益气化瘀通络方对特发性肺纤维化临床疗效及外周血T淋巴细胞亚群的影响
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摘要
目的:观察中药益气化瘀通络方对特发性肺纤维化患者T淋巴细胞亚群CD4~+、CD8~+水平的影响。方法:将符合纳入标准的患者按照随机数字表法分为对照组(40例)和治疗组(40例),对照组给予口服泼尼松治疗,治疗组在对照组的基础上给予中药益气化瘀通络方,疗程12周后评价两组疗效,测评治疗前后SGRQ呼吸症状积分,检测治疗前后及随访肺功能及血气分析指标,检测两组患者外周血治疗前后T淋巴细胞亚群(CD4~+、CD8~+)水平。结果:治疗组总有效率为82.05%,优于对照组总有效率63.16%。两组治疗后呼吸症状评分、活动受限、疾病影响及总体积分均下降,且治疗组下降更为明显。治疗组治疗后及随访DLCO、PaO_2均明显升高(P<0.01),组间比较差异具有明显统计学意义(P<0.05,P<0.01)。治疗组治疗后CD4~+、CD8~+、CD4~+/CD8~+较治疗前升高,对照组治疗后无明显变化,组间差异具有统计学意义(P<0.05)。结论:益气健化瘀通络方联合泼尼松疗效明显优于单用泼尼松组,不仅能降低患者呼吸症状评分,提升PaO_2水平,防止二氧化碳潴留,促进肺脏通气功能恢复,还能改善免疫功能,纠正CD4~+/CD8~+失衡,从而提高IPF患者的近期及远期疗效。
Objective: To observe the effect of supplementing Qi and removing blood stasis and dredging collateral decoction on T lymphocyte subsets CD4~+,CD8~+levels in patients with idiopathic pulmonary fibrosis. Methods: According to the random number table method,patients who met the diagnostic criteria and inclusion criteria were divided into a control group( 40 cases) and a treatment group( 40 cases). The control group was given oral Prednisone,and the treatment group was given supplementing Qi and removing blood and dredging collateral decoction on the basis of the therapy in the control group. The course of treatment was for 12 weeks in two groups,and the patients were followed up for 12 weeks. Evaluate the clinical effect and SGRQ scores and measure lung function and blood gas analysis index,peripheral blood T lymphocyte subsets( CD4~+,CD8~+) levels. Results: The total effective rate in the treatment group was 82. 05%,which was superior to that in the control group with the total effective rate of 63. 16%. Respiratory symptom scores,activity limitation,disease influence and the total scores were decreased in both groups,and those in the treatment group were de-creased more significantly. DLCO and PaO_2 were significantly increased after treatment and follow-up( P <0. 01),and the difference between two groups was statistically significant( P < 0. 05,P < 0. 01). CD4~+,CD8~+,CD4~+/ CD8~+were increased after treatment and follow-up in the treatment group,but in the control group they had no significant change,and the difference between two groups was statistically significant( P <0. 05). Conclusion: The effect of supplementing Qi and removing blood stasis and dredging collateral decoction combined with Prednisone is obviously superior to the effect of Prednisone alone. The therapy can not only reduce the respiratory symptom score,enhance the level of PaO_2 and prevent carbon dioxide retention,promote the recovery of lung ventilation function, but can also improve the immune function, correct CD4~+/ CD8~+imbalance,so as to improve the short-term and long-term effects on patients with IPF.
Objective: To observe the effect of supplementing Qi and removing blood stasis and dredging collateral decoction on T lymphocyte subsets CD4~+,CD8~+levels in patients with idiopathic pulmonary fibrosis. Methods: According to the random number table method,patients who met the diagnostic criteria and inclusion criteria were divided into a control group( 40 cases) and a treatment group( 40 cases). The control group was given oral Prednisone,and the treatment group was given supplementing Qi and removing blood and dredging collateral decoction on the basis of the therapy in the control group. The course of treatment was for 12 weeks in two groups,and the patients were followed up for 12 weeks. Evaluate the clinical effect and SGRQ scores and measure lung function and blood gas analysis index,peripheral blood T lymphocyte subsets( CD4~+,CD8~+) levels. Results: The total effective rate in the treatment group was 82. 05%,which was superior to that in the control group with the total effective rate of 63. 16%. Respiratory symptom scores,activity limitation,disease influence and the total scores were decreased in both groups,and those in the treatment group were de-creased more significantly. DLCO and PaO_2 were significantly increased after treatment and follow-up( P <0. 01),and the difference between two groups was statistically significant( P < 0. 05,P < 0. 01). CD4~+,CD8~+,CD4~+/ CD8~+were increased after treatment and follow-up in the treatment group,but in the control group they had no significant change,and the difference between two groups was statistically significant( P <0. 05). Conclusion: The effect of supplementing Qi and removing blood stasis and dredging collateral decoction combined with Prednisone is obviously superior to the effect of Prednisone alone. The therapy can not only reduce the respiratory symptom score,enhance the level of PaO_2 and prevent carbon dioxide retention,promote the recovery of lung ventilation function, but can also improve the immune function, correct CD4~+/ CD8~+imbalance,so as to improve the short-term and long-term effects on patients with IPF.
引文
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[9]李颖,王雪京,张纾难,等.肺痿冲剂方治疗肺间质纤维化61例疗效观察[J].中医杂志,2013,54(6):496-499.
[10]佀庆帅,芮婷,亢秀红,等.特发性肺纤维化中西医结合诊疗研究现状[J].北京中医药,2014,33(3):235-237.
[11]黄瑞欧,王志英.特发性肺纤维化中医研究现况[J].中医药信息,2011,28(2):117-120.
[12]李艳艳,张燕萍,王书臣,等.益气通络法治疗肺络闭阻、气阴两虚型特发性肺纤维化的临床研究[J].时珍国医国药,2014,25(3):630-632.
[13]张蔷,高文远,满淑丽.黄芪中有效成分药理活性的研究进展[J].中国中药杂志,2012,37(21):3203-3207.
[14]周海燕,孟昭阳.浅析五味子的临床效用[J].光明中医,2015,30(3):642-643.
[15]曹静,赵文静,旺建伟,等.水蛭的本草考证及现代研究[J].中医药信息,2015,32(4):122-124.
[2]张伟,张雪玲,朱雪,等.清金益肺汤对痰热蕴肺型特发性肺纤维化大鼠血管重塑的干预作用[J].中国中医药科技,2014,21(4):374-376.
[3]赵仲雪,庞立健,滑振,等.IPF中医病机“气络失和”与TGF-β1/Smads信号传导通路活化的相关性探讨[J].中国实验方剂学杂志,2015,23(17):204-207.
[4]黄慧,孙雪峰,徐作军,等.特发性肺纤维化诊治循证指南(摘译本)[J].中华结核和呼吸杂志,2011,34(7):486-494.
[5]王恺京,陆英,赵倩,等.特发性肺纤维化的发病机制和临床治疗[J].中国医药导报,2015,12(12):32-35.
[6]孙辉,李建生,谢洋.特发性肺纤维化患者测评工具的研制与思考[J].中华中医药杂志,2015,30(11):4002-4006.
[7]白艳玲,王春媛,侯衍修,等.特发性肺纤维化体液免疫学变化的临床意义[J].中国现代医学杂志,2015,25(18):41-45.
[8]姜素丽,李亚,田燕歌,等.调补肺肾三法对COPD大鼠T淋巴细胞亚群及CD4+CD25+的影响及远后效应[J].中国中西医结合杂志,2013,33(11):1538-1544.
[9]李颖,王雪京,张纾难,等.肺痿冲剂方治疗肺间质纤维化61例疗效观察[J].中医杂志,2013,54(6):496-499.
[10]佀庆帅,芮婷,亢秀红,等.特发性肺纤维化中西医结合诊疗研究现状[J].北京中医药,2014,33(3):235-237.
[11]黄瑞欧,王志英.特发性肺纤维化中医研究现况[J].中医药信息,2011,28(2):117-120.
[12]李艳艳,张燕萍,王书臣,等.益气通络法治疗肺络闭阻、气阴两虚型特发性肺纤维化的临床研究[J].时珍国医国药,2014,25(3):630-632.
[13]张蔷,高文远,满淑丽.黄芪中有效成分药理活性的研究进展[J].中国中药杂志,2012,37(21):3203-3207.
[14]周海燕,孟昭阳.浅析五味子的临床效用[J].光明中医,2015,30(3):642-643.
[15]曹静,赵文静,旺建伟,等.水蛭的本草考证及现代研究[J].中医药信息,2015,32(4):122-124.