钩藤饮子合小青龙汤辨证治疗咳嗽变异性哮喘（风邪犯肺证）的效果及对外周血白三烯D4、C4及尿白三烯E4水平的影响

Efficacy of Gouteng Yinzi with Xiaoqinglong Decoction in the dialectical treatment of cough variant asthma (pathogenic wind invading the lung) and its influence on levels of peripheral blood leukotriene D4 and C4 and urinary leukotriene E4

关键词:  钩藤饮子合小青龙汤  咳嗽变异性哮喘  肺功能  白三烯  尿白三烯

Key words:  Gouteng Yinzi with Xiaoqinglong Decoction  cough variant asthma  lung function  leukotriene  urinary leukotriene

摘要:

[目的] 探究钩藤饮子合小青龙汤辨证治疗咳嗽变异性哮喘（风邪犯肺证）的效果及对外周血白三烯D4（LTD4）、C4（LTC4）及尿白三烯E4（LTE4）水平的影响。[方法] 选取海口市人民医院100例咳嗽变异性哮喘患者为研究对象，按照简单随机法分为对照组和观察组，对照组（50例）给予孟鲁司特钠片和沙美特罗替卡松粉吸入剂治疗，观察组（50例）在对照组基础上加用钩藤饮子合小青龙汤治疗，比较治疗2个月后两组患者的临床疗效、中医症状积分改善情况、肺功能[第1秒用力呼气容积（FEV1）、呼气高峰流速（PEF）、用力肺活量（FVC）]、外周血炎症因子水平[LTD4、LTC4、LTE4、血清嗜酸性粒细胞（EOS）、免疫球蛋白（IgE）]、药物不良反应及治疗结束6个月内预后。[结果] 治疗2个月后，观察组疗效优于对照组（P<0.05）；两组中医症状积分降低（P<0.05），且治疗后观察组中医症状积分低于对照组（P<0.05）；两组FEV1、PEF、FVC水平升高（P<0.05），外周血LTD4、LTC4、LTE4、血清EOS、IgE水平降低（P<0.05），且治疗后上述指标组间比较差异有统计学意义（P<0.05）；治疗期间，两组不良反应发生率比较差异无统计学意义（P>0.05）；治疗结束后6个月内随访，对照组有13例复发，复发率26.00%，观察组出现4例复发，复发率8.00%，组间比较差异有统计学意义（P<0.05）。[结论] 钩藤饮子合小青龙汤治疗咳嗽变异性哮喘（风邪犯肺证）临床有效、安全，可改善症状，提高肺功能，抑制炎症因子水平，且复发率较低。

Abstract:

[Objective] To explore the effects of Gouteng Yinzi with Xiaoqinglong Decoction in the dialectical treatment of cough variant asthma (pathogenic wind invading the lung) and its influence on levels of peripheral blood leukotriene D4 (LTD4) and leukotriene C4 (LTC4) and urinary leukotriene E4 (LTE4).[Methods] Totally 100 patients with cough variant asthma in the hospital were selected as the research subjects, and they were divided into control group and observation group according to the simple random number table method. Control group (n=50) was given Montelukast Sodium Tablets and Salmeterroticasone powder inhaler, and observation group was additionally treated with Gouteng Yinzi with Xiaoqinglong Decoction on the basis of control group. The clinical efficacy, improvement status of traditional Chinese medicine(TMC) symptoms, lung function[forced expiratory volume (FEV1), peak expiratory flow rate (PEF), forced vital capacity (FVC)], levels of peripheral blood inflammatory factors[leukotriene D4 (LTD4), leukotriene C4 (LTC4), urinary leukotriene E4 (LTE4), serum eosinophil (serum EOS), immunoglobulin (IgE)] and adverse drug reactions after 2 months of treatmentand prognosis within 6 months after the end of treatment were compared between the two groups.[Results] After 2 months of treatment, the TCM efficacy of observation group was significantly better than that of control group(P<0.05). The TCM syndromes scores were significantly reduced (P<0.05), and the syndromes scores of observation group were significantly lower than those of control group(P<0.05). The levels of lung function indexes FEV1, PEF and FVC in the two groups were significantly increased(P<0.05) while the levels of peripheral blood LTD4, LTC4 and LTE4, serum EOS and IgE were significantly decreased(P<0.05), and there were significant differences in the above indicators between the groups after treatment (P<0.05). During treatment, there were no significant differences in the incidence rates of adverse reactions between the two groups(P>0.05). During follow-up within 6 months after the end of treatment, there were 13 cases of recurrence in control group with a recurrence rate of 26.00%, and there were 4 cases of recurrence in observation group with a recurrence rate of 8.00% (P<0.05).[Conclusion] Gouteng Yinzi with Xiaoqinglong Decoction is clinically effective and safe in the treatment of cough variant asthma of pathogenicevil invading the lung syndrome, and it can significantly improve symptoms, enhance lung function and inhibit inflammatory factors, with low recurrence rate.