木防己汤加味方联合中药离子导入治疗气虚痰瘀型弥漫性肺间质纤维化临床研究
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R563.9

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Clinical Study on Modified Mufangji Tang and Chinese Herbs Iontophoresis for Diffuse Pulmonary Interstitial Fibrosis of Qi Deficiency and Phlegm-Stasis Type
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    摘要:

    目的:观察木防己汤加味方联合中药离子导入治疗气虚痰瘀型弥漫性肺间质纤维化的临床疗效。方法:将60 例弥漫性肺间质纤维化患者随机分为观察组和对照组各30 例。对照组在抗菌、对症支持治疗的基础上给予强的松片口服,观察组在对照组的基础上给予木防己汤加味方联合中药离子导入治疗。2 组均连续治疗4 周。观察治疗后2 组患者临床疗效,治疗前后中医证候积分、肺功能[用力肺活量(FVC)、FEV1 占预计值百分比(FEV1%)、一氧化碳弥散量(DLCO)、氧分压(PO2)]、全血白细胞、中性粒细胞、嗜酸性粒细胞、血管内皮生长因子(VEGF) 及肺泡灌洗液中肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6) 水平。结果:治疗后,观察组总有效率为90.00%,对照组为56.67%,2 组比较,差异有统计学意义(P<0.05)。治疗前,2 组中医证候积分比较,差异无统计学意义(P>0.05);治疗后,2 组中医证候积分均显著低于治疗前(P<0.05),且观察组中医证候积分显著低于对照组(P<0.05)。治疗前,2 组肺功能指标FVC、FEV1%、DLCO、PO2 水平比较,差异无统计学意义(P>0.05);治疗后,2 组上述肺功能指标均较治疗前明显改善(P<0.05),且观察组各项指标改善较对照组更显著(P<0.05)。治疗期间,2 组血液白细胞、中性粒细胞、嗜酸性粒细胞水平治疗前后比较,差异无统计学意义(P>0.05)。治疗前,2 组血清VEGF 值比较,差异无统计学意义(P>0.05);治疗后,观察组血清VEGF 水平较治疗前降低,且低于对照组(P<0.05);而对照组VEGF 水平则与治疗前差异不太(P>0.05)。治疗前,2 组TNF-α、IL-1β、IL-6 水平比较,差异无统计学意义(P>0.05);治疗后,2 组TNF-α、IL-1β、IL-6 水平均较治疗前降低(P<0.05),且观察组TNF-α、IL-1β、IL-6 水平均低于对照组(P<0.05)。结论:在常规治疗的基础上采用木防己汤加味方及中药离子导入治疗气虚痰瘀型弥漫性肺间质纤维化疗效显著,能改善中医证候及VEGF 水平,减轻炎症反应,改善肺功能。

    Abstract:

    Abstract: Objective: To observe the clinical effect of the therapy of modified Mufangji tang and Chinese herbs iontophoresis on diffuse pulmonary interstitial fibrosis of qi deficiency and phlegm-stasis type. Methods:A total of 60 patients with diffuse pulmonary interstitial fibrosis were randomly divided into the observation group and the control group,with 30 cases in each group. The control group was orally given prednisone tablets based on the antibacterial and symptomatic supportive treatment,and the observation group was additionally given the therapy of modified Mufangji tang and Chinese herbs iontophoresis based on the treatment of the control group. Both groups were treated for four weeks. The clinical effects in the two groups after treatment, and the Chinese medicine syndrome scores, levels of lung function indexes including forced vital capacity(FVC), the percentage of FEV1 to evaluated value(FEV1% ), diffusing capacity of the lungs for carbon monoxide(DLCO) and oxygen partial pressure(PO2),whole blood leukocytes,neutrophils,eosinophils,vascular endothelial growth factor(VEGF),tumor necrosis factor-α(TNF-α),interleukin-1 β(IL-1β) and interleukin-6(IL-6) in alveolar lavage fluid before and after treatment were observed. Results:After treatment,the total effective rate was 90.00% in the observation group and 56.67% in the control group,the difference being significant(P<0.05). Before treatment,there was no significant difference in Chinese medicine syndrome scores between the two groups(P>0.05). After treatment,the Chinese medicine syndrome scores in both groups were significantly lower than those before treatment(P<0.05), and the score in the observation group was significantly lower than that in the control group(P<0.05). Before treatment,there was no significant difference in the levels of FVC, FEV1% , DLCO and PO2 between the two groups(P>0.05). After treatment, the improvement of the above lung function indexes in both groups was better than that before treatment(P<0.05), and the improvement of the above indexes in the observation group was more significant than that in the control group(P<0.05). During treatment, the levels of whole blood leukocytes, neutrophils and eosinophils in both groups before and after treatment showed no significant significance(P>0.05). Before treatment,there was no significant difference in the level of serum VEGF between the two groups(P>0.05). After treatment, the level of serum VEGF in the observation group was decreased when compared with that before treatment(P<0.05),and the above level in the observation group was lower than that in the control group(P<0.05); the VEGF level in the control group was not significantly different from that before treatment(P>0.05). Before treatment,there was no significant difference in the levels of TNF-α,IL-1β and IL-6 in alveolar lavage fluid between the two groups(P>0.05). After treatment,the above three levels in both groups were decreased when compared with that before treatment(P<0.05),and the above three levels in the observation group were lower than those in the control group(P<0.05). Conclusion:On the basis of conventional treatment,the therapy of modified Mufangji tang and Chinese herbs iontophoresis has a significant effect on diffuse pulmonary interstitial fibrosis of qi deficiency and phlegmstasis type, which can improve the Chinese medicine syndrome and the VEGF level, reduce inflammatory responses and improve lung function.

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宋东升,周庆伟,崔伟锋.木防己汤加味方联合中药离子导入治疗气虚痰瘀型弥漫性肺间质纤维化临床研究[J].新中医,2022,54(12):60-65

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  • 在线发布日期: 2022-06-22
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