脐灸治疗肺脾气虚型特发性肺间质纤维化合并胃食管反流疗效观察
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摘要
目的:评价脐灸治疗肺脾气虚型特发性肺间质纤维化合并胃食管反流患者的临床疗效。方法:将116例肺脾气虚型特发性肺间质纤维化合并胃食管反流的患者随机分为对照组和观察组,每组58例。对照组采用常规治疗,观察组在对照组常规治疗基础上给予脐灸治疗,每周2次,每次2 h,治疗12周,治疗后随访12周。比较治疗前后两组复合生理指标(CPI)、中医证候评分、圣乔治呼吸问卷(SGRQ)评分及6分钟步行试验(6MWT)。结果:在中医证候评分(咳嗽、活动后气促、倦怠乏力、烧心、反酸)、CPI评分、6MWT方面,观察组改善情况优于对照组(均P<0.05),两组治疗后SGRQ评分比较差异无统计学意义(P>0.05);治疗结束后12周随访时两组CPI评分及中医证候(咳嗽、倦怠乏力)评分比较差异无统计学意义(均P>0.05),6MWT、SGRQ情况及中医证候(活动后气促、反酸、烧心)评分观察组优于对照组(均P<0.05)。结论:脐灸治疗可以改善肺脾气虚型特发性肺间质纤维化合并胃食管反流患者肺的通气及弥散功能,减轻临床症状,提高患者的生活质量及活动耐力,具有一定的长期疗效。
Objective To evaluate the clinical efficacy of umbilical moxibustion in the treatment of patients with idiopathic pulmonary interstitial fibrosis complicated with gastroesophageal reflux of lung-spleen qi deficiency. Methods A total of 116 patients with idiopathic pulmonary fibrosis complicated with gastroesophageal reflux of lung spleen-deficiency were randomized into an observation group(58 cases) and a control group(58 cases). In the control group, the routine treatment was applied; in the observation group, on the base of the treatment as the control group, the umbilical moxibustion was used. The treatment was given 2 times a week, 2 h each time for 12 weeks, and followed up for 12 weeks after treatment. The composite physiological indicators(CPI), TCM syndrome scores, the St. George respiratory questionnaire score(SGRQ) and 6-minute walk test(6 MWT) were compared before and after treatment in the two groups.Results The improvement of the TCM syndrome scores(cough, post-activity shortness of breath, fatigue, heartburn, acid reflux), CPI score and 6 MWT in the observation group was better than those in the control group(all P<0.05). There was no significant difference in the scores of SGRQ scale between the two groups after treatment(P>0.05). There was no significant difference in the scores of CPI scores and syndromes(cough and fatigue) between the two groups at 12 weeks after treatment(all P>0.05). The 6 MWT, SGRQ scale scores and syndrome scores(post-activity shortness of breath,acid reflux, heartburn) were better than those in the control group in the follow up(all P<0.05). Conclusion Umbilical moxibustion can improve the ventilation and diffusion function of lung in patients with idiopathic pulmonary fibrosis and gastroesophageal reflux of lung-spleen qi deficiency, reduce clinical symptoms and improve patients' quality of life and activity endurance. And it has long-term effect.
Objective To evaluate the clinical efficacy of umbilical moxibustion in the treatment of patients with idiopathic pulmonary interstitial fibrosis complicated with gastroesophageal reflux of lung-spleen qi deficiency. Methods A total of 116 patients with idiopathic pulmonary fibrosis complicated with gastroesophageal reflux of lung spleen-deficiency were randomized into an observation group(58 cases) and a control group(58 cases). In the control group, the routine treatment was applied; in the observation group, on the base of the treatment as the control group, the umbilical moxibustion was used. The treatment was given 2 times a week, 2 h each time for 12 weeks, and followed up for 12 weeks after treatment. The composite physiological indicators(CPI), TCM syndrome scores, the St. George respiratory questionnaire score(SGRQ) and 6-minute walk test(6 MWT) were compared before and after treatment in the two groups.Results The improvement of the TCM syndrome scores(cough, post-activity shortness of breath, fatigue, heartburn, acid reflux), CPI score and 6 MWT in the observation group was better than those in the control group(all P<0.05). There was no significant difference in the scores of SGRQ scale between the two groups after treatment(P>0.05). There was no significant difference in the scores of CPI scores and syndromes(cough and fatigue) between the two groups at 12 weeks after treatment(all P>0.05). The 6 MWT, SGRQ scale scores and syndrome scores(post-activity shortness of breath,acid reflux, heartburn) were better than those in the control group in the follow up(all P<0.05). Conclusion Umbilical moxibustion can improve the ventilation and diffusion function of lung in patients with idiopathic pulmonary fibrosis and gastroesophageal reflux of lung-spleen qi deficiency, reduce clinical symptoms and improve patients' quality of life and activity endurance. And it has long-term effect.
引文
[1]Raghu G,Rochwerg B,Zhang Y,et al.An official ATS/ERS/JRS/ALAT clinical practice guideline:treatment of idiopathic pulmonary fibrosis.An update of the 2011 clinical practice guideline[J].Am J Respir Crit Care Med,2015,192(2):e3-e19.
[2]王辉,陈雪芬,魏路清.肺纤维化发病机制新进展[J].武警后勤学院学报(医学版),2013,22(1):69-73.
[3]Raghu G,Collard HR,Egan JJ,et al.An Official ATS/ERS/JRS/ALAT Statement:idiopathic pulmonary fibrosis:evidence-based guidelines for diagnosis and management[J].Am J Respir Crit Care Med,2011,183(6):788-824.
[4]林三仁,许国铭,胡品津,等.中国胃食管反流病共识意见[J].胃肠病学,2007,12(4):233-239.
[5]张伯臾,董建华,周仲瑛.中医内科学[M].上海:上海科学技术出版社,1985:49.
[6]Wells A,Desai SM,Goh N,et al.Idiopathic pulmonary fibrosis:a composite physiologic index derived from disease extent observed by computed tomography.[J].Am J Respir Crit Care Med,2003,167(7):962-969.
[7]Best AC,Meng J,Lynch AM,et al.Idiopathic pulmonary fibrosis:physiologic tests,quantitative CT indexes,and CTvisual scores as predictors of mortality[J].Radiology,2008,246(3):935-940.
[8]Jones PW,Quirk FH,Baveystock CM.The St George's Respiratory Questionnaire[J].Respir Med,1991,85 Suppl B(Suppl 2):25.
[9]王阶,熊兴江,张兰凤.病证结合模式及临床运用探索[J].中国中西医结合杂志,2012,32(3):297-299.
[10]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002.
[11]臧凝子,庞立健,刘创,等.特发性肺纤维化在病证结合模式指导下的疗效评价体系框架[J].世界科学技术-中医药现代化,2014(10):2118-2123.
[12]Wells A,Behr J,Stansen W,et al.Effect of nintedanib on composite physiologic index(CPI)in idiopathic pulmonary fibrosis(IPF)[C]//Ers International Congress,2017:OA3403.
[13]Behr J,Demedts M,Buhl R,et al.Lung function in idiopathic pulmonary fibrosis-extended analyses of the IFIGENIA trial[J].Respir Res,2009,10(1):1-9.
[14]张纾难,疏欣杨,韩春生,等.131例特发性肺纤维化患者中医证候聚类分析[J].环球中医药,2011,4(1):20-22.
[15]王英,张伟.从“聚于胃,关于肺”论治特发性肺间质纤维化合并胃食管反流病[J].长春中医药大学学报,2016,32(4):736-738.
[16]郑建,朱雪,王丽芹,等.从“治痿独取阳明”论治肺纤维化[J].新中医,2014(1):9-10.
[17]王英,孙宇鹏,张伟.从“治痿独取阳明”谈“培土生金法”在弥漫性肺间质疾病中应用[J].辽宁中医药大学学报,2016(10):113-115.
[18]冯尔和.西药脐疗法治小儿支气管炎疗效观察[J].中华中医药杂志,2008,23(8):746-747.
[2]王辉,陈雪芬,魏路清.肺纤维化发病机制新进展[J].武警后勤学院学报(医学版),2013,22(1):69-73.
[3]Raghu G,Collard HR,Egan JJ,et al.An Official ATS/ERS/JRS/ALAT Statement:idiopathic pulmonary fibrosis:evidence-based guidelines for diagnosis and management[J].Am J Respir Crit Care Med,2011,183(6):788-824.
[4]林三仁,许国铭,胡品津,等.中国胃食管反流病共识意见[J].胃肠病学,2007,12(4):233-239.
[5]张伯臾,董建华,周仲瑛.中医内科学[M].上海:上海科学技术出版社,1985:49.
[6]Wells A,Desai SM,Goh N,et al.Idiopathic pulmonary fibrosis:a composite physiologic index derived from disease extent observed by computed tomography.[J].Am J Respir Crit Care Med,2003,167(7):962-969.
[7]Best AC,Meng J,Lynch AM,et al.Idiopathic pulmonary fibrosis:physiologic tests,quantitative CT indexes,and CTvisual scores as predictors of mortality[J].Radiology,2008,246(3):935-940.
[8]Jones PW,Quirk FH,Baveystock CM.The St George's Respiratory Questionnaire[J].Respir Med,1991,85 Suppl B(Suppl 2):25.
[9]王阶,熊兴江,张兰凤.病证结合模式及临床运用探索[J].中国中西医结合杂志,2012,32(3):297-299.
[10]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002.
[11]臧凝子,庞立健,刘创,等.特发性肺纤维化在病证结合模式指导下的疗效评价体系框架[J].世界科学技术-中医药现代化,2014(10):2118-2123.
[12]Wells A,Behr J,Stansen W,et al.Effect of nintedanib on composite physiologic index(CPI)in idiopathic pulmonary fibrosis(IPF)[C]//Ers International Congress,2017:OA3403.
[13]Behr J,Demedts M,Buhl R,et al.Lung function in idiopathic pulmonary fibrosis-extended analyses of the IFIGENIA trial[J].Respir Res,2009,10(1):1-9.
[14]张纾难,疏欣杨,韩春生,等.131例特发性肺纤维化患者中医证候聚类分析[J].环球中医药,2011,4(1):20-22.
[15]王英,张伟.从“聚于胃,关于肺”论治特发性肺间质纤维化合并胃食管反流病[J].长春中医药大学学报,2016,32(4):736-738.
[16]郑建,朱雪,王丽芹,等.从“治痿独取阳明”论治肺纤维化[J].新中医,2014(1):9-10.
[17]王英,孙宇鹏,张伟.从“治痿独取阳明”谈“培土生金法”在弥漫性肺间质疾病中应用[J].辽宁中医药大学学报,2016(10):113-115.
[18]冯尔和.西药脐疗法治小儿支气管炎疗效观察[J].中华中医药杂志,2008,23(8):746-747.