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消喘膏贴敷疗法对稳定期慢性阻塞性肺疾病患者气道炎症的影响
【作者】 田怡；
【导师】 王蕾；
【作者基本信息】 北京中医药大学 ， 中医内科学， 2011， 硕士
【摘要】 研究目的：慢性阻塞性肺疾病(Chronic Obstructive Pulmonary Disease, COPD)是呼吸系统常见病、多发病,病情呈进行性发展,目前尚无完全治愈的方法,严重影响患者的劳动能力和生存质量。目前西医对COPD尤其是稳定期的治疗,多是对症治疗；药物治疗的重点只在于改善症状和(或)减少并发症。冬病夏治消喘膏穴位敷贴疗法临床广泛应用于慢性咳喘疾患的防治,广安门医院呼吸科前期工作提示本疗法的在改善慢阻肺稳定期患者生存质量、减少冬季发作次数等发面具有显著的优势,但目前相关作用机制的研究尚欠缺。因此,我们旨在通过对诱导痰气道炎症因子的检测,以期窥探消喘膏治疗的可能作用靶点,为进一步完善和推广消喘膏穴位贴敷技术提供科学实验依据,从一个侧面揭示中医冬病夏治经典理论的科学内涵。研究方法：病例资料：按照COPD稳定期中西医诊断标准、纳入标准,纳入56例首次接受贴敷治疗的稳定期COPD门诊患者,随机分为两组,治疗组予以消喘膏贴敷治疗,安慰剂对照组予安慰剂贴敷,贴敷穴位为双侧肺腧(BL13)、心腧(BL15)、膈腧(BL17),每次贴敷6小时,于2009年夏季三伏治疗3次,随访1年。完成病例50例,脱落6例。气道炎症的机制研究：在敷贴前、6个月后分别留取诱导痰样本,制备痰涂片,观察中性粒细胞计数；上清液处理后-70℃保存采用ELISA方法测定IL-8(白细胞介素8)、SIgA(分泌型免疫球蛋白A)、LEP(瘦素)的分泌水平；生活质量研究：第一次敷贴前、敷贴后3、6、12个月分别进行相关问卷调查,主要观察指标包括:St·George’s呼吸疾病问卷(SGRQ)、中医证型评分、MMRC评分。结果：气道炎症的机制研究：①中性粒细胞计数(COPD气道炎症常见浸润细胞)：治疗组疗后中性粒细胞计数减少优于对照组(P<0.05),对照组疗后中性粒细胞计数无明显变化(P>0.05)。②IL-8、LEP(炎症介质,加重炎症反应)：治疗组诱导痰上清液中IL-8、LEP含量疗后降低(P<0.05),且显著优于对照组,对照组疗后IL-8有所升高(P>0.05)。③SIgA(黏膜免疫蛋白,减少反复感染)：治疗组诱导痰上清液SIgA含量疗后较疗前升高(P<0.05),而对照组略有降低(P<0.05)。生活质量研究：①圣乔治问卷：治疗组敷贴治疗后各项数值均较疗前降低(P<0.05),到冬季又有所升高,对照组与疗前比无明显变化。②MMRC评分：治疗组在疗后12个月评分较疗前降低(P<0.05),余无统计学差异。③中医症状评分：治疗组、对照组的中医症状积分在敷贴治疗后较疗前均有减少(P<0.05),治疗组分值较对照组低,但两组间无统计学差异。无不良反应记录。结论：冬病夏治消喘膏穴位贴敷法可增强气道粘膜保护,改善气道慢性炎症,提高COPD,患者生存质量,减轻冬季症状加重,起到对稳定期COPD的治疗作用
【Abstract】 Objective:Chronic Obstructive Pulmonary Disease (COPD) is a common, frequently-occurring and progressive disease. At present, there is no effective treatment measure for COPD, which has seriously affectted the patients’ability of work and quality of life. Up to now, most western medicine treatment to COPD, especially stationary phase, is symptomatic treatment. The focus of therapy is improving symptoms and(or) reducing complications. And traditional Chinese medicine treatment, which named "treatment of wintertime disease in summer by point application with Xiao chuan paste(XCP)", had been widely used in clinical practice. Guang an men hospital pulmonary department had done research before and point out the it can improve COPD patients’life quality and reduce attack frequency in winter. But till lack of co-relational research, especially the study of mechanism of action. Therefore, this research is designed for explore the possible target of "Xiao Chuan paste" cure COPD patients, through component testing of induced sputum. Also could supply scientific experiment evidence for further perfecting and promoting XCP’clinical practice, and reveal the scientific connotation of classical theory "treatment of wintertime disease in summer by point application" from a sideway.Methods:Case information:according to the diagnostic and exclusion criteria both in west medicine and TCM,56 COPD patients were randomly divided into two groups (6 expulsions). The treatment group with 30 patients were gave XCP stuck on fei shu (BL13)、xin shu (BL15)、ge shu (BL17) both sides 6 hours every day in dog-days of summer.20 patients in control group were gave placebo stuck on the same points 6hours in the same days as treatment group. Airway inflammation research:before treatment, got every patients’induced sputum,-70℃preserved. After 6-month follow-up, got induced sputum again, and compared with the first-time sputum. The main observed indexes were IL-8、SIgA、LEP、total quantity of inflammatory cell. Quality of life research:before first time paste, did St·George’s respiratory disease questionnaire、rating of TCM syndrome type、MMRC score. And did the follow-up again at 3、6、12month. The main point of compare is the change of correlation analysis about follow-up questionnaire index。Results:Airway inflammation research:①Inflammation cells(common cell in COPD airway inflammation):The reducing of total quantity of inflammatory cell of treatment group is significantly better than control group(P<0.05), control group do not has obverse change in this index(P>0.05).②IL-8、LEP(mediators of inflammation, which can improve the inflammation):IL-8、LEP in supernatant fluid of induced sputum of control group is decreased obviously(P<0.05) after treatment, and much better than control group, IL-8 of control group even increased(P>0.05);③SIgA(tunicae mucosa immune proteins, reduce frequency of influence):SIgA in supernatant fluid of induced sputum of control group increased after treatment P< 0.05), which was depressed in control group(P<0.05)。Quality of life research:①SGRQ questionnaire:all index of treatment group has decreased after therapy (P<0.05), but they increased some in winter, control group do not has significant change.②MRC score:the grade of treatment group fall down compared to therapy before(P<0.05), after 12 months.③Traditional Chinese medicine symptom score:the grade of both group decreased after treatment(P<0.05), score of treatment group is lower than, control group, but not has statistics difference. There was no adverse reaction.Conclusion:Xiao Chuan paste point application treatment could enhance airway mucosal protection, improve the airway chronic inflammation, raise the QOL of COPD patients, lighten the exacerbation in winter, cure COPD patients in stable period at last.