作者：杨环玮，周进，王虹，耿立梅

单位：

1.066000河北省秦皇岛市中医医院肺病科 2.050000河北省石家庄市，河北省中医院肺病科 通信作者：周进，E-mail：yyx1202@yeah.net

Units：

1.Department of Pulmonary, Qinhuangdao Hospital of Traditional Chinese Medicine, Qinhuangdao 066000, China 2.Department of Pulmonary, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang 050000, China Corresponding author: ZHOU Jin, E-mail: yyx1202@yeah.net

关键词：

肺疾病,慢性阻塞性; 补肺益肾内服膏剂; 自血穴位注射; 治疗结果;

Keywords：

Pulmonary disease, chronic obstructive; Bufei Yishen ointment; Self blood acupoint injection; Treatmentoutcome

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.189

Funds：

河北省中医药管理局科研计划项目（2019532）；秦皇岛市科技局科研计划项目（201805A165）

摘要：

目的 探讨补肺益肾内服膏剂联合自血穴位注射治疗老年慢性阻塞性肺疾病(COPD)稳定期的疗效。方法 选取2020年3月至2021年12月秦皇岛市中医医院收治的老年COPD稳定期患者90例为研究对象。采用随机数字表法将其分为对照组和联合组,各45例。对照组在常规治疗的基础上采用自血穴位注射治疗,联合组在对照组的基础上采用补肺益肾内服膏剂治疗,两组均连续治疗3个月。比较两组临床疗效,治疗前及治疗4、12周肺功能指标[用力肺活量(FVC)、第1秒用力呼气容积(FEV1)及FEV1/FVC],治疗前后炎症指标(NF-κΒ、IL-8、IL-17)、免疫指标[Toll样受体(TLR)2、TLR4及CD3+、CD4+、CD8+T淋巴细胞分数],气道重塑相关指标{治疗前后气道重塑血清标志物[转化生长因子β1(TGF-β1)、血管内皮生长因子(VEGF)、基质金属蛋白酶(MMP)-2、MMP-9]和治疗前及治疗4、12周气道重塑影像学检查指标(气道壁厚度、气道壁面积、气道壁占气道外径比例、气道壁面积占气道总横截面积的比例)},治疗前后圣乔治呼吸问卷评分。结果 联合组临床疗效优于对照组(P<0.05)。治疗方法与时间在FVC、FEV1、FEV1/FVC上存在交互作用(P<0.05);治疗方法、时间在FVC、FEV1、FEV1/FVC上主效应显著(P<0.05)。联合组治疗12周FVC、FEV1、FEV1/FVC高于对照组(P<0.05)。对照组、联合组治疗12周FVC、FEV1、FEV1/FVC分别高于本组治疗前、治疗4周(P<0.05)。治疗后,联合组NF-κB、IL-8、IL-17低于对照组(P<0.05)。对照组、联合组治疗后NF-κB、IL-8、IL-17分别低于本组治疗前(P<0.05)。治疗后,联合组TLR2、TLR4、CD8+T淋巴细胞分数低于对照组,CD3+、CD4+T淋巴细胞分数高于对照组(P<0.05)。对照组、联合组治疗后TLR2、TLR4、CD8+T淋巴细胞分数分别低于本组治疗前,CD3+、CD4+T淋巴细胞分数分别高于本组治疗前(P<0.05)。治疗后,联合组TGF-β1、VEGF、MMP-2、MMP-9低于对照组(P<0.05)。对照组、联合组治疗后TGF-β1、VEGF、MMP-2、MMP-9分别低于本组治疗前(P<0.05)。治疗方法与时间在气道壁厚度、气道壁面积、气道壁占气道外径比例、气道壁面积占气道总横截面积的比例上存在交互作用(P<0.05);治疗方法、时间在气道壁厚度、气道壁面积、气道壁占气道外径比例、气道壁面积占气道总横截面积的比例上主效应显著(P<0.05)。联合组治疗12周气道壁厚度、气道壁面积小于对照组,气道壁占气道外径比例、气道壁面积占气道总横截面积的比例低于对照组(P<0.05)。对照组、观察组治疗12周气道壁厚度、气道壁面积分别低于本组治疗前、治疗4周,气道壁占气道外径比例、气道壁面积占气道总横截面积的比例分别低于本组治疗前、治疗4周(P<0.05)。治疗后,联合组呼吸症状、活动能力、疾病影响得分及圣乔治呼吸问卷总分低于对照组(P<0.05)。对照组、联合组治疗后呼吸症状、活动能力、疾病影响得分及圣乔治呼吸问卷总分分别低于本组治疗前(P<0.05)。结论 补肺益肾内服膏剂联合自血穴位注射可有效提高老年COPD稳定期患者的临床疗效,改善肺功能,减轻炎症反应,提高免疫力,抑制气道重塑,提高生活质量。

Abstract：

【Abstract】　Objective To explore the effect of Bufei Yishen ointment combined with self blood acupoint injectionin the treatment of elderly patients with stable chronic obstructive pulmonary disease (COPD) . Methods A total of 90 elderlypatients with stable COPD who were admitted to Qinhuangdao Hospital of Traditional Chinese Medicine from March 2020 toDecember 2021 were selected as the research objects. They were divided into control group and combined group by randomnumber table method, 45 cases in each group. The control group was treated with self blood acupoint injection on the basis ofroutine treatment, and the combined group was treated with Bufei Yishen ointment on the basis of the control group. Both groupswere treated for 3 months. The clinical efficacy, pulmonary function indexes [forced vital capacity (FVC) , forced expiratory volumein one second (FEV1) and FEV1/FVC] before treatment and at 4 and 12 weeks after treatment, inflammatory indexes (NF-κB,IL-8, IL-17) and immune indexes [Toll-like receptor (TLR) 2, TLR4 and CD3+ , CD4+ , CD8+ T lymphocyte count] before and aftertreatment, airway remodeling related indicators {serum markers of airway remodeling [transforming growth factor-β1 (TGF-β1) ,vascular endothelial growth factor (VEGF) , matrix metalloproteinase (MMP) -2, MMP-9] before and after treatment and imagingexamination indicators of airway remodeling (airway wall thickness, airway wall area, the ratio of airway wall to airway outerdiameter, the ratio of airway wall area to total airway cross-sectional area) before treatment and at 4, 12 weeks after treatment} ,St George's Respiratory Questionnaire score before and after treatment of the two groups were compared. Results The clinicalefficacy of the combined group was better than that of the control group (P < 0.05) . There was an interaction between treatmentmethod and time on FVC, FEV1 and FEV1/FVC (P< 0.05) . The main effects of treatment method and time on FVC, FEV1 andFEV1/FVC were significant (P < 0.05) . FVC, FEV1 and FEV1/FVC at 12 weeks after treatment in the combined group were higherthan those in the control group (P< 0.05) . FVC, FEV1, FEV1/FVC of the control group and the combined group at 12 weeks aftertreatment were higher than those before treatment and at 4 weeks after treatment, respectively (P < 0.05) . After treatment, NF-κB, IL-8 and IL-17 in the combined group were lower than those in the control group (P < 0.05) . NF-κB, IL-8 and IL-17after treatment in the control group and the combined group were lower than those before treatment, respectively (P < 0.05) . Aftertreatment, TLR2, TLR4 and the fraction of CD8+ T lymphocytes in the combined group were lower than those in the control group,and the fraction of CD3+and CD4+T lymphocytes was higher than that in the control group (P < 0.05) . After treatment, TLR2,TLR4 and the fraction of CD8+ T lymphocytes in the control group and the combined group were lower than those before treatment,and the fraction of CD3+and CD4+T lymphocytes was higher than that before treatment, respectively (P < 0.05) . After treatment,TGF-β1, VEGF, MMP-2 and MMP-9 in the combined group were lower than those in the control group (P < 0.05) . TGF-β1,VEGF, MMP-2 and MMP-9 after treatment in the control group and the combined group were lower than those before treatment,respectively (P < 0.05) . There was an interaction between treatment method and time on airway wall thickness, airway wall area,proportion of airway wall to airway outer diameter, and proportion of airway wall area to total airway cross-sectional area (P < 0.05) .The main effects of treatment method and time on airway wall thickness, airway wall area, proportion of airway wall to airway outerdiameter, and proportion of airway wall area to total airway cross-sectional area were significant (P < 0.05) . The thickness ofairway wall and airway wall area at 12 weeks after treatment in the combined group were smaller than those in the control group,the ratio of airway wall to airway outer diameter and the ratio of airway wall area to total airway cross-sectional area were lowerthan those in the control group (P < 0.05) . In the control group and the observation group, the airway wall thickness and airwaywall area at 12 weeks after treatment were smaller than those before treatment and at 4 weeks after treatment, the proportion ofairway wall to airway outer diameter and the proportion of airway wall area to total airway cross-sectional area were lower thanthose before treatment and at 4 weeks after treatment, respectively (P < 0.05) . After treatment, the scores of respiratory symptoms,activity ability, disease influence and total score of St George's Respiratory Questionnaire in the combined group were lowerthan those in the control group (P < 0.05) . The scores of respiratory symptoms, activity ability, disease influence and total scoreof St George's Respiratory Questionnaire after treatment in the control group and the combined group were lower than thosebefore treatment, respectlvely (P < 0.05) . Conclusion Bufei Yishen ointment combined with self blood acupoint injection caneffectively improve the clinical efficacy of elderly patients with stable COPD, improve lung function, reduce inflammation, improveimmunity, inhibit airway remodeling and improve quality of life.

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