麻杏石甘汤加减结合常规疗法治疗邪热壅肺证支气管哮喘急性发作期的临床研究

Clinical research on treating acute bronchial asthma of evil heat obstructing lung with Maxing Shigan Decoction combined with conventional therapy

关键词:  支气管哮喘  急性期  邪热壅肺证  麻杏石甘汤  常规疗法  临床疗效

Key words:  bronchial asthma  acute  evil heat obstructing lung  Maxing Shigan Decoction  conventional therapy  clinical curative effect

摘要:

[目的]评价麻杏石甘汤加减结合常规疗法治疗邪热壅肺证支气管哮喘急性发作期的临床疗效，并探讨其机制。[方法]将符合纳入标准的188例患者，随机分为试验组和对照组各94例，研究中脱落10例，脱落率为5.32%，最终完成178例患者，试验组90例，对照组88例。对照组给予常规西医常规疗法，试验组给予麻杏石甘汤加减配合西医常规疗法，1周为1个疗程，共治疗2个疗程，随访6个月；观察治疗2个疗程后两组中医证候疗效、哮喘症状、肺功能、呼出气一氧化氮（FeNO）评分及临床疗效；治疗后6个月血清白介素-4（IL-4）及干扰素-γ（IFN-γ）表达水平及复发情况。[结果]两组患者治疗后喘息、咳嗽、咳痰、胸闷、哮鸣症状评分均低于治疗前（P<0.05）；治疗后试验组中医证候评分均低于对照组（P<0.05）；两组治疗后白天症状、夜晚症状评定均较治疗前降低，有显著性差异（P<0.05）；与对照组比较，试验组治疗后更低于对照组（P<0.05）。两组患者治疗后肺功能均较治疗前改善（P<0.05）；治疗后试验组均优于对照组（P<0.05）。治疗后两组患者FeNO水平均显著降低（P<0.05），且试验组FeNO水平降低优于对照组（P<0.05）；试验组总有效率为96.7%，对照组为89.8%，两组有效率比较差异无统计学意义（χ²=3.363，P>0.05）；治疗后6个月两组患者血清中IL-4表达水平显著降低（P<0.05），IFN-γ显著升高（P<0.05），且试验组患者IL-4降低水平及IFN-γ升高水平均优于对照组（P<0.05）。[结论]麻杏石甘汤加减结合常规疗法能够有效缓解支气管哮喘患者的临床症状，改善呼吸功能，降低FeNO水平，疗效满意，患者依从性高。

Abstract:

[Objective] In order to evaluate the clinical curative effect by the method of Maxing Shigan Decoction combined with conventional therapy to treat acute bronchial asthma of evil heat obstructing lung syndrome, and explore the mechanism.[Methods] The 188 cases patients of acute bronchial asthma of evil heat obstructing lung syndrome accorded with the inclusion criteria were selected and randomly divided into the experimental group and the control group, each group had 94 patients. With 10 cases lost in the study, the lost rate was 5.32%. A total of 178 patients were completed, including 90 in the experimental group and 88 in the control group. The control group was given conventional Western medicine therapy, the experimental group was given Maxing Shigan Decoction combined with conventional Western medicine therapy, 1 week for a course and 2 courses were treated consecutively of two groups and followed up for 6 months; after 2 courses of treatment, two groups of TCM syndromes effect, asthma symptoms, lung function, exhaled gas-nitric oxide(FeNO) score and the clinical efficacy were observed. After 6 months treatment, expression levels of serum IL-4, IFN-γ and recurrence were observed.[Results] The score of respite, coughing, sputum, chest tightness and wheezing in the two groups was lower than before treatment (P<0.05). After treatment, the TCM syndrome score of the experimental group was lower than that of the control group (P<0.05). After treatment, both the day and night symptoms were lower than before treatment, with significant difference (P<0.05), the experimental group was lower than the control group (P<0.05). The lung function was improved after treatment than before in 2 groups (P<0.05); the experimental group was better than the control group (P<0.05). The FeNO levels of two groups were no significantly reduced (P<0.05), and the FeNO levels of the experimental group was lower than the control group (P<0.05). The total effective rate of the experimental group was 96.7% and 89.8% in the control group, and the difference in the efficiency of the two groups was no statistically significant (χ²=3.363, P>0.05). After 6 months treatment, 2 groups of patients with serum IL-4 expression level decreased significantly (P<0.05), while IFN-γ increased significantly (P<0.05), and the level of IL-4 decreased and the level of IFN-γ increased were better than the control group (P<0.05).[Conclusion] Maxing Shigan Decoction combined with conventional therapy can effectively relieve the clinical symptoms of patients with bronchial asthma, improve respiratory function, reduce FeNO level, satisfactory effect, and patient compliance.