清热化痰法对抗菌药物在AECOPD痰热证患者肺组织转运能力的影响及疗效评价

Influence of antibiotics transshipment in the lung tissue and therapeutic evaluation of clearing away heat and dispersing phlegm in AECOPD syndrome of phlegm and heat

关键词:  清热化痰法  抗菌药物  慢性阻塞性肺疾病急性加重期痰热证  肺组织转运能力  疗效评价

Key words:  clearing away heat and dispersing phlegm  antibiotic  acute exacerbation of chronic obstructive pulmonary disease with syndrome of phlegm and heat  transshipment in the pulmonary tissue  therapeutic evaluation

摘要:

[目的] 研究清热化痰法对抗菌药物在慢性阻塞性肺疾病急性加重期(AECOPD)痰热证患者肺组织转运能力的影响、作用机制及疗效评价。[方法] 将61例AECOPD患者随机分为治疗组和对照组。2 组均给予抗感染、平喘、必要时机械通气治疗。治疗组在基础治疗的基础上口服清热化痰中药复方;对照组在基础治疗的基础上给予氨溴索针剂,每次30 mg静脉注射,每日2次,疗程1周。观察治疗前后患者的症状、COPD评估测试(CAT)量表、深部痰中抗菌药物浓度、血清中性粒细胞弹性蛋白酶(NE)水平。[结果] 1)临床症状方面:两组在总有效率比较方面均无统计学差异;第7天所有症状及主要症状比较差异有统计学意义(P<0.05),治疗组优于对照组, 第4天无统计学差异;单一症状方面咳嗽及痰量比较差异有统计学意义(P<0.05),治疗组优于对照组;咳痰难易度及胸闷改善比较差异有统计学意义(P<0.05),对照组优于治疗组;CAT量表评分比较差异有统计学意义(P<0.05),治疗组优于对照组。2)痰样本中药物浓度:两组之间比较无统计学差异,但治疗组中位数较对照组为高。3)NE:治疗组与对照组NE差值无统计学差异,治疗后两组均在一定程度上降低NE的水平。[结论] 清热化痰中药复方同氨溴索一样具备协助提高局部病灶组织中药物浓度的潜在趋势,其作用机制可能是通过影响NE,减少黏液分泌,减轻气道阻塞,促进抗菌药物在肺组织中的正相扩散。此外,两者均有助于改善AECOPD患者的临床症状,在单一症状方面各具优势,但清热化痰法更有助于改善患者治疗1周后的生活质量。

Abstract:

[Objective] To study the influence of antibiotics transshipment in the lung tissue,mechanism and therapeutic evaluation of clearing away heat and dispersing in acute exacerbation of chronic obstructive pulmonary disease(AECOPD). [Methods] All 65 patients of AECOPD were randomly divided into the treatment group and control group. All were given the therapies of anti-infection, anti-asthma and even mechanical ventilation when necessary. The treatment group was then given the Chinese herbal compound formula orally, control group was given mucosolvan injection (30 mg intravenation) twice a day for one week. The symptoms, chart of CAT, density of antibiotics in deep sputum, content neutrophil elastase(NE) in blood were observed before and after treatment. [Results] 1)Clinic symptom: two groups had no statistical difference in the efficiency of and treatment. There was significant difference in the change of all symptoms and main symptoms at the seventh day of treatment(P<0.05), and treatment group was better than the control group, while no significant difference in fourth days. About the single symptom, the improvement of cough and expectoration quantity had significant difference compared with the control group(P<0.05), and about the comparison on expectoration difficulty and chest tightness improvement, the control group was excellent(P<0.05). There was significant difference between two groups in CAT chart, and better of that in treatment group(P<0.05). 2)Density of antibiotics in deep sputum: drug concentration between two groups had no significant difference, but the treatment group had higher median than the control group. 3)NE:there was no statistical difference in the two groups, and both of them to some extent reduced the level of NE after treatment. [Conclusion] Chinese medicine and ambroxol have potential trend to improve drug concentration in the local tumor tissue. The mechanism that may influence NE to reduce mucus secretion, ease obstruction in airway so as to promote mutually spread of antibiotics in the pulmonary tissue. Moreover, both of them can improve symptoms of AECOPD patients, especially in single symptoms they have their own advantages. Chinese medicine also can improve the quality of life of patients after one week of treatment.