芪术肺纤汤治疗特发性肺间质纤维化的临床有效性研究
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摘要
研究目的：运用中医理论为指导,观察芪术肺纤汤治疗特发性肺间质纤维化(IPF)的临床疗效。
研究方法：根据2000年《美国胸科学会(ATS)和欧洲呼吸学会(ERS)关于特发性肺间质纤维化诊断与治疗的声明》和2002年中华医学会呼吸病学分会《特发性肺(间质)纤维化诊断和治疗指南(草案)》中的诊断标准,选择30例特发性肺间质纤维化非急性发作期患者,采用自身前后对照的方法,给予芪术肺纤汤治疗6个月,进行治疗前后中医证候评分、肺功能(DLco、VC、TLC)变化、动脉血气分析(PaO2、PaCO2)、胸部CT、SGRQ评分以及6分钟步行试验的比较,观察各指标评分,并进行综合疗效的评价。采用SPSS统计软件分析结果。
研究结果：
1.中医证候评分：治疗后患者中医证候总分较治疗前明显下降,治疗前后有非常显著差异(P＜0.01)；其中主要症状方面,喘息症状积分较治疗前显著下降(P＜0.01),气短、咳嗽症状积分治疗后较治疗前下降,具有明显的疗效(P<0.05),咯痰症状积分治疗后较治疗前略有下降,但无统计学意义(P>0.05)；中医证候总体显效2例(8%),有效1 6例(64%),无效7例(28%),总有效率为72%。
2.功能性指标：肺功能,治疗后患者VC较治疗前明显提高,差异具有统计意义(P＜0.05),而TLC和DLco无明显进展,差异不具有统计学意义(P＞0.05)；动脉血气分析,治疗后Pa02及PaCO2与治疗前比较亦无明显进展,差异无统计学意义(P>0.05)。
3.影像学指标：1例治疗后较治疗前后有所改善(4%),16例基本稳定(64%),8例有所进展(32%),总有效率为68%。
4.生存质量：治疗后活动受限SGRQ评分及总分积分较治疗前均有所降低,差异具有统计学意义(P＜0.05)；呼吸症状SGRQ评分、疾病影响SGRQ评分较治疗前有所降低,但无统计学意义(P>0.05)；6分钟步行试验,治疗6个月后步行距离较治疗前明显提高,差异有统计学意义(P<0.05)。
5.综合疗效：显效2例(8%),有效17例(68%),无效6例(24%),总有效率为76%。
结论：芪术肺纤汤不仅能改善患者的中医证候,改善喘息、气短、咳嗽等主要症状,减轻患者痛苦；还能明显改善患者的VC,延缓TLC及DLco的下降,在一定程度上延缓动脉血气分析以及影像学上的进一步恶化；并且能明显提高患者的生存质量。可见芪术肺纤汤对IPF患者的治疗具有良好的临床疗效。
Objective:
To observe the clinical effect of Qi Zhu Fei Xian Dcoction on patients with idiopathic pulmonary fibrosis (IPF) by taking Chinese medicine theories
Method:
30 cases were included according to the diagnosis standard of IPF proposed by American Thoracic Society Idiopathic Pulmonary Fibrosis: Diagnosis and Treatment International Consensus Statement2000 and th-e diagnosis standard proposed by Chinese Society Of Respiratory dise-ases in 2002. The patients taken Qi Zhu Fei Xian Decoction 6 months and observe the change of syndrome score, pulmonary function tests (D-Lco、VC、TLC), HRCT, arterial blood gas analysis (PaO2, PaCO2), SGRQ sco-re and 6-minute-walking-test (6-MWT) and and make a comprehensive eva-luation. The results were analysised by SPSS software.
Results:
1. syndrome score:the post-treatment total score of syndrome is obviously declined than pre-treatment, and has a significantly differences (P<0.01); the post-treatment score of gasp, shortness of breath and cough also declined (P<0.05); while the score of expectoration declined mildy, and there was no significant difference (P>0.05).In all, the result of syndrome score were 2 cases excellent (8%)、16 cases effective(64%) and 7 cases invalid (28%), the total effective rate was 72%.
2. Functional indexes:after treatment, the index of VC was signi-ficantly increased,and DLco, TLC, PaO2 or PaCO2 had no significant change(P>0.05)
3. HRCT:There was 1 case better than before treatment (4%)、16 cases stable (64%), and 8 cases invalid(32%), the total effective rate was 68%.
4. Quality of Life (QOL):activity component of SGQR scores and total scores all declined, and there was a significant differences between before and after treatment (P<0.05), and respiratory symptoms component and impact component of SGQR scores also declined, but there were no differences (P>0.05). the effect of 6MWT was improved, and the difference was statistically significant (P<0.05).
5. comprehensive effect:there were 2 cases excellent (8%),17 cases effective(68%) and 7 cases invalid (24%), and the total effective rate was 72%.
Conclusion:
Qi Zhu Fei Xian dcoction not only improve the clinical symptoms of patients with IPF, such as gasp、shortness of breath and cough, and relieve patients'pain. And also improve VC, and delay the decline of TLC, DLco, and the worsening of arterial blood gas analysis and HRCT. Meanwhile it could obviously improve the quality of life. It is clear that there is a significant clinical effect on patients with the treatment of Qi Zhu Fei Xian Tang.
研究方法：根据2000年《美国胸科学会(ATS)和欧洲呼吸学会(ERS)关于特发性肺间质纤维化诊断与治疗的声明》和2002年中华医学会呼吸病学分会《特发性肺(间质)纤维化诊断和治疗指南(草案)》中的诊断标准,选择30例特发性肺间质纤维化非急性发作期患者,采用自身前后对照的方法,给予芪术肺纤汤治疗6个月,进行治疗前后中医证候评分、肺功能(DLco、VC、TLC)变化、动脉血气分析(PaO2、PaCO2)、胸部CT、SGRQ评分以及6分钟步行试验的比较,观察各指标评分,并进行综合疗效的评价。采用SPSS统计软件分析结果。
研究结果：
1.中医证候评分：治疗后患者中医证候总分较治疗前明显下降,治疗前后有非常显著差异(P＜0.01)；其中主要症状方面,喘息症状积分较治疗前显著下降(P＜0.01),气短、咳嗽症状积分治疗后较治疗前下降,具有明显的疗效(P<0.05),咯痰症状积分治疗后较治疗前略有下降,但无统计学意义(P>0.05)；中医证候总体显效2例(8%),有效1 6例(64%),无效7例(28%),总有效率为72%。
2.功能性指标：肺功能,治疗后患者VC较治疗前明显提高,差异具有统计意义(P＜0.05),而TLC和DLco无明显进展,差异不具有统计学意义(P＞0.05)；动脉血气分析,治疗后Pa02及PaCO2与治疗前比较亦无明显进展,差异无统计学意义(P>0.05)。
3.影像学指标：1例治疗后较治疗前后有所改善(4%),16例基本稳定(64%),8例有所进展(32%),总有效率为68%。
4.生存质量：治疗后活动受限SGRQ评分及总分积分较治疗前均有所降低,差异具有统计学意义(P＜0.05)；呼吸症状SGRQ评分、疾病影响SGRQ评分较治疗前有所降低,但无统计学意义(P>0.05)；6分钟步行试验,治疗6个月后步行距离较治疗前明显提高,差异有统计学意义(P<0.05)。
5.综合疗效：显效2例(8%),有效17例(68%),无效6例(24%),总有效率为76%。
结论：芪术肺纤汤不仅能改善患者的中医证候,改善喘息、气短、咳嗽等主要症状,减轻患者痛苦；还能明显改善患者的VC,延缓TLC及DLco的下降,在一定程度上延缓动脉血气分析以及影像学上的进一步恶化；并且能明显提高患者的生存质量。可见芪术肺纤汤对IPF患者的治疗具有良好的临床疗效。
Objective:
To observe the clinical effect of Qi Zhu Fei Xian Dcoction on patients with idiopathic pulmonary fibrosis (IPF) by taking Chinese medicine theories
Method:
30 cases were included according to the diagnosis standard of IPF proposed by American Thoracic Society Idiopathic Pulmonary Fibrosis: Diagnosis and Treatment International Consensus Statement2000 and th-e diagnosis standard proposed by Chinese Society Of Respiratory dise-ases in 2002. The patients taken Qi Zhu Fei Xian Decoction 6 months and observe the change of syndrome score, pulmonary function tests (D-Lco、VC、TLC), HRCT, arterial blood gas analysis (PaO2, PaCO2), SGRQ sco-re and 6-minute-walking-test (6-MWT) and and make a comprehensive eva-luation. The results were analysised by SPSS software.
Results:
1. syndrome score:the post-treatment total score of syndrome is obviously declined than pre-treatment, and has a significantly differences (P<0.01); the post-treatment score of gasp, shortness of breath and cough also declined (P<0.05); while the score of expectoration declined mildy, and there was no significant difference (P>0.05).In all, the result of syndrome score were 2 cases excellent (8%)、16 cases effective(64%) and 7 cases invalid (28%), the total effective rate was 72%.
2. Functional indexes:after treatment, the index of VC was signi-ficantly increased,and DLco, TLC, PaO2 or PaCO2 had no significant change(P>0.05)
3. HRCT:There was 1 case better than before treatment (4%)、16 cases stable (64%), and 8 cases invalid(32%), the total effective rate was 68%.
4. Quality of Life (QOL):activity component of SGQR scores and total scores all declined, and there was a significant differences between before and after treatment (P<0.05), and respiratory symptoms component and impact component of SGQR scores also declined, but there were no differences (P>0.05). the effect of 6MWT was improved, and the difference was statistically significant (P<0.05).
5. comprehensive effect:there were 2 cases excellent (8%),17 cases effective(68%) and 7 cases invalid (24%), and the total effective rate was 72%.
Conclusion:
Qi Zhu Fei Xian dcoction not only improve the clinical symptoms of patients with IPF, such as gasp、shortness of breath and cough, and relieve patients'pain. And also improve VC, and delay the decline of TLC, DLco, and the worsening of arterial blood gas analysis and HRCT. Meanwhile it could obviously improve the quality of life. It is clear that there is a significant clinical effect on patients with the treatment of Qi Zhu Fei Xian Tang.
引文
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