health Intermittent Positive-Pressure Breathing Trial. Am Rev Respir Dis. 1989,139(6):1435-1438.
83. Laaban JP.Nutrition and chronic respiratory failure. Ann Med Interne (Paris). 2000 ,151(7):542-548.
84. Ezzell L, Jensen GL.Malnutrition in chronic obstructive pulmonary disease. Am J Clin Nutr. 2000 ,72(6):1415-1416.
85. Nagaya N,Kojima M,Kangawa K.Ghrelin,a Novel Growth Hormonereleasing Peptide,in the Treatment of Cardiopulmonary-associated Cachexia.Intern Med.2006 ;45(3):127-134.
86. Landbo C,Prescott E,lange P,et al.Prognostic value of nutritional status in chronic obstructive pulmonary disease.Am J RespirCrit Car Med, 1999 Dec;160(6):1856-1861.
87. Schols AM,Shangen J,Volovics L,et al.Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease.Am J Respir Crit Care Med, 1998 ,157(6 Pt 1):1791-1797.
88. Nocturnal Oxygen Therapy Trial Group.Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive pulmonary disease:a clinical trial.Ann Intern Med.1980,93:391-398.
89. Celli BR, Cote CG, Marin JM, et al.The bodymass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004,350(10):1005-1012.
90. Landbo C,Prescott E,Lange P, et al.Prognostic value of nutritional status in chronic obstructive pulmonary disease.Am J Respir Crit Care Med . 1999 ,160(6):1856-1861.
91.杜月君,罗怡,霍震.慢性阻塞性肺疾病体重指数与再住院关系分析[J].医学理论与实践,2007,(20)2:183-184.
92. Sin DD,Man SF.Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases?The potential role of systemicinflammation in chronic obstructive pulmonary disease.Circulation 2003,107(11):1514–1519.
93. De Torres JP,Cordoba-Lanus E,Lopez-Aguilar C,et al.C-reactive protein levels and clinically important predictive outcomes in stable COPD patients.Eur Respir J 2006;27(5):902–907.
94. Gan WQ,Man SF,Senthilselvan A,Sin DD.Association between chronic obstructive pulmonary disease and systemic inflammation:a systematic review and a metaanalysis.Thorax 2004;59:574–580.
95. Schneider A,Dinant GJ,Maag I, et al.The added value of Creactive protein to clinical signs and symptoms in patients with obstructive airway disease:results of a diagnostic study in primary care.BMC Fam Pract.2006;7:28.
96. Pepys MB.C-reactive protein fifty years on.Lancet.1981:1(8221):653–657.
97.杜迎雪,李素敏.110例急性呼吸道感染C反应蛋白检测的分析[J].中国民康医学,2003,15(1):34-35.
98. Eid AA,Ionescu AA,Nixon LS.et al.Inflammatory response and body composition in chronic obstructive pulmonary disease[J].Am J Respir Crit Care Med.2001.164(7):1414-1418.
99.何宪章,严明生,郭晓兰,等. CRP检测在慢性阻塞性肺疾病中的应用[J].川北医学院学报,2003,18(4):96.
100.卿克勤,张锐. C反应蛋白与慢性阻塞性肺疾病的急性加重期关系的探讨[J].四川省卫生管理干部学院学报,2004, 23(1): 2-3.
101. Malo O,Sauleda J,Busquets X, et al.Systemic inflammation during exacerbations of chronic obstructive pulmonary disease.Arch Bronconeumol 2002,38(4):172–176.
102.熊曙光,陈余思. C反应蛋白在慢性阻塞性肺疾病急性加重期的应用评价[J].临床肺科杂志,2007,12(6):608-610.
103.张冰,王丹琪,夏国光.白细胞介素6及C反应蛋白在慢性阻塞性肺疾病患者急性加重中的意义[J].中国呼吸与危重监护杂志,2003,2(2):85-86.
104. Karadag F, Kirdar S, Karul AB, et al. The value of Creactive protein as a marker of systemic inflammation in stable chronic obstructive pulmonary disease. Eur J Intern Med. 2008 Mar,19(2):104-108.
105. J.P.de Torres,E.CordobaLanus,C.Lo′pezAguilar, et al.Creactive protein levels and clinically important predictive outcomes in stable COPD patients. Eur Respir J. 2006,27(5):902-907.
106. PintoPlata VM, Müllerova H, Toso JFThorax. et al.Creactive protein in patients with COPD, control smokers and nonsmokers. 2006 Jan;61(1):23-28.
107. Yoshikawa T,Dent G,Ward J,et al.Impaired Neutrophil Chemotaxis in Chronic Obstructive Pulmonary Disease[J].Am J Respir Crit Care Med,2007,175(5):473-479.
108. Larsson K.Inflammatory markers in COPD. Clin Respir J. 2008,2(1):84-87.
109. Facchinetti F,Amadei F,Geppetti P,et al. Alpha,beta-unsaturated aldehydes in cigarette smoke release inflammatory mediators from human macrophages.[J].Am J Respir Cell Mol Biol,2007,37(5):617-623.
110.林美玲,张宏斌,许珏.慢性阻塞性肺疾病患者血清IL-8检测及其临床意义[J].实用医技杂志,2006,13(13):2237-2238.
111. Wang HY,Liu JK,Huang HX, et al.Relationship among bacterial colonization,airway inflammation,and bronchodilator response in patients with[J].Chin Medi J,2006,119(8):684-687.
112. Hu XR, Han SX, Wang T, et al.Association between interleukin-8 in lung tissues and stages of chronic obstructive pulmonary diseases. Sichuan Da Xue Xue Bao Yi Xue Ban. 2009 ,40(5):885-888.
113.秦兴国,肖平,陈风华,等.已酮可可碱吸入对慢性阻塞性肺疾病患者的疗效观察[J].中国临床医学,2000,7(3):289-291.
114. DouradoVZ, Tanni SE, Vale SA,et al. Systemic manifestations in chronic obstructive pulmonary disease. J Bras Pneumol,2006, 32(2):161-171.
115. Aarson SD, Angel JB, Lnnau M, et al. Granulocyte inflammatory markers and airway infection during acute exacerbation of chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2001,163(2):349-355.
116. KeatingsVM, Collins PD, ScottDM, et al.Differences in interleukin-8 and tumor necrosis factor-αin induced sputum From patients with chronic obstructive pulmonary disease or asthma [J].Am J Respir Cirt Care Med,1996, 153:530-534.
117. Patuzzo C, Gile LS, ZorzettoM, et al.Tumor necrosis factor gene complex in COPD and disseminated bronchiectasis[ J].Chest, 2000, 117(5): 13-53.
118. AmraniY, PanettieriRA, FrossardN, et al.Activation of the TNFa-p55 receptor inducesmyocyte proliferation andmodulates agonistevoked calcium transients in cultured human tracheal smooth muscle cells[J].Am J Respir Cell MolBio,l 1996, 15: 55-63.
119. Emala CW,Kuhl J,HungerFold CL, et al.TNFa inhibits isoproterenolstimulated adenylyl cyclase activity in cultured airway smoothmuscle cells[J].Am J Physio,l 1997, 272:L644-L650.
120. Sun G,StaceyMA,Vittori E,et al.Cellular andmolecular characteristics of inflammation in chronic bronchitis.Eur J Clin Invest,1998,28:364-372.
121. Nguyen LT,Bedu M,Caillaud D,et al.Increased resting energy expenditure isrelated to plasmaTNF-αconcentration in stable COPD patients.Clin Nutr,1999,18:269-274.
122. Di SteFano A,Capelli A,Lusuardi M,et al.Severity of airflow limitation is associated with severity of airway inflammation in smokers.Am J Respir Crit Care Med,1998,158:1277-1285.
123. MeyerPA,ManninoDM, Redd SC,et al. Characteristics of adults dying with COPD[J].Chest,2002,122(6):2003-3008.
124.杨玲,徐卫国,林建海.精氨酸辅助治疗COPD合并营养不良[J].上海第二医科大学学报,2004,24(1):49-51.
125. Wouters EF, Creutzberg EC, Schols AM. Systemic effects in COPD [J].Chest,2002,121(5Suppl):127S-130S.
126.詹娟,孙圣华.COPD患者缺氧对TNF-α系统的激活及与营养不良的相关性[J].医学临床研究,2003,20(12):881-884.
127. Kenji M,Toshiyuki T. Elevated Production of Tumor Necrosis factor-αby Monocytes in Patients With Obstructive Sleep Apnea Syndrome.Chest, 2004, 126(5): 1473-1479.
128.李振坤,张涛,李其皓,等.肿瘤坏死因子α在OSAHS COPD重叠综合症及OSAHS中的血清水平研究[J].临床肺科杂志,2007,12(9):955-957.
129.张双胜,程荣健,程道胜.健脾补肺法和固肾益肺法对稳定期慢性阻塞性肺疾病患者营养状况、TNF-α及肺功能影响的临床研究[J] .中国中医药科技,2007, 14(2):70-71.
1.中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2007年修订版).中华结核和呼吸杂志,2007,30( 1):8-17.
2.傅曙华.慢性阻塞性肺疾病病因病机及治法探讨.湖南中医杂志,2003,19(4):34.
3.田正鉴,徐幼明,李亚清.慢性阻塞性肺疾病中医病机探微〔J〕.湖北中医学院学报,2001,3(1):29-30.
4.张峻斌,罗侃.“下虚上实”是慢阻肺病机特点和临床表现的高度概括.中国中医基础医学杂志.2004,10(5):30-32.
5.陈晓东.慢性阻塞性肺病稳定期从脾虚血癖论治探析.中医函拦通讯,2000,19(6):20-21.
6.尚景盛,王玉光.应用对应分析研究COPD中医证候与病情分级的相关性[J].上海中医药大学学报,2004,18(4),29-30.
7.何军强,黄广平.中医对COPD病因病机的认识及中医固本治疗.陕西中医学院学报,2005,28(3):12-13.
8.李建生.中医药治疗慢性阻塞性肺疾病研究的实践与若干思考[J].河南中医,2005,25(5),13-15.
9.余学庆,李建生.慢性阻塞性肺疾病中医证候文献分析.辽宁中医杂志,2006,33(7):794-795.
10.徐雯洁,王天芳,王智瑜,等.基于现代文献的慢性阻塞性肺疾病中医证候及证候要素的研究.中华中医药杂志,2008,23(1):19-22.
11.李素云,吴其标.曹世宏教授论治慢性阻塞性肺疾病经验选粹.中医药学刊,2002,20(l):28-29.
12.陈凯佳,梁直英,等.500例慢性阻塞性肺疾病中医证型规律探讨.现代中西医结合杂志,2002,11(18):1755-1757.
13.喻清和,邱志楠.慢性阻塞性肺疾病的辨证治疗浅析.中医药学刊,2003,21(7):11-90.
14.谢健,黄明霞.赵淳教授治疗慢性肺心病急性期经验述要[J].中医药学刊,2004,22(3) :398-399.
15.周苛.慢性阻塞性肺病发作期的辨证治疗.南京中医药大学学报,1995,(4):1.
16.周庆伟,李素云《金匮要略》皂荚丸治疗慢性阻塞性肺病痰浊阻肺型的临床研究[J].中国医药学报,1997,4(12):35-36.
17.吕英,张慧琪.化痰合剂对慢性阻塞性肺疾病急性加重期化痰作用的研究[J].中国中医急症,2005,14(3):213-214.
18.李泽庚,彭波,孙敬.化痰降气胶囊对慢性阻塞性肺疾病模型大鼠影像学的影响[J].安徽中医学院学报,2004,23(1):46-48.
19.崔焱,梁直英,董竞成.活血化瘀方治疗慢性阻塞性肺疾病急性加重期的临床观察[J].中国中西医结合杂志,2005,25(4):327-329.
20.白敬华,王惠兰.益气活血对慢性阻塞性肺疾病血液流变学及血瘀证的影响[J].甘肃中医学院学报,1996,13(4):46.
21.林育华.活血化淤法治疗慢阻肺95例临床观察[J].新中医,1998, 30(2):33-34.
22.陈宪海,王经武,刘春红.慢性阻塞性肺疾病稳定期中医治法述要.山东中医药大学学报,2003,27(6) :413-414.
23.李艳,祝庆华.补肺益肾法对慢性阻塞性肺疾病稳定期肺功能的影响.长春中医药大学学报,2007,23(4) :37-38.
24.陈云凤,扈晓宇,刘洪,等.培本宁肺法对慢性阻塞性肺病稳定期患者临床疗效及肺功能的影响.成都中医药大学学报,2007,30(2) :19-21.
25.焦丽杰.慢性阻塞性肺病继发低氧性肺动脉高压的中医治疗思路与方法[J].中国中西医结合杂志,2000,20(11):867-868.
26.耿宏伟,胡秀红.金水宝胶囊治疗慢性阻塞性肺疾病60例〔J〕.中医研究,2000,13(4):40.
27.王耀峰.补肺益肾胶囊治疗COPD临床研究.山东医药,2007,47(13):30.
28.钱冬梅.生脉注射液改善慢性阻塞性肺病患者免疫功能的疗效观察〔J〕.华西药学杂志,2002,17(4):315.
29.刘明.温补脾肾汤治疗慢性支气管炎117例[J].河南中医, 1997,17(4):222.
30.王真,张泓,宓雅珠.温补脾肾方治疗慢性阻塞性肺病稳定期23例[J].浙江中医杂志, 1999: 234-235.
31.杨素娟,杨绍俊,杨斐斐.健脾固肾丸治疗慢性阻塞性肺病稳定期56例[J].陕西中医,2003,24(4):299.
32.赵文,罗凤鸣,何成奇.肺康复与补肾中药对COPD稳定期患者肺功能及生活质量的影响[J].现代中西医结合杂志,2003,24(12):26-43.
33.单丽囡,刘小虹,钟亮环.培土生金法配合西药治疗慢性阻塞性肺疾病稳定期的临床观察[J].湖北中医杂志,2007,29(4) :26-27.
34.冯学祯,姚惠青.健脾补肺法结合西药治疗慢性阻塞性肺病稳定期36例临床观察[J].青海医药杂志,2006,36(9):82-83.
35.刘小虹,刘琼.培土生金法在慢性阻塞性肺疾病缓解期的床用研究[J].新中医,2002,34(10):18.
36.王平.补脾益肺丸治疗慢性阻塞性肺病86例[J].四川中医,2003,21(10):40.
37.涂晓龙.慢性阻塞性肺疾病肺肾传变规律探讨.辽宁中医杂志,2007,34(10):13-93.
38.张铭熙.健脾益肺补肾法治疗慢性阻塞性肺疾病稳定期临床研究[J].中国中医药信息杂志,2006,13(7):64-65.
39.郑彩霞,王洪刚,刘振安.穴位贴敷为主治疗慢性阻塞性肺疾病90例[J].中医研究,2005,18(10):36-37.
40.彭明松,龚新全,谢六安.中药穴位贴敷治疗慢性阻塞性肺疾病的临床观察[J].湖北中医杂志,2006,28(7):44-45.
41.曾飞球,刘建新,林夏飞.经络导平佐治慢性阻塞性肺疾病的临床研究[J].中国老年学杂志,2004,7(24):605.
42.万文蓉.针灸治疗慢性阻塞性肺疾病36例[J].Chinese A cupuncture&Moxibustion, 2006,26(9): 672.
43.陈钦,钟力炜,刘洪波,等.推拿治疗慢性阻塞性肺疾病的疗效[J].中国临床康复,2006,10(7):10-12.
44.刘小红.点按肺腧结合缩唇呼气在慢性阻塞性肺病中的临床研究[J].按摩与导引,2005,21(6):78.
45. Hogg JC, Chu F, Utokaparch S, et al. The nature of smallairway obstruction in chronic obstructive pulmonary disease. N Engl J Med. 2004;350:2645-2653.
46.岳圆圆,李永春.丹参对慢性阻塞性肺疾病大鼠模型气道保护作用的实验研究[J].中国全科医学,2007,10(7):549-551.
47.张朝宁,吴立文,孙杰,等.益肾通肺汤对COPD大鼠血清IL-8、TNF-α的影响[J].甘肃中医学院学报,2006,23(1):23-25.
48.张炳填,易亚乔,李鑫辉,等.栝蒌薤白半夏汤对COPD大鼠IL-8、TNF-α水平影响的实验研究[J].湖南中医杂志,2006,22(5):79-80.
49.王胜,季红燕,等.益气健脾方对慢性阻塞性肺疾病患者痰液炎症细胞计数和IL-8、TNFa水平的影响.中国中西医结合杂志,2005,25 (2):111-113.
50.李素云,李建生,马利军,等.补肺益肾颗粒对慢性阻塞性肺疾病患者缓解期黏附分子的影响[J].中国医药学报,2003,18(8):500-502.
51.张双胜,程荣健,程道胜.健脾补肺法和固肾益肺法对稳定期慢性阻塞性肺疾病患者营养状况、TNF-α及肺功能影响的临床研究.中国中医药科技,2007,14(2):70-71.