作者：丁静，周进，张艳红，冯文杰，杨京华，王品，艾健

单位：

066000河北省秦皇岛市中医医院肺病科 通信作者：周进，E-mail：yyx1202@yeah.net

Units：

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

关键词：

肺疾病,慢性阻塞性; 补肺保元膏; 无烟灸; 治疗结果; 肺功能;

Keywords：

Pulmonary disease, chronic obstructive; Bufei Baoyuan ointment; Smokeless moxibustion; Treatment outcome; Pulmonary function

CLC：

DOI：

10.12114/j.issn.1008-5971.2023.00.008

Funds：

河北中医药管理局课题（2019532，2022538）；2018年度秦皇岛市科学技术研究与发展计划（201805A165）

摘要：

目的 探讨补肺保元膏联合无烟灸治疗老年慢性阻塞性肺疾病(COPD)稳定期肺肾气虚证患者的临床疗效。方法 选取2019年1月至2021年1月秦皇岛市中医医院收治的COPD稳定期肺肾气虚证患者152例，采用信封法将其分为对照组、无烟灸组、补肺保元膏组和联合组，各38例。对照组给予常规西医治疗，无烟灸组在对照组基础上给予无烟灸治疗，补肺保元膏组在对照组基础上给予补肺保元膏治疗，联合组在对照组基础上给予补肺保元膏联合无烟灸治疗，均治疗3个月。比较四组临床疗效，治疗前后圣乔治呼吸问卷评分，治疗前、治疗4周后及治疗12周后肺功能指标[用力肺活量(FVC)、第1秒用力呼气容积(FEV1)及FEV1/FVC]，治疗前后实验室检查指标[核因子κB(NF-κB)、IL-8、IL-17、Toll样受体(TLR)2、TLR4、CD3~+T淋巴细胞百分比、CD4~+T淋巴细胞百分比、CD8~+T淋巴细胞百分比]，研究期间不良反应发生率。结果 共130例患者纳入统计分析，其中对照组32例、无烟灸组31例、补肺保元膏组35例、联合组32例。联合组总有效率高于对照组、无烟灸组、补肺保元膏组(P<0.05)。治疗后，四组圣乔治呼吸问卷的呼吸症状、活动能力、疾病影响评分及总评分分别较本组治疗前降低(P<0.05)；治疗后，无烟灸组、补肺保元膏组、联合组圣乔治呼吸问卷的呼吸症状、活动能力、疾病影响评分及总评分低于对照组，联合组低于无烟灸组、补肺保元膏组(P<0.05)。干预方法与时间在FVC、FEV1、FEV1/FVC上不存在交互作用(P>0.05)；干预方法在FVC、FEV1、FEV1/FVC上主效应不显著(P>0.05)；时间在FVC、FEV1、FEV1/FVC上主效应显著(P<0.05)；治疗4周后，四组FEV1/FVC分别高于本组治疗前(P<0.05)；治疗12周后，四组FVC、FEV1分别大于本组治疗前，FEV1/FVC分别高于本组治疗前(P<0.05)；治疗12周后，联合组FEV1/FVC高于对照组、无烟灸组、补肺保元膏组(P<0.05)。治疗后，四组NF-κB、IL-8、IL-17、TLR2、TLR4、CD8~+T淋巴细胞百分比分别较本组治疗前降低，CD3~+T淋巴细胞百分比、CD4~+T淋巴细胞百分比分别较本组治疗前升高(P<0.05)；治疗后，无烟灸组、补肺保元膏组、联合组NF-κB、IL-8、IL-17、TLR2、TLR4低于对照组，联合组CD3~+T淋巴细胞百分比、CD4~+T淋巴细胞百分比高于对照组，联合组CD8~+T淋巴细胞百分比低于对照组(P<0.05)。四组不良反应发生率比较，差异无统计学意义(P>0.05)。结论 在常规治疗的基础上，给予老年COPD稳定期肺肾气虚证患者补肺养元膏联合无烟灸治疗疗效更佳，能提高患者生活质量，改善患者肺功能及免疫功能，值得临床推广。

Abstract：

【Abstract】 Objective To investigate the clinical efficacy of Bufei Baoyuan ointment combined with smokeless moxibustion in the treatment of elderly patients with chronic obstructive pulmonary disease (COPD) in stable phase with lung kidney Qi deficiency syndrome. Methods A total of 152 elderly patients with COPD in stable phase with lung-kidney Qi deficiency syndrome who admitted to Qinhuangdao Hospital of Traditional Chinese Medicine from January 2019 to January 2021 were selected and randomly divided into control group, smokeless moxibustion group, Bufei Baoyuan ointment group and combined group by envelope method, 38 cases in each group. The control group was treated with conventional western medicine, the smokeless moxibustion group was treated with smokeless moxibustion on the basis of the control group, the Bufei Baoyuan ointment group was treated with Bufei Baoyuan ointment on the basis of the control group, and the combined group was treated with Bufei Baoyuan ointment combined with smokeless moxibustion on the basis of the control group, all groups were treated for 3 months. The clinical efficacy, St.George's Respiratory Questionnaire score before and after treatment, pulmonary function indexes [forced vital capacity (FVC) , forced expiratory volume in the first second (FEV1) and FEV1/FVC] before treatment and at 4 weeks after treatment and 12 weeks after treatment, laboratory indexes [nuclear factor kappa-B (NF-κB) , IL-8, IL-17, Toll-like receptor (TLR) 2 , TLR4, CD 3 + T lymphocytes, CD4 + T lymphocytes, CD8 + T lymphocytes] before and after treatment, and the incidence of adverse reactions during the study were compared among the four groups. Results A total of 130 patients were included in the statistical analysis, including 32 patients in the control group, 31 patients in the smokeless moxibustion group, 35 patients in the Bufei Baoyuan ointment group, and 32 patients in the combined group. The total effective rate of the combined group was higher than that of the control group, smokeless moxibustion group, and Bufei Baoyuan ointment group (P < 0.05) . After treatment, the score of respiratory symptoms, activity ability and disease impact and total score of St.George 's Respiratory Questionnaire in the four groups were lower than those before treatment, respectively (P < 0.05) ; after treatment, the score of respiratory symptoms, activity ability and disease impact and total score of St.George 's Respiratory Questionnaire in the smokeless moxibustion group, Bufei Baoyuan ointment group and combined group were lower than those in the control group, and those in the combined group were lower than those in the smokeless moxibustion group and Bufei Baoyuan ointment group (P < 0.05) . There was no interaction between intervention methods and time on FVC, FEV 1, and FEV1/FVC (P > 0.05) ; the main effect of intervention methods on FVC, FEV 1, and FEV1/FVC was not significant (P > 0.05) ; the main effect of time in FVC, FEV 1, and FEV1/FVC was significant (P < 0.05) ; after 4 weeks of treatment, FEV1/FVC in the four groups was higher than that before treatment, respectively (P < 0.05) ; after 12 weeks of treatment, FVC and FEV 1 in the four groups were bigger than those before treatment, FEV 1/FVC in the four groups was higher than that before treatment, respectively ( P < 0.05) ; after 12 weeks of treatment, FEV1/FVC in the combined group was higher than that in the control group, smokeless moxibustion group and Bufei Baoyuan ointment group (P < 0.05) . After treatment, NF-κB, IL-8, IL-17, TLR2, TLR4, CD8 + T lymphocytes in the four groups were lower and CD3 + T lymphocytes and CD4 + T lymphocytes were higher than those before treatment, respectively (P < 0.05) ; after treatment, NF-κB, IL-8, IL-17, TLR2, and TLR4 in the smokeless moxibustion group, Bufei Baoyuan ointment group, and combined group were lower than those in the control group, CD3 + T lymphocytes and CD4 + T lymphocytes in the combined group were higher than those in the control group, and CD 8 + T lymphocytes in the combined group were lower than those in the control group ( P < 0.05) . There was no significant difference in the incidence of adverse reactions among the four groups (P > 0.05) . Conclusion On the basis of conventional treatment, Bufei Yangyuan ointment combined with smokeless moxibustion is more effective in the treatment of elderly patients with COPD in stable phase with lung-kidney Qi deficiency syndrome, which can improve the quality of life, pulmonary function and immune function of patients, and is worthy of clinical promotion.

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