玄参甘桔汤合三拗汤加减治疗燥热伤肺型感染后咳嗽的疗效观察
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摘要
目的:观察玄参甘桔汤合三拗汤加减治疗感染后咳嗽(PIC)燥热伤肺证的临床疗效及对变应性炎症和神经源性炎症介质的影响。方法:将180例符合要求的PIC患者,根据就诊先后随机按2∶1分为观察组122例和对照组58例。对照组口服复方甲氧那明胶囊,2粒/次,3次/d,观察组内服玄参甘桔汤合三拗汤加减辨证,1剂/d。两组疗程均连续治疗7 d。进行咳嗽症状积分(日间和夜间咳嗽情况)、咳嗽视觉模拟评分(VAS)和燥热伤肺证评分;记录止咳起效时间、咳嗽缓解时间、咳嗽消失时间和咳嗽复发情况;采用咳嗽专用生活质量问卷(CQLQ)评价患者生活质量;检测治疗前后变应性炎症介质肿瘤坏死因子-α(TNF-α),白细胞介素-1β(IL~(-1)β),IL-6,IL-8和痰液神经源性炎症介质P物质(SP),神经肽A(NKA),降钙素原基因相关肽(CGRP)水平。结果:经Ridit分析,观察组临床疗效优于对照组(P <0. 05);治疗后观察组日间咳嗽积分、夜间咳嗽积分,VAS评分和燥热伤肺证积分均低于对照组(P <0. 01);观察组止咳起效时间、咳嗽缓解时间和咳嗽消失时间均短于对照组(P <0. 01);观察组咳嗽缓解率、咳嗽消失率均高于对照组,咳嗽复发率低于对照组(P <0. 05);观察组CQLQ除情感健康和人身安全恐惧外其它维度评分和总分均低于对照组(P <0. 01);观察组患者血清TNF-α,IL~(-1)β,IL-6,IL-8水平均低于对照组(P <0. 01);观察组患者痰液SP,NKA,CGRP水平均明显低于对照组(P <0. 01)。结论:玄参甘桔汤合三拗汤加减治疗PIC燥热伤肺证患者能控制咳嗽等症状,缩短咳嗽病程、减少复发,提高患者的生活质量,并能抑制变应性炎症和神经源性炎症,临床疗效优于复方甲氧那明治疗。
Objective: To observe the clinical efficacy of addition and subtraction therapy of Xuanshen Ganju Tang combined with Sanniutang to post infection cough( PIC) with lung injury caused by dryness and heat,and investigate its effects on allergic inflammation and neurogenic inflammatory mediators. Method: One hundred and eighty eligible patients with PIC were randomly divided into control group( 58 cases) and observation group( 122 cases) according to the visiting sequence. Patients in control group got compound methoxyphenamine capsules,2 capsules/time and tid. Patients in observation group got addition and subtraction therapy of Xuanshen Ganju Tang,combined with Sanniutang,1 dose/day. The treatment course was 7 days in both groups. Symptom scores for cough( day and night),visual analogue scale of coughing( VAS) and scores for lung injury caused by dryness and heat injury were graded. Time to relieve a cough,time to relieve symptoms,time to vanish cough,and cough recurrence were recorded. Life quality was evaluated by cough-specific quality of life questionnaire( CQLQ),and the levels of tumor necrosis factor-α( TNF-α),interleukin-1β( IL~(-1)β),IL-6,IL-8 and substance P in sputum neurogenic inflammatory mediators( SP),neuropeptide A( NKA) and calcitonin gene related peptide( CGRP) were detected. Result: Ridit analysis showed that the clinical efficacy in observation group was better than that in control group( P < 0. 05). After treatment,scores of coughing at daytime and night,VAS and lung injury caused by dryness and heat were all lower than those in control group( P < 0. 01). Time to relieve a cough,time to relieve symptoms,and time to vanish cough were all shorter than those in control group( P < 0. 01).Remission rate of cough and vanishing rate of cough in observation group were higher,while recurrence rate of cough was lower than those in control group( P < 0. 05). Expect for emotional health and fear of personal safety,scores of other items in CQLQ,the total score and levels of TNF-α,IL~(-1)β,IL-6,IL-8,SP,NKA and CGRP in observation group were all lower than those in control group( P < 0. 01). Conclusion: Addition and subtraction therapy of Xuanshen Ganju Tang combined with Sanniutang can control systems of cough,shorten coughing course,reduce recurrence rate,improve patients' life of quality,and can inhibit allergic inflammation and neurogenic inflammatory mediators in the treatment of PIC with symptom of lung injury caused by dryness and heat,with a better clinical efficacy than pure compound methoxyphenamine capsules.
Objective: To observe the clinical efficacy of addition and subtraction therapy of Xuanshen Ganju Tang combined with Sanniutang to post infection cough( PIC) with lung injury caused by dryness and heat,and investigate its effects on allergic inflammation and neurogenic inflammatory mediators. Method: One hundred and eighty eligible patients with PIC were randomly divided into control group( 58 cases) and observation group( 122 cases) according to the visiting sequence. Patients in control group got compound methoxyphenamine capsules,2 capsules/time and tid. Patients in observation group got addition and subtraction therapy of Xuanshen Ganju Tang,combined with Sanniutang,1 dose/day. The treatment course was 7 days in both groups. Symptom scores for cough( day and night),visual analogue scale of coughing( VAS) and scores for lung injury caused by dryness and heat injury were graded. Time to relieve a cough,time to relieve symptoms,time to vanish cough,and cough recurrence were recorded. Life quality was evaluated by cough-specific quality of life questionnaire( CQLQ),and the levels of tumor necrosis factor-α( TNF-α),interleukin-1β( IL~(-1)β),IL-6,IL-8 and substance P in sputum neurogenic inflammatory mediators( SP),neuropeptide A( NKA) and calcitonin gene related peptide( CGRP) were detected. Result: Ridit analysis showed that the clinical efficacy in observation group was better than that in control group( P < 0. 05). After treatment,scores of coughing at daytime and night,VAS and lung injury caused by dryness and heat were all lower than those in control group( P < 0. 01). Time to relieve a cough,time to relieve symptoms,and time to vanish cough were all shorter than those in control group( P < 0. 01).Remission rate of cough and vanishing rate of cough in observation group were higher,while recurrence rate of cough was lower than those in control group( P < 0. 05). Expect for emotional health and fear of personal safety,scores of other items in CQLQ,the total score and levels of TNF-α,IL~(-1)β,IL-6,IL-8,SP,NKA and CGRP in observation group were all lower than those in control group( P < 0. 01). Conclusion: Addition and subtraction therapy of Xuanshen Ganju Tang combined with Sanniutang can control systems of cough,shorten coughing course,reduce recurrence rate,improve patients' life of quality,and can inhibit allergic inflammation and neurogenic inflammatory mediators in the treatment of PIC with symptom of lung injury caused by dryness and heat,with a better clinical efficacy than pure compound methoxyphenamine capsules.
引文
[1]中华医学会呼吸病学分会哮喘学组.咳嗽的诊断与治疗指南(2015)[J].中华结核和呼吸杂志,2016,39(5):323-354.
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[3]蒋春芳,刘纯.成人感染后咳嗽的发病机制临床诊断与西医治疗进展[J].现代医药卫生,2016,32(14):2178-2182.
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[5]范良,潘小丹,张美萃.傅汝梅辨治感染后咳嗽经验介绍[J].中国中医急症,2014,23(10):1852-1853.
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[7]范良,张美萃,潘小丹.感染后咳嗽60例临床观察[J].中国中医基础医学杂志,2015,21(5):588-589.
[8]管奕婷,凌琼.三拗汤治疗感染后咳嗽30例[J].中国中医药现代远程教育,2014,12(10):40-41.
[9]胡诣璋,赵俊,崔瑷.感染后咳嗽发病机制及治疗进展[J].临床药物治疗杂志,2016,14(1):11-16.
[10]中华中医药学会内科分会肺系病专业委员会.咳嗽中医诊疗专家共识意见(2011版)[J].中医杂志,2011,52(10):896-899.
[11] French C T,Irwin R S,Fletcher K E,et al. Evaluation of a cough-specific quality-of-life questionnaire[J].Chest,2002,121(4):1123-1131.
[12]马文建,鲁玉芬,刘永新,等.小儿肺咳颗粒治疗儿童感染后咳嗽的疗效与作用机制[J].中国实验方剂学杂志,2017,23(14):204-209.
[13]李际强,云芯芯,张忠德,等.应用晁恩祥风咳理论治疗病毒感染致气道高反应的研究思路[J].中国中医急症,2014,23(8):1479-1481.
[14]刘彦梅,吴欣娟,位庚.感染后咳嗽的中医辨证诊治思路[J].陕西中医,2017,38(11):1585-1586.
[15]唐华平,郝月琴,李双保.加味玄麦甘桔汤对哮喘豚鼠气道T淋巴细胞凋亡的影响[J].南京中医药大学学报,2007,23(4):250-251.
[16]胡健,张至强,曾时杰,等.三拗汤治疗支气管哮喘的研究进展[J].陕西中医药大学学报,2017,40(5):130-133.
[17] Lukacs N W,Smit J J,Mukherjee S,et al. Respiratory virus-induced TLR7 activation controls IL-17-associated increased mucus via IL-23 regulation[J]. J Immunol,2010,185(4):2231-2239.
[18]陈如冲,刘春丽,罗炜,等.感冒后咳嗽敏感性及气道神经源性炎症改变[J].中国实用内科杂志,2007,27(9):674-676.
[2]赖克方,聂怡初.感染后咳嗽发病机制、诊断与治疗研究进展[J].中华肺部疾病杂志:电子版,2014,7(5):1-5.
[3]蒋春芳,刘纯.成人感染后咳嗽的发病机制临床诊断与西医治疗进展[J].现代医药卫生,2016,32(14):2178-2182.
[4]姜燕,刘昊,毛兵.中医药治疗感染后咳嗽系统评价[J].辽宁中医药大学学报,2017,19(2):149-152.
[5]范良,潘小丹,张美萃.傅汝梅辨治感染后咳嗽经验介绍[J].中国中医急症,2014,23(10):1852-1853.
[6]卢保强,黄少君,范良.傅汝梅教授治疗慢性咳嗽经验[J].中医学报,2013,28(9):1280-1281.
[7]范良,张美萃,潘小丹.感染后咳嗽60例临床观察[J].中国中医基础医学杂志,2015,21(5):588-589.
[8]管奕婷,凌琼.三拗汤治疗感染后咳嗽30例[J].中国中医药现代远程教育,2014,12(10):40-41.
[9]胡诣璋,赵俊,崔瑷.感染后咳嗽发病机制及治疗进展[J].临床药物治疗杂志,2016,14(1):11-16.
[10]中华中医药学会内科分会肺系病专业委员会.咳嗽中医诊疗专家共识意见(2011版)[J].中医杂志,2011,52(10):896-899.
[11] French C T,Irwin R S,Fletcher K E,et al. Evaluation of a cough-specific quality-of-life questionnaire[J].Chest,2002,121(4):1123-1131.
[12]马文建,鲁玉芬,刘永新,等.小儿肺咳颗粒治疗儿童感染后咳嗽的疗效与作用机制[J].中国实验方剂学杂志,2017,23(14):204-209.
[13]李际强,云芯芯,张忠德,等.应用晁恩祥风咳理论治疗病毒感染致气道高反应的研究思路[J].中国中医急症,2014,23(8):1479-1481.
[14]刘彦梅,吴欣娟,位庚.感染后咳嗽的中医辨证诊治思路[J].陕西中医,2017,38(11):1585-1586.
[15]唐华平,郝月琴,李双保.加味玄麦甘桔汤对哮喘豚鼠气道T淋巴细胞凋亡的影响[J].南京中医药大学学报,2007,23(4):250-251.
[16]胡健,张至强,曾时杰,等.三拗汤治疗支气管哮喘的研究进展[J].陕西中医药大学学报,2017,40(5):130-133.
[17] Lukacs N W,Smit J J,Mukherjee S,et al. Respiratory virus-induced TLR7 activation controls IL-17-associated increased mucus via IL-23 regulation[J]. J Immunol,2010,185(4):2231-2239.
[18]陈如冲,刘春丽,罗炜,等.感冒后咳嗽敏感性及气道神经源性炎症改变[J].中国实用内科杂志,2007,27(9):674-676.