玉屏风散对慢性阻塞性肺疾病急性加重及细胞免疫失衡的调节作用

Regulating effect of Yupinfeng powder on exacerbation of COPD and cellular immune imbalance

关键词:  慢性阻塞性肺疾病  气虚质  急性加重  玉屏风散  免疫

Key words:  chronic obstructive pulmonary disease  qi deficiency  acute exacerbation  Yupinfeng powder  immune

摘要:

[目的] 探讨玉屏风散对气虚质稳定期慢性阻塞性肺疾病(简称慢阻肺，下同)患者的临床干预效果，对急性加重的预防及细胞免疫失衡的调节作用。[方法] 将86例患者按随机数字表法分为对照组43例和观察组43例。对照组予以长效支气管舒张剂吸入，对中度及以上患者联合吸入糖皮质激素及口服化痰平喘西药、适当氧疗等西医常规治疗；观察组在对照组基础上加服玉屏风散颗粒剂1袋(组方:黄芪15 g，白术15 g，防风7.5 g)/次，2次/日，饭后30 min温开水冲服。治疗6个月后，比较两组患者治疗前后肺功能、6分钟步行试验(6MWT)、慢阻肺评估测试评分(CAT)、改良版英国医学研究委员会呼吸困难量表评分(mMRC)、生活质量评价量表(SF-36)评分的变化，以及免疫指标CD4⁺、CD8⁺、CD4⁺/CD8⁺、Th17、Treg、Th17/Treg水平的变化；统计两组治疗期间急性加重次数，并进行比较；进行安全性评价。[结果] 观察组患者治疗后FEV1/Pred(%)、FVC/Pred(%)、FEV1/FVC(%)较治疗前均有升高(P<0.05)；两组患者6MWT距离较治疗前均有延长(P<0.05)，CAT评分均有降低(P<0.05)，且治疗后观察组6MWT距离显著长于对照组(P<0.05)，CAT评分明显低于对照组(P<0.05)；治疗后两组患者SF-36评分的8个维度分数均有提高(P<0.05)，且治疗后观察组RP、GH、VT 3个维度的分数明显高于对照组(P<0.05)；治疗后两组患者CD4⁺、CD4⁺/CD8⁺较治疗前明显升高(P<0.05)，CD8⁺明显降低(P<0.05)，且治疗后观察组CD4⁺、CD4⁺/CD8⁺明显高于对照组(P<0.05)，CD8⁺明显低于对照组(P<0.05)；治疗后两组患者Th17较治疗前均有降低(P<0.05)，Treg较治疗前均有升高(P<0.05)，Th17/Treg 在观察组表现出较治疗前明显降低(P<0.05)，治疗后与对照组相比，观察组Th17/Treg 明显低于对照组(P<0.05)；观察组的急性加重次数、急性加重持续天数、AECOPD发病率均显著低于对照组(P<0.05)。[结论] 玉屏风散治疗气虚质慢性阻塞性肺病患者，可提高生活质量、调节机体细胞免疫、减少慢阻肺急性加重，无明显不良反应，安全有效。

Abstract:

[Objective] To explore Yupinfeng powder on the deficiency of qualitative stability of chronic obstructive pulmonary disease (COPD) patients clinical intervention effect,and the prevention of acute exacerbation and regulation of cellular immune imbalance.[Methods] According to the random number table method,the 86 patients can be divided into control group and observation group,each group had 43 cases. The control group was treated with effective bronchi relaxation suction. For those moderate patients,they were treated with inhaled corticosteroids and combined with eliminating phlegm to smooth wheezing oral Western medicine,appropriate oxygen therapy Western medicine treatment. Based on the basic Western medicine treatment,the observation group was added with Yupinfeng powder granule,take one bag orally,twice a day,30 minutes later after breakfast or dinner (formula:astragalus,atractylodes 15 g,windproof 7.5 g). After 6 months treatment,pulmonary function,6 MWT,CAT,mMRC,SF-36 scale changes,and the immune indexes of CD4⁺,CD8⁺,CD4⁺/CD8⁺ and the change of Th17 and Treg and Th17/Treg level,the treatment of acute aggravating during treatment period were compared between two group before and after treatment. The safety evaluation was record.[Results] After treatment,FEV1 Pred(%),FVC Pred(%),FEV1/FVC(%) in observation group were higher than before treatment (P<0.05). After treatment,6 MWT distance were extended than before treatment in both groups (P<0.05),the CAT scores were lower than before treatment in both groups (P<0.05). After treatment,6 MWT distance in observation group was longer than that in control group significantly(P<0.05),the CAT score in observation group was significantly lower than that in control group(P<0.05). After treatment,eight dimensions of SF-36 scoring scores were increased in both two groups(P<0.05),and the RP,GH,VT and scores of three dimensions in observation group was obviously higher than that in control group(P<0.05). After treatment,CD4⁺,CD4⁺/CD8⁺ were increased significantly than that before treatment in two groups (P<0.05),and CD8⁺ were significantly decreased(P<0.05). After treatment,CD4⁺,CD4⁺/CD8⁺ in observation group were significantly higher than that in control group(P<0.05),and CD8⁺ in observation group was significantly lower than that in control group(P<0.05). After treatment,Th17 was lower in both two groups than that before treatment(P<0.05),Treg was increased in both two groups before treatment (P<0.05). Th17/Treg was significantly lower in observation group than that before treatment(P<0.05). After treatment,Th17/Treg in observation group was significantly lower than that in control group(P<0.05). The number of exacerbations,the last days of exacerbations, the incidence of AECOPD in observation group were significantly lower than that in control group(P<0.05).[Conclusion] Yupinfeng powder can treat COPD patients with qi deficiency syndrome,by improving the quality of life,regulating the body's cell immunity,reducing COPD exacerbations,with no obvious adverse reaction,which is safety and effective.