摘要
[目的]观察病位病性辨证结合三伏灸贴治疗支气管哮喘的临床疗效。[方法]将180例患者随机分治疗组和对照组,各90例,研究中因病情恶化脱落9例,脱落率为5.0%,最终完成171例,治疗组87例,对照组84例。两组均予常规治疗。对照组给予沙美特罗替卡松粉吸入,每次1吸,每日2次;治疗组给予病位病性辨证+三伏灸贴治疗,两组均治疗1个三伏周期。比较两组治疗前后中医症状评分、生存质量评分、肺功能评分、炎性指标及治疗后有效率。[结果]与本组治疗前比较,两组患者治疗后在中医症状评分、生存质量评分均降低(P<0.05);治疗后治疗组在喘息、咳嗽、哮鸣音、胸膈满闷、活动受限、哮喘症状及对自我健康的关心方面均低于对照组(P<0.05),在心理功能状况、对刺激原的反应方面两组比较无统计学差异(P>0.05);治疗后治疗组在第1秒用力呼吸容积(FEV1)、FEV1/用力肺活量(FVC)、最大呼气流量(PEF)均高于对照组(P<0.05);在白介素-4(IL-4)、肿瘤坏死因子-α(TNF-α)、血清免疫球蛋白E(IgE)低于对照组(P<0.05),在干扰素-γ(INF-γ)表达方面比较无统计学意义(P>0.05);两组临床疗效比较差异有统计学意义(P<0.05)。[结论]在常规治疗基础上,病位病性辨证结合三伏灸贴能够有效缓解支气管哮喘患者的临床症状,改善呼吸功能,提高生存质量,其机制可能与降低血清IL-4、TNF-α、IgE表达水平相关。
[Objective] In order to observe the clinical curative effect by the method of syndrome differentiation according to the location and the nature combined with Sanfu Plaster to treat bronchial asthma. [Methods] Select 180 cases patients of bronchial asthma were randomly divided into the treatment group and control group, each group had 90 patients. Nine cases were lost because it get worse in the study, and the lost rate was 5.0%. A total of 171 patients were completed, including 87 in the treatment group and 84 in the control group.Both groups were treated with conventional therapy. The control group was given salmeterol fluticasone propionate powder inhalation,1 suction/times, 2 times/d; the treatment group was given syndrome differentiation according to the location and the nature combined with Sanfu Plaster treated, and both groups were treated with a tricycle. Two groups of traditional Chinese medicine(TCM)symptom scores,quality of life score, lung function score, the inflammatory index and the efficiency after treatment were compared of before and after treatment. [Results] Compared with this group before treatment that two groups of TCM symptom and quality of life scores were lower than before treatment(P<0.05); the treatment group was lower than the control group in wheezing rale, coughing, wheezing, chest tightness,activity limitation, asthma symptoms and self-health after treatment(P<0.05); there was no statistically significant difference between the two groups in the psychological function and the response to the stimulus(P>0.05); the treatment group was higher than the control group in FEV1, FEV1/FVC and PEF after treatment(P<0.05); in IL-4, TNF-α and IgE were lower than the control group(P<0.05); there was no statistical significance in the expression of INF-γ(P>0.05); the difference between the two groups was statistically significant that clinical efficacy were compared(P<0.05). [Conclusion] Syndrome differentiation according to the location and the nature combined with Sanfu Plaster on the basis of conventional therapy can effectively relieve the clinical symptoms of patients with bronchial asthma, improve respiratory function and improve the quality of life, the mechanism may be associated with decreased serum IL-4, TNF-α and IgE expression levels.
引文
[1]Suzuki SC,Ogawa M,Ohta S,et al.Induction of airway allergic inflammation by hypothiocyanite via epithelial cells[J].The Journal of biological chemistry,2016,291(53):27219-27227.
[2]陈丽燕,唐颖,张俐,等.支气管哮喘患者外周血中白细胞介素22水平的检测及其临床意义[J].吉林大学学报(医学版),2017,43(2):349-352.
[3]Alqahtani JM,Asaad AM,Awadalla Nabil J,et al.Environmental determinants of bronchial asthma among saudi school children in southwestern saudi arabia[J].International journal of environmental research and public health,2016,14(1):1-10.
[4]姚亮,汤杰,李海燕,等.穴位敷贴防治支气管哮喘的研究进展[J].中华中医药学刊,2015,33(10):2436-2439.
[5]刘玉华.冬病夏治穴位贴敷防治支气管哮喘作用机制研究概况[J].中医杂志,2015,56(21):1884-1886.
[6]刘宝厚.病位病性辨证法的创立及其实用价值[J].西部中医药,2015,28(10):62-64.
[7]中华医学会呼吸病学分会哮喘学组.支气管哮喘防治指南[J].中华结核和呼吸杂志,2013,33(8):615-616.
[8]郑筱萸.中药新药临床研究指导原则[S].北京:中国医药科技出版社,2002:61-66.
[9]李凡,蔡映云.支气管哮喘生存质量评估表的制定、评估和临床应用[J].现代健康,2001,5(2):18-20.
[10]Gomez JL,Crisafi GM,Holm CT,et al.Genetic variation in chitinase3-like 1(CHI3L1)contributes to asthma severity and airway expression of YKL-40[J].The Journal of Allergy and Clinical Immunology,2015,136(1):51-58.
[11]Jiang HH,Xie Y,Abel PW,et al.Regulator of G-protein signaling 2repression exacerbates airway hyper-responsiveness and remodeling in asthma[J].American journal of respiratory cell and molecular biology,2015,53(1):42-49.
[12]王庆军,王燕.金水宝胶囊联合沙美特罗替卡松粉吸入剂对支气管哮喘患者临床疗效、肺功能及细胞免疫因子的影响[J].中国现代医学杂志,2017,27(7):117-120.
[13]王洪源,钱俊峰.老年支气管哮喘患者免疫功能、炎症因子和25-羟维生素D3的水平[J].中国老年学杂志,2018,38(2):367-369.
[14]Sharma S,Kho AT,Chhabra D,et al.Glucocorticoid genes and the developmental origins of asthma susceptibility and treatment response[J].American journal of respiratory cell and molecular biology,2015,52(5):543-553.
[15]Stephenson ST,Brown LAS,Helms MN,et al.Cysteine oxidation impairs systemic glucocorticoid responsiveness in children with difficult-to-treat asthma[J].The Journal of allergy and clinical immunology,2015,136(2):454-461.
[16]王洋,张罗丹,尚芳,等.冬病夏治三伏贴治疗支气管哮喘缓解期肺肾两虚证临床观察[J].中国实验方剂学杂志,2017,23(20):185-189.
[17]刘玉华.冬病夏治穴位贴敷防治支气管哮喘作用机制研究概况[J].中医杂志,2015,56(21):1884-1886.
[18]王朝辉,韩东岳,郄丽丽,等.基于数据挖掘分析穴位贴敷治疗支气管哮喘的选穴与用药规律[J].中国针灸,2015,35(6):591-593.
[19]李博林,王亚利,杨倩,等.冬病夏治穴位贴敷疗法对非急性发作期支气管哮喘患者神经-内分泌-免疫网络系统的影响[J].中国中西医结合杂志,2017,37(1):68-71.
[20]付雪,戴恩来.刘宝厚教授“病位病性辨证”理论初探[J].甘肃中医药大学学报,2016,33(1):20-22.
[21]郭洁,武蕾,梁亚飞,等.小青龙汤加味联合信必可都保治疗对支气管哮喘患者炎症因子变化影响分析[J].中华中医药学刊,2018,36(1):207-210.
