海南医科大学学报

目的:对名中医王玉林自拟方热哮汤对急性期支气管哮喘(BA)的安全性和疗效、机制进行临床研究。方法:将80例急性发作期BA患者随机分成西医组40例、中西医组40例。西医组以西医常规治疗:沙美特罗替卡松每次1吸,吸入每日2次,配合氧疗及诱因治疗。中西医组在西医组治疗基础上联合热哮汤煎服,疗程15 d。观察证候评分、血气分析(PaCO₂、 PaO₂),诱导痰IL-5、EOS、IL-13、肺功能(PEF%Pred、FEV1%Pred),中西医组的肾、肝功能、血常规,记录不良反应。结果:两组总有效率比较,差异具有统计学意义(P<0.01)。中西医组在治疗后对中医证候积分改善优于西医组(P<0.05)。中西医组于治疗后肺功能(FEV1%Pred)改善优于西医组(P<0.01),中西医组PEF%Pred较西医组改善(P<0.05)。中西医组治疗后血气分析(PaO₂)上升较西医组明显(P<0.05),两组治疗后对血气分析(PaCO₂)改进无显著差异(P>0.05)。中西医组治疗后痰IL-13、EOS及IL-5降低较西医组多(P<0.01)。中西医组治疗前后肝功能(AST、ALT)、肾功能(Cr、Urea)、血常规(WBC、 RBC、 PLT)比较,差异均无统计学意义(P>0.05);未见明显不良反应。结论:热哮汤治疗急性发作期支气管哮喘热哮证安全且有效,作用靶点与降低炎症因子和嗜酸性粒细胞相关可能性大,致气道炎症影响及高反应降低。

Objective: To study the safety, efficacy and mechanism of Wang Yulin self-made recipe Rexiao decoction in the treatment of acute bronchial asthma. Methods:A total of 80 patients with acute bronchial asthma were randomly divided into the western medicine group(control group, n=40) and the traditional Chinese and western medicine group(n=40). The control group was treated with routine western medicine: salmeterol was inhaled twice a day, combined with oxygen therapy and inducement therapy; while the Chinese and western medical group was treated with Rexiao decoction based onthe western medical group. The course of treatment in the Chinese and western medical groupwas15 days. The syndrome score, blood gas analysis(PaCO₂, PaO₂) and induced sputum IL-5, EOS, IL-1,and pulmonary function(PEF% Pred, FEV1% Pred)were observed;kidney, liver function, blood routine, and adverse reactions wererecorded. Results:The total effective rate was 85% in the western medicine group and 92.5%in the traditional Chinese and western medicine group(P<0.01). After treatment, the score of TCM syndromes in the Chinese and western medicine group was better than that in the western medicine group(P<0.05). After treatment, the pulmonary function(FEV1% Pred) of the traditional Chinese and western medicine group was better than that of the western medicine group, and the PEF% Pred of the Chinese and western medicine group was better than that of the western medicine group. The blood gas(PaO₂)in the traditional Chinese and western medicine group after treatment was significantly higher than that in the control group(P<0.05). There was no significant difference in the improvement of blood gas analysis(PaCO₂) between the western medicine group and the traditional Chinese and western medicine group(P>0.05). The decrease of IL-13,EOS and IL-5 in sputum of the traditional Chinese and western medicine group was more than that of the western medicine group(P<0.01). There was no significant difference in liver function(AST, ALT), renal function(Cr, Urea), blood routine(WBC, RBC, PLT) before and after treatment in traditional Chinese and western medicine group(P>0.05), but no obvious adverse reactions were found. Conclusion:Rexiao decoction is safe and effective in the treatment of asthma of heat wheezing type at the acute stage. The target and inflammatory factors, eosinophils are likely to decrease, and the effect of airway inflammation and high reaction are decreased.