大蒜素注射液雾化吸入治疗老年继发性呼吸道深部真菌感染及对不同中医证候的影响之临床研究
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摘要
本研究以中医理论为指导，在初步实验研究及以往临床实践的基础上，进行大蒜素注射液雾化吸入对老年继发性呼吸道深部真菌感染的治疗以及对不同中医证候的影响的临床研究，以期进一步探讨中医药在治疗老年继发性呼吸道深部真菌感染方面的新途径和作用机理。
目的：观察大蒜素注射液雾化吸入治疗老年继发性呼吸道深部真菌感染的临床疗效，及对真菌的清除效果、中医临床症状疗效、炎性因子、体液免疫指标的变化，并对不同证候的疗效进行评价和研究，为探讨大蒜素注射液雾化吸入的作用机制提供科学依据。
方法：按照研究方案，入选本研究的患者共38人，随机分为两组，治疗组22例(大蒜素注射液雾化吸入组)、对照组16例(西药对照组)。治疗组使用生理盐水20ml+大蒜素注射液7.5mg，每日雾化吸入2次，给药时间为7天一疗程，共计二个疗程；对照组口服氟康唑50mg，每日2次，给药时间为7天一疗程，共计二个疗程。疗效性指标观测：痰真菌培养(用药前痰真菌培养3次，用药后痰真菌培养3次，对用药前后的痰真菌培养进行观测)；炎性因子(C-反应蛋白(CRP)、白介素-6(IL-6)、白介素-8(IL-8))；体液免疫指标(IgA、IgG、IgM、C3、C4)；中医临床症状积分(对患者的中医临床主症和次症进行前后积分记录)。中医证候观测：对患者全部进行证候记录并分型。安全性指标观测：用药前后各记录一次体温、呼吸、脉搏、血压；血液常规、尿、大便常规，肝、肾功能以及心电图(ECG)检查。
结果：大蒜素注射液雾化吸入治疗老年继发性呼吸道深部真菌感染中医临床症状疗效的总有效率为86.36％，而对照组的总有效率为37.5％，其差异具有统计学意义(P＜0.05)。治疗组的真菌清除率达到59.09％，对照组的为50％，差异无统计学意义(P＞0.05)。治疗组的炎性因子中的IL-6在治疗后显著下降，治疗前后的差异显著(P＜0.05)，变化程度与对照组类似(P＞0.05)。CPR和IL-8在治疗前后差异不具有统计学意义(P＞0.05)。治疗组的各项免疫指标在治疗后有改善，但治疗前后的差异均没有统计学意义(P＞0.05)。治疗组三种不同证候的临床效果有区别，痰浊阻肺中医临床症状疗效总有效率和真菌清除率分别为100％和100％，痰热蕴肺分别为71.42％和28.57％，肺气阴两虚分别为87.50％和50％，不管是真菌清除效果还是中医临床症状疗效，痰浊阻肺与其他证候相比差别显著(P＜0.05)；痰热蕴肺和肺气阴两虚证，其真菌清除效果和中医临床症状疗效相互之间差异无统计学意义(P＞0.05)。
结论：老年继发性呼吸道深部真菌感染患者年高体弱，免疫功能低下，往往还患有各种基础病，长期、大剂量的使用广谱抗生素、免疫抑制剂等药物，正气进一步损伤，常因正虚感邪而致病，因此本虚标实，正虚痰阻，是其病机关键。故扶正祛邪、标本同治是治疗本病的重要法则。大蒜素在改善老年继发性呼吸道深部真菌感染患者中医临床症状、清除真菌等诸方面疗效确切，并且以痰浊阻肺型患者疗效最为突出。大蒜素治疗本病的疗效机理，可能是通过降低IL-6的水平来阻止中性粒细胞(PMN)的特异趋化吸引力，阻止炎症细胞的趋化聚集，减少PMN在呼吸道深部的毛细血管的扣留时间，降低PMN对呼吸道深部的毛细血管内皮细胞的损伤，从而提高机体的免疫防御能力，达到扶正祛邪、标本兼治的治疗作用。因此，大蒜素雾化治疗安全可靠，无毒副作用，可用于老年继发性呼吸道深部真菌感染患者的治疗。
Taken the Chinese medicine theory as the instruction and based on the preliminaryexperimental study and former clinical practice, the thesis conducts the clinicalresearch on pulverization inhalation therapy of garlic allicin injection for the secondaryepiphyte infection affection of agedness' deep respiratory tract and the influence ondifferent syndrome in a traditional herbalist doctor view, scientifically discusses theeffective curative for the secondary epiphyte infection affection of agedness' deeprespiratory tract so as to enhance the treatment function.
Aim: to observe the clinical curative effect of pulverization inhalation therapy of garlicallicin for the secondary epiphyte infection affection of agedness' deep respiratory tract,to conduct index statistics analysis of epiphyte elimination effect, the clinical curativeeffect, inflammation factor and body fluid immunity, and to provide the scientific basisfor opening the out the function mechanism of pulverization inhalation therapy ofgarlic allicin;
Method: According to the research, the selected and effective patients are 38 persons.They are divided into two groups stochastically by random numeric table, 16 examplesfor comparison group (western medicine comparison group) and 22 examples fortreatment group (pulverization inhalation therapy of garlic allicin injection group).Each patient of comparison group takes 50mg Fluconazole twice a day, and eachpatient of treatment group inbreathe 7.5mg pulverization of garlic allicin injection plus20ml physiological brine twice a day. Seven days form a treatment period and the totalis two periods.
Security index observation: A check-up record will be taken before and after takingdrugs respectively concerning body temperature, the breath, the pulse, the bloodpressure, general blood items, the urine, the bowel movement items, the liver, thekidney function as well as the electrocardiogram (ECG).
Curative effect index observation: phlegm epiphyte cultivation (three times phlegmepiphyte cultivation both before and after taking drugs and observation); Inflammationfactor (C-Reactive Protein, CRP, Human Interleukin-6(IL-6), Human Interleukin-8(IL-8)); body fluid immunity index (IgA, IgG, IgM, C3, Ca); integral of clinicsyndrome in Chinese medicine view (integral register of main symptom and minorsymptom);
Traditional Chinese medical appearance observation: to record all the syndrome ofpatients and classify the type;
Result: Total effective rate of pulverization inhalation therapy of garlic allicininjection for the secondary epiphyte infection affection of agedness' deep respiratorytract is 86.36%, while the total effective rate of comparison group is 37.5%. Thedifferences have statistical significance (P〈0.05). The epiphyte elimination effect isobvious and the rate of elimination achieves 59.09%. The differences with comparisongroup have no statistical significance (P〉0.05). The differences of inflammation factorCPR and IL-8 have no statistical significance before and after treatment (P〉0.05), butIL-6 decreases greatly after treatment and the differences before and after treatment areobvious (P〈0.05) with similar change degree of comparison group (P〉0.05). Thedifferences of treatment group's immunity index have no statistical significance (P〉0.05). The clinic effects on three different syndrome of treatment group aredifferent. The total effective rate and the epiphyte elimination rate are 100% and 100%respectively for syndrome of turbid phlegm obstructing lung. The total effective rateand the epiphyte elimination rate are 71.42% and 28.57% respectively for syndrome ofphlegm-heat obstructing lung. The total effective rate and the epiphyte elimination rateare 87.50% and 50% respectively for syndrome of deficiency of both qi and yin oflung. In spite of epiphyte elimination effect of clinic symptom curative effect, there arestatistical significance for the differences between syndrome of turbid phlegmobstructing lung and other syndromes (P〈0.05). While the difference between othertwo syndromes, syndrome of phlegm-heat obstructing lung and syndrome ofdeficiency of both qi and yin of lung, have no statistical significance ( P〉0.05 ).
Conclusion: The patients of secondary epiphyte infection affection of agedness' deeprespiratory tract are aged and weak. Their immunity function level is low. Sometimes because of long-term and big dosage use of broad-spectrum antibiotics andimmunosuppressant drug after suffering from basic illness, they have root deficiencybut excess manifestation, deficincy combined with excess, or syndrome of phlegm dueto deficient vital qi, this is the key factor of illness. Therefore, strengthening andconsolidating body resistance and benefiting qi for activating blood circulation so as toenhance immunity function is the important principle for treatment. Garlic allicin hassolid curative effect on improving the clinic symptom and epiphyte elimination ofsecondary epiphyte infection affection of agedness' deep respiratory tract sufferers,especially to the patients of syndrome of turbid phlegm obstructing lung. The curativemechanism of garlic allicin may be by reducing the level of IL-6 to prevent the specialtendency attraction of PMN, to hold back the assembly tendency of inflammationfactor, to decrease the detention time of PMN in capillary vessel of deep respiratorytract, and to reduce the damage to endothelial cell of capillary vessel of deeprespiratory tract, so as to enhance the immunity recovery ability of the body, strengthenvital qi to eliminate pathogenic factor and treat both manifestation and root cause ofdisease. So pulverization inhalation therapy of garlic allicin injection is safe, reliableand has no toxic or side effect and can be used for treatment of for the secondaryepiphyte infection affection of agedness' deep respiratory tract.
目的：观察大蒜素注射液雾化吸入治疗老年继发性呼吸道深部真菌感染的临床疗效，及对真菌的清除效果、中医临床症状疗效、炎性因子、体液免疫指标的变化，并对不同证候的疗效进行评价和研究，为探讨大蒜素注射液雾化吸入的作用机制提供科学依据。
方法：按照研究方案，入选本研究的患者共38人，随机分为两组，治疗组22例(大蒜素注射液雾化吸入组)、对照组16例(西药对照组)。治疗组使用生理盐水20ml+大蒜素注射液7.5mg，每日雾化吸入2次，给药时间为7天一疗程，共计二个疗程；对照组口服氟康唑50mg，每日2次，给药时间为7天一疗程，共计二个疗程。疗效性指标观测：痰真菌培养(用药前痰真菌培养3次，用药后痰真菌培养3次，对用药前后的痰真菌培养进行观测)；炎性因子(C-反应蛋白(CRP)、白介素-6(IL-6)、白介素-8(IL-8))；体液免疫指标(IgA、IgG、IgM、C3、C4)；中医临床症状积分(对患者的中医临床主症和次症进行前后积分记录)。中医证候观测：对患者全部进行证候记录并分型。安全性指标观测：用药前后各记录一次体温、呼吸、脉搏、血压；血液常规、尿、大便常规，肝、肾功能以及心电图(ECG)检查。
结果：大蒜素注射液雾化吸入治疗老年继发性呼吸道深部真菌感染中医临床症状疗效的总有效率为86.36％，而对照组的总有效率为37.5％，其差异具有统计学意义(P＜0.05)。治疗组的真菌清除率达到59.09％，对照组的为50％，差异无统计学意义(P＞0.05)。治疗组的炎性因子中的IL-6在治疗后显著下降，治疗前后的差异显著(P＜0.05)，变化程度与对照组类似(P＞0.05)。CPR和IL-8在治疗前后差异不具有统计学意义(P＞0.05)。治疗组的各项免疫指标在治疗后有改善，但治疗前后的差异均没有统计学意义(P＞0.05)。治疗组三种不同证候的临床效果有区别，痰浊阻肺中医临床症状疗效总有效率和真菌清除率分别为100％和100％，痰热蕴肺分别为71.42％和28.57％，肺气阴两虚分别为87.50％和50％，不管是真菌清除效果还是中医临床症状疗效，痰浊阻肺与其他证候相比差别显著(P＜0.05)；痰热蕴肺和肺气阴两虚证，其真菌清除效果和中医临床症状疗效相互之间差异无统计学意义(P＞0.05)。
结论：老年继发性呼吸道深部真菌感染患者年高体弱，免疫功能低下，往往还患有各种基础病，长期、大剂量的使用广谱抗生素、免疫抑制剂等药物，正气进一步损伤，常因正虚感邪而致病，因此本虚标实，正虚痰阻，是其病机关键。故扶正祛邪、标本同治是治疗本病的重要法则。大蒜素在改善老年继发性呼吸道深部真菌感染患者中医临床症状、清除真菌等诸方面疗效确切，并且以痰浊阻肺型患者疗效最为突出。大蒜素治疗本病的疗效机理，可能是通过降低IL-6的水平来阻止中性粒细胞(PMN)的特异趋化吸引力，阻止炎症细胞的趋化聚集，减少PMN在呼吸道深部的毛细血管的扣留时间，降低PMN对呼吸道深部的毛细血管内皮细胞的损伤，从而提高机体的免疫防御能力，达到扶正祛邪、标本兼治的治疗作用。因此，大蒜素雾化治疗安全可靠，无毒副作用，可用于老年继发性呼吸道深部真菌感染患者的治疗。
Taken the Chinese medicine theory as the instruction and based on the preliminaryexperimental study and former clinical practice, the thesis conducts the clinicalresearch on pulverization inhalation therapy of garlic allicin injection for the secondaryepiphyte infection affection of agedness' deep respiratory tract and the influence ondifferent syndrome in a traditional herbalist doctor view, scientifically discusses theeffective curative for the secondary epiphyte infection affection of agedness' deeprespiratory tract so as to enhance the treatment function.
Aim: to observe the clinical curative effect of pulverization inhalation therapy of garlicallicin for the secondary epiphyte infection affection of agedness' deep respiratory tract,to conduct index statistics analysis of epiphyte elimination effect, the clinical curativeeffect, inflammation factor and body fluid immunity, and to provide the scientific basisfor opening the out the function mechanism of pulverization inhalation therapy ofgarlic allicin;
Method: According to the research, the selected and effective patients are 38 persons.They are divided into two groups stochastically by random numeric table, 16 examplesfor comparison group (western medicine comparison group) and 22 examples fortreatment group (pulverization inhalation therapy of garlic allicin injection group).Each patient of comparison group takes 50mg Fluconazole twice a day, and eachpatient of treatment group inbreathe 7.5mg pulverization of garlic allicin injection plus20ml physiological brine twice a day. Seven days form a treatment period and the totalis two periods.
Security index observation: A check-up record will be taken before and after takingdrugs respectively concerning body temperature, the breath, the pulse, the bloodpressure, general blood items, the urine, the bowel movement items, the liver, thekidney function as well as the electrocardiogram (ECG).
Curative effect index observation: phlegm epiphyte cultivation (three times phlegmepiphyte cultivation both before and after taking drugs and observation); Inflammationfactor (C-Reactive Protein, CRP, Human Interleukin-6(IL-6), Human Interleukin-8(IL-8)); body fluid immunity index (IgA, IgG, IgM, C3, Ca); integral of clinicsyndrome in Chinese medicine view (integral register of main symptom and minorsymptom);
Traditional Chinese medical appearance observation: to record all the syndrome ofpatients and classify the type;
Result: Total effective rate of pulverization inhalation therapy of garlic allicininjection for the secondary epiphyte infection affection of agedness' deep respiratorytract is 86.36%, while the total effective rate of comparison group is 37.5%. Thedifferences have statistical significance (P〈0.05). The epiphyte elimination effect isobvious and the rate of elimination achieves 59.09%. The differences with comparisongroup have no statistical significance (P〉0.05). The differences of inflammation factorCPR and IL-8 have no statistical significance before and after treatment (P〉0.05), butIL-6 decreases greatly after treatment and the differences before and after treatment areobvious (P〈0.05) with similar change degree of comparison group (P〉0.05). Thedifferences of treatment group's immunity index have no statistical significance (P〉0.05). The clinic effects on three different syndrome of treatment group aredifferent. The total effective rate and the epiphyte elimination rate are 100% and 100%respectively for syndrome of turbid phlegm obstructing lung. The total effective rateand the epiphyte elimination rate are 71.42% and 28.57% respectively for syndrome ofphlegm-heat obstructing lung. The total effective rate and the epiphyte elimination rateare 87.50% and 50% respectively for syndrome of deficiency of both qi and yin oflung. In spite of epiphyte elimination effect of clinic symptom curative effect, there arestatistical significance for the differences between syndrome of turbid phlegmobstructing lung and other syndromes (P〈0.05). While the difference between othertwo syndromes, syndrome of phlegm-heat obstructing lung and syndrome ofdeficiency of both qi and yin of lung, have no statistical significance ( P〉0.05 ).
Conclusion: The patients of secondary epiphyte infection affection of agedness' deeprespiratory tract are aged and weak. Their immunity function level is low. Sometimes because of long-term and big dosage use of broad-spectrum antibiotics andimmunosuppressant drug after suffering from basic illness, they have root deficiencybut excess manifestation, deficincy combined with excess, or syndrome of phlegm dueto deficient vital qi, this is the key factor of illness. Therefore, strengthening andconsolidating body resistance and benefiting qi for activating blood circulation so as toenhance immunity function is the important principle for treatment. Garlic allicin hassolid curative effect on improving the clinic symptom and epiphyte elimination ofsecondary epiphyte infection affection of agedness' deep respiratory tract sufferers,especially to the patients of syndrome of turbid phlegm obstructing lung. The curativemechanism of garlic allicin may be by reducing the level of IL-6 to prevent the specialtendency attraction of PMN, to hold back the assembly tendency of inflammationfactor, to decrease the detention time of PMN in capillary vessel of deep respiratorytract, and to reduce the damage to endothelial cell of capillary vessel of deeprespiratory tract, so as to enhance the immunity recovery ability of the body, strengthenvital qi to eliminate pathogenic factor and treat both manifestation and root cause ofdisease. So pulverization inhalation therapy of garlic allicin injection is safe, reliableand has no toxic or side effect and can be used for treatment of for the secondaryepiphyte infection affection of agedness' deep respiratory tract.
引文
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