中医内外合治社区获得性肺炎(痰热证)的临床研究
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摘要
目的观察咳喘2方直流电离子导入联合宣肺化痰方煎服治疗社区获得性肺炎(痰热证)的疗效并探讨其作用机制。方法患者180例随机分为对照组、A组、B组、C组4组。对照组采用西医常规治疗,A组为西医常规联合咳喘2方直流电离子导入治疗,B组为西医常规治疗联合宣肺化痰方煎服,C组为西医常规治疗联合咳喘2方直流电离子导入及宣肺化痰方煎服治疗。疗程均为1周。比较4组临床症状(咳嗽、咯痰、发热)改善情况、治疗前后T淋巴细胞亚群(CD4+、CD8+、CD4+/CD8+)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平。结果各组在治疗前后症状评分与治疗前比较,均改善(均P <0.01)。C组治疗后咳嗽、咯痰症状积分均显著低于A、B组及对照组(均P <0.01);在发热方面,3组治疗后均无发热症状。各组在治疗后TNF-α、IL-6炎症因子水平与治疗前比较,均改善(均P <0.01)。TNF-α、IL-6方面,治疗后C组下降均优于A组、B组及对照组(均P <0.01)。A组、B组各炎症因子治疗后水平均低于对照组,但差别不大(P> 0.05)。各组在治疗后CD4+、CD8+、CD4+/CD8+免疫因子水平与治疗前比较,均改善(均P <0.01)。治疗后C组CD4+、CD8+水平上升水平均优于A组、B组及对照组(均P <0.01)。治疗后A组、B组各炎症因子水平与对照组比较,差别均不大(均P> 0.05)。治疗后C组CD4+/CD8+水平上升与对照组差别不大(P> 0.05)。结论中药直流电离子导入及宣肺化痰方煎服联合西医常规治疗社区获得性肺炎(痰热型)疗效更好。
Objective: To observe the curative effect and the mechanism of the Second Kechuan Decoction DC iontophoresis combined with Xuanfei Huatan Decoction on phlegm-heat type community acquired pneumonia.Methods: 180 patients were randomly divided into group A,group B,group C and the control group. The control group was treated with conventional Western medicine. Group A was added with DC iontophoresis of the Second Kechuan Decoction,group B Xuanfei Huatan Decoction. Group C was treated with all above. The treatment lasted for 1 week. The following data was compared among 4 groups: improvement of clinical symptoms(cough,phlegm,fever),T lymphocyte subsets(CD4+、CD8+、CD4+/CD8+) before and after treatment,and the levels of TNF-α and IL-6. Results: There was no significant difference in each group before treatment(all P > 0.05). The scores of symptoms in each group after treatment were improved(all P < 0.01). The scores of cough and expectoration symptoms in group C after treatment were significantly lower than those in group A,B and the control groups(all P< 0.01). No fever symptoms were found in the three groups after treatment. The levels of TNF-α and IL-6 in each group were improved after treatment(all P < 0.01),and group C was better than the other three(all P < 0.01);those in group A and B were lower than those of the control group with little difference(P > 0.05). The levels of CD4+,CD8+ and CD4+/CD8+ were improved after treatment(all P < 0.01);the improvement of CD4+ and CD8+ in group C was superior to that in group A,B and the control group(all P < 0.01). After treatment,the levels of inflammatory factors in group A and group B were not significantly different from those in the control group(all P > 0.05).There was no significant difference in CD4+/CD8+ level between group C and the control group(P > 0.05). Conclusion: DC ionization of traditional Chinese medicine and Xuanfei Huatan Decoction combined with conventional Western medicine treatment on community-acquired pneumonia(phlegm-heat type) are more effective.
Objective: To observe the curative effect and the mechanism of the Second Kechuan Decoction DC iontophoresis combined with Xuanfei Huatan Decoction on phlegm-heat type community acquired pneumonia.Methods: 180 patients were randomly divided into group A,group B,group C and the control group. The control group was treated with conventional Western medicine. Group A was added with DC iontophoresis of the Second Kechuan Decoction,group B Xuanfei Huatan Decoction. Group C was treated with all above. The treatment lasted for 1 week. The following data was compared among 4 groups: improvement of clinical symptoms(cough,phlegm,fever),T lymphocyte subsets(CD4+、CD8+、CD4+/CD8+) before and after treatment,and the levels of TNF-α and IL-6. Results: There was no significant difference in each group before treatment(all P > 0.05). The scores of symptoms in each group after treatment were improved(all P < 0.01). The scores of cough and expectoration symptoms in group C after treatment were significantly lower than those in group A,B and the control groups(all P< 0.01). No fever symptoms were found in the three groups after treatment. The levels of TNF-α and IL-6 in each group were improved after treatment(all P < 0.01),and group C was better than the other three(all P < 0.01);those in group A and B were lower than those of the control group with little difference(P > 0.05). The levels of CD4+,CD8+ and CD4+/CD8+ were improved after treatment(all P < 0.01);the improvement of CD4+ and CD8+ in group C was superior to that in group A,B and the control group(all P < 0.01). After treatment,the levels of inflammatory factors in group A and group B were not significantly different from those in the control group(all P > 0.05).There was no significant difference in CD4+/CD8+ level between group C and the control group(P > 0.05). Conclusion: DC ionization of traditional Chinese medicine and Xuanfei Huatan Decoction combined with conventional Western medicine treatment on community-acquired pneumonia(phlegm-heat type) are more effective.
引文
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[4] Pérez-Deago B,Alonso-Porcel C,Elvira-Menendez C,et al.Epidemiology and management of community acquired pneumonia:more than 10 years experience[J]. Semergen,2018,44(6):389-394.
[5]肖斌,贺作玉.莫西沙星注射液联合喜炎平注射液治疗社区获得性肺炎的临床疗效观察[J].药学研究,2015,34(7):422-424.
[6]杨维建.美洛西林钠舒巴坦钠联合喜炎平治疗中老年社区获得性肺炎的疗效观察[J].中国民康医学,2013,25(2):10,63.
[7]刘向欣,尹素凤,刘运秋.医院与社区获得性肺炎患者病原菌分布及耐药性分析[J].现代预防医学,2013,40(23):4469-4471,4474.
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[9]徐向东,姚卫海,曹迎.社区获得性肺炎—中医证型相关分析[J].江西中医药,2012,43(353):17-19.
[10]戴勇,老昌辉,魏成功,等.宣肺化痰方标准煎剂与煮散剂药理作用对比[J].中国实验方剂学杂志,2013,9(13):286-290.
[11]梁可云,段晨霞,戴勇,等.宣肺化痰方煮散剂与饮片汤剂治疗痰热蕴肺型急性支气管炎临床效价对比研究[J].江西中医药,2014,3(45):28-31.
[12]冯冰虹,赵宇红,黄建华.桑白皮的有效成分筛选及其药理学研究[J].中药材,2004,27(3):204-205.
[13]曾颂,李书渊,吴志坚,等.半夏镇咳祛痰的成分—效应关系研究[J].中国现代中药,2013,15(6):452-455.
[14]魏新玲.直流电药物离子导入疗法发展概述[J].西南国防医药,2004,14(5):571-572.
[15]樊万虎,张成文.肿瘤坏死因子与病毒性疾病[J].中国实验临床免疫学杂志,1993,5(3):3-4.
[16]程龙,李建生,马利军,等.老年细菌性肺炎患者免疫功能的变化[J].中华老年医学杂志,2001,20(6):433-436.
[2] Smith pR. What diagnostic tests are needed for communityacquired pneumonia[J]. Med Clin North Am,2001(85):1381-1396.
[3] Varghese E,Khar RK. Enhanced skin permeation of diclofenac by iontophoresis:In vitro and in vivo stud ies[J].Controlled Release,1996,38(1):21-25.
[4] Pérez-Deago B,Alonso-Porcel C,Elvira-Menendez C,et al.Epidemiology and management of community acquired pneumonia:more than 10 years experience[J]. Semergen,2018,44(6):389-394.
[5]肖斌,贺作玉.莫西沙星注射液联合喜炎平注射液治疗社区获得性肺炎的临床疗效观察[J].药学研究,2015,34(7):422-424.
[6]杨维建.美洛西林钠舒巴坦钠联合喜炎平治疗中老年社区获得性肺炎的疗效观察[J].中国民康医学,2013,25(2):10,63.
[7]刘向欣,尹素凤,刘运秋.医院与社区获得性肺炎患者病原菌分布及耐药性分析[J].现代预防医学,2013,40(23):4469-4471,4474.
[8] Varghese E,Khar RK. Enhanced skin permeation of diclofenac by iontophoresis:In vitro and in vivo studies[J].Controlled Release,1996,38(1):21-25.
[9]徐向东,姚卫海,曹迎.社区获得性肺炎—中医证型相关分析[J].江西中医药,2012,43(353):17-19.
[10]戴勇,老昌辉,魏成功,等.宣肺化痰方标准煎剂与煮散剂药理作用对比[J].中国实验方剂学杂志,2013,9(13):286-290.
[11]梁可云,段晨霞,戴勇,等.宣肺化痰方煮散剂与饮片汤剂治疗痰热蕴肺型急性支气管炎临床效价对比研究[J].江西中医药,2014,3(45):28-31.
[12]冯冰虹,赵宇红,黄建华.桑白皮的有效成分筛选及其药理学研究[J].中药材,2004,27(3):204-205.
[13]曾颂,李书渊,吴志坚,等.半夏镇咳祛痰的成分—效应关系研究[J].中国现代中药,2013,15(6):452-455.
[14]魏新玲.直流电药物离子导入疗法发展概述[J].西南国防医药,2004,14(5):571-572.
[15]樊万虎,张成文.肿瘤坏死因子与病毒性疾病[J].中国实验临床免疫学杂志,1993,5(3):3-4.
[16]程龙,李建生,马利军,等.老年细菌性肺炎患者免疫功能的变化[J].中华老年医学杂志,2001,20(6):433-436.