平喘养肺汤联合布地奈德治疗COPD稳定期患者的疗效与安全性研究

摘要  目的：研究平喘養肺汤联合布地奈德治疗慢性阻塞性肺疾病（COPD）稳定期患者的疗效与安全性。方法：选取2016年4月至2018年12月亳州市中医院肺病科收治的COPD稳定期患者88例作为研究对象，按照抽签法随机分为观察组及对照组，每组44例。对照组予以布地奈德治疗，观察组则在布地奈德治疗的基础上增用平喘养肺汤治疗。分别比较2组临床疗效，治疗前后肺功能指标变化，治疗前后Keap1-Nrf2-ARE信号通路相关指标水平，不良反应发生率。结果：观察组总有效率高于对照组，差异有统计学意义（ P <0.05）。治疗后观察组第1秒最大呼气量（FEV1）、最大呼气峰流速值（PEF）、第1秒最大呼气量与用力肺活量的比值（FEV1/FVC）等指标均高于对照组（均 P <0.05）。治疗后观察组各项Keap1-Nrf2-ARE信号通路指标低于对照组（均 P <0.05），观察组不良反应发生率低于对照组（ P <0.05）。结论：平喘养肺汤联合布地奈德治疗COPD稳定期患者的疗效显著，且安全性较好，其主要作用机制可能与调节Keap1-Nrf2-ARE信号通路有关，值得临床推广应用。

关键词  慢性阻塞性肺疾病;平喘养肺汤;布地奈德;疗效;安全性

Study on the Efficacy and Safety of Pingchuan Yangfei Decoction Combined with Budesonide in Treating Patients with Chronic Obstructive Pulmonary Disease at Stable Stage

CUI Lei

（Bozhou Hospital of Traditional Chinese Medicine，Bozhou 236800，China）

Abstract Objective： To study the efficacy and safety of Pingchuan Yangfei Decoction combined with budesonide in the treatment of patients with chronic obstructive pulmonary disease（COPD）at stable stage. Methods： A total of 88 patients with COPD stable period admitted to Bozhou Hospital of Traditional Chinese Medicine from April 2016 to December 2018 were selected as research objects，and were divided into an observation group and a control group by random lottery，with 44 cases in each group.The control group was treated with budesonide，while the observation group was treated with Pingchuan Yangfei Decoction on the basis of budesonide.Clinical efficacy of the 2 groups were compared，including the level of pulmonary function indicators before and after treatment，the level of related indicators of keap1-nrf2-are signaling pathway before and after treatment，and adverse reactions. Results： The total effective rate of the observation group was higher than that of the control group（ P <0.05）.After treatment，the maximum expiratory volume（FEV1），peak expiratory velocity（PEF），and ratio of the maximum expiratory volume（FEV1/FVC）of the 1st second in the observation group were all higher than those in the control group（all  P <0.05）.After treatment，the levels of Keap1-nrf2-ARE signaling pathway indicators in the observation group were lower than those in the control group（all  P <0.05）.The incidence of adverse reactions in the observation group was lower than that in the control group（all  P <0.05）. Conclusion： Pingchuan Yangfei Decoction combined with budesonide in the treatment of COPD patients at stable stage has significant efficacy and good safety，and its main mechanism may be related to the regulation of Keap1-nrf2-are signaling pathway.It is worthy of clinical application.

Keywords  Chronic obstructive pulmonary disease; Pingchuan Yangfei Decoction; Boudesnard; Curative effects; Security

中图分类号：R563 文献标识码：A  doi： 10.3969/j.issn.1673-7202.2020.14.014

慢性阻塞性肺疾病（Chronic Obstructive Pulmonary Disease，COPD）是指一组以气流受限为主要特征的气道不完全可逆的呼吸系统疾病，具有较高的发病率，患者普遍伴有长期反复咳嗽、咳痰、喘息等一系列症状，且伴有不同程度的肺功能障碍，并表现为进行性发展，严重影响了患者的日常生活以及工作[1-2]。相关研究显示，COPD稳定期患者仍伴有不同程度的慢性炎性反应，如不予以积极有效的干预易引起COPD的急性发作，从而加重病情[3]。因此针对COPD稳定期患者进行有效的治疗显得尤为重要，已是目前临床关注的热点。其中布地奈德是目前临床上广泛用以治疗COPD的药物之一，治疗效果良好，然而长期使用可能引发一系列不良反应，继而降低患者的耐受性，不利于预后。中医认为[4]，COPD当属“咳嗽”“肺胀”等范畴，肺脾肾亏虚以及痰瘀交阻是其主要病机，因此在临床工作中可将补肺纳肾健脾作为治疗COPD的新靶点和新方向。……