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TCM

Traditional Chinese Medicine

2166-6067

Scientific Research Publishing

10.12677/TCM.2023.121049

TCM-60848

TCM20230100000_56152240.pdf

医药卫生

基于培土生金理论探讨加味玉屏风散治疗支气管扩张症的临床疗效 Clinical Study of Modified Yupingfeng Powder in the Treatment of Bronchiectasis Based on the Theory of Spleen Invigorating and Lung Benefiting

魏

萍

¹ ^* 陈

志斌

¹ ² 李

大治

¹ ² 施

金晶

¹ ²

福建中医药大学附属第二人民医院，呼吸与危重症医学科，福建福州

null

09 01 2023

12 01 311 316

2014

This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/

目的：基于培土生金理论探讨加味玉屏风散治疗支气管扩张症稳定期肺脾气虚证患者的临床疗效。方法：将支气管扩张症稳定期肺脾气虚证患者60例，随机分为对照组和治疗组，每组30例。对照组口服桉柠蒎0.3g/次，2次/d，治疗组在对照组基础上，加用加味玉屏风散治疗，疗程6个月。比较两组治疗前后的中医证候积分、急性加重风险、炎症因子(白介素6 (IL-6)、C反应蛋白(CRP)和降钙素原(PCT))和肺功能指标(呼气峰流量(PEF)、第1 s用力呼气容积(FEV1)、呼出25%肺活量时最大呼气流量(FEF25%)、呼出50%肺活量时最大呼气流量(FEF50%)和最大呼气中段流速(MMEF))。结果：两组患者治疗后中医证候积分、急性加重风险、IL-6、CRP均较治疗前显著性下降，且治疗组显著低于对照组，差异具有统计学意义。两组患者治疗后FEF50%、FEF25%和MMEF较治疗前显著升高，且治疗组显著高于对照组，差异具有统计学意义。结论：加味玉屏风散可显著改善支气管扩张症患者证候积分，减少急性加重风险，还可以减少各种炎症因子，改善小气道功能，这可能与减少呼吸道细菌、减轻气道分泌物阻塞有关。 Objective: To explore the clinical effect of modified Yupingfeng Powder in the treatment of bron-chiectasis in stable phase of deficiency of lung and temper based on the theory of Spleen Invigo-rating and Lung benefiting. Methods: 60 patients with bronchiectasis in stable phase of deficiency of lung and temper were selected and divided into control group and treatment group via random number table, with 30 cases in each group. The control group was given eucalyptus pinase 0.3 g one time, twice one day, and the treatment group was additionally given modified Yupingfeng Powder, a course of 6 months. To compare syndrome scores, risk of acute exacerbation, inflammatory factors (interleukin-6 (IL-6), C-reactive protein (CRP) and procalcitonin (PCT)) and pulmonary function (peak expiratory flow (PEF), forced expiratory volume of 1s (FEV1), maximum expiratory flow at 25% of vital capacity (FEF25%), maximum expiratory flow at 50% of vital capacity (FEF50%) and maximum mid-expiratory flow (MMEF)), between the two groups before and after treatment. Results: Syndrome score, risk of acute exacerbation, IL-6 and CRP in 2 groups were significantly decreased after treatment, and the treatment group was significantly lower than the control group, and the difference was statistically significant. After treatment, FEF50%, FEF25% and MMEF in 2 groups were significantly higher than before treatment, and the treatment group was significantly higher than the control group, and the difference was statistically significant. Conclusion: Modified Yupingfeng Powder can significantly improve the syndrome scores, reduce the risk of acute exacerbation, reduce various inflammatory factors and improve the function of small airway of patients with bronchiectasis, which may be related to the reduction of respiratory bacteria and airway secretion obstruction.

培土生金，玉屏风散，支气管扩张症，肺脾气虚证, Spleen Invigorating and Lung Benefiting Yupingfeng Powder Bronchiectasis Deficiency of Lung and Temper

摘要

关键词

培土生金，玉屏风散，支气管扩张症，肺脾气虚证

Clinical Study of Modified Yupingfeng Powder in the Treatment of Bronchiectasis Based on the Theory of Spleen Invigorating and Lung Benefiting<sup> </sup>

Ping Wei, Zhibin Chen, Dazhi Li, Jinjing Shi

The Second People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou Fujian

Received: Nov. 22^nd, 2022; accepted: Jan. 23^rd, 2023; published: Jan. 31^st, 2023

ABSTRACT

Objective: To explore the clinical effect of modified Yupingfeng Powder in the treatment of bronchiectasis in stable phase of deficiency of lung and temper based on the theory of Spleen Invigorating and Lung benefiting. Methods: 60 patients with bronchiectasis in stable phase of deficiency of lung and temper were selected and divided into control group and treatment group via random number table, with 30 cases in each group. The control group was given eucalyptus pinase 0.3 g one time, twice one day, and the treatment group was additionally given modified Yupingfeng Powder, a course of 6 months. To compare syndrome scores, risk of acute exacerbation, inflammatory factors (interleukin-6 (IL-6), C-reactive protein (CRP) and procalcitonin (PCT)) and pulmonary function (peak expiratory flow (PEF), forced expiratory volume of 1s (FEV1), maximum expiratory flow at 25% of vital capacity (FEF25%), maximum expiratory flow at 50% of vital capacity (FEF50%) and maximum mid-expiratory flow (MMEF)), between the two groups before and after treatment. Results: Syndrome score, risk of acute exacerbation, IL-6 and CRP in 2 groups were significantly decreased after treatment, and the treatment group was significantly lower than the control group, and the difference was statistically significant. After treatment, FEF50%, FEF25% and MMEF in 2 groups were significantly higher than before treatment, and the treatment group was significantly higher than the control group, and the difference was statistically significant. Conclusion: Modified Yupingfeng Powder can significantly improve the syndrome scores, reduce the risk of acute exacerbation, reduce various inflammatory factors and improve the function of small airway of patients with bronchiectasis, which may be related to the reduction of respiratory bacteria and airway secretion obstruction.

Keywords:Spleen Invigorating and Lung Benefiting, Yupingfeng Powder, Bronchiectasis, Deficiency of Lung and Temper

This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).

http://creativecommons.org/licenses/by/4.0/

1. 引言

支气管扩张症是一种慢性气道炎症性疾病，病因不详，细菌定植是恶性循环假说 [ 1 ] 的重要环节，呼吸道感染致中小气道阻塞引起支气管扩张，分泌物清除能力下降促进细菌定植，炎症又促进支气管扩张，形成恶性循环。铜绿假单胞菌是导致支气管扩张症加重的重要病原菌 [ 2 ]。欧洲数据显示该病病死率每年以3%的速度增加 [ 3 ]，50%患者每年急性加重不少于2次，频繁加重导致肺功能下降，医疗支出增加，致残致死率上升 [ 4 ]。根据五行相生相克理论，培土生金法在治疗慢性呼吸系统疾病方面有着良好的临床疗效，玉屏风散是其代表方剂 [ 5 ] [ 6 ]。鉴于此，根据培土生金理论，研究加味玉屏风散治疗支气管扩张症稳定期肺脾气虚证患者的临床疗效。

2. 资料与方法 2.1. 一般资料

选取2021年1月1日~2022年1月1日我院呼吸科门诊及住院的支气管扩张症稳定期肺脾气虚证患者60例，随机分为对照组30例和治疗组30例。本研究经我院伦理委员会批准。

2.1.1. 纳入标准

① 符合《中国成人支气管扩张症诊断与治疗专家共识》(简称《共识》)中的西医诊断标准 [ 7 ] ；② 符合《支气管扩张症中医证候诊断标准》中肺脾气虚证的中医诊断标准 [ 8 ] ；③ 肺部HRCT确证存在支气管扩张；④ 近3个月内未使用抗生素；⑤ 患者依从性良好，签署书面知情同意书。

2.2. 仪器与试剂

迈瑞BC-7500，锦瑞MT-60，万孚FS301。

2.3. 方法

对照组口服桉柠蒎(国药准字H20052401) 0.3 g/次，2次/d，疗程6个月。治疗组在对照组基础上，加用加味玉屏风散治疗。方剂组成：黄芪30 g，白术20 g，防风10 g，金荞麦20 g，由我院煎药房统一配制，早晚分2次口服，1日1剂，疗程6个月。所有患者治疗期间若出现急性加重，按《共识》进行常规治疗 [ 7 ]。

2.4. 观察指标 2.4.1. 证候积分

参照《证候类中药新药临床研究技术指导原则》 [ 9 ]，设定支气管扩张症(肺脾气虚证)证候积分项目为其诊断条件:咯痰，气短，自汗，纳呆，神疲，痞满，每项分值为0~3分，得分越高，证候越严重，评分时间为治疗前1日和治疗后第7日。

2.4.2. 研究期间的急性加重次数

急性加重的评定参考《共识》 [ 7 ] 、《咳嗽中医诊疗专家共识意见》 [ 10 ] 的标准：① 咳嗽频繁；② 痰量增加或性质改变；③ 脓痰增多伴或不伴喘息；④ 呼吸困难；⑤ 咯血；⑥ 和(或)全身不适；出现以上3种或3种以上症状的改变，并持续48小时以上。急性加重次数按平均每人次计算。

2.4.3. 炎症指标

包括白介素6 (IL-6)、C反应蛋白(CRP)和降钙素原(PCT)，IL-6和CRP检测方法为乳胶增强免疫散射比浊法，PCT检测方法为荧光免疫层析法，时间为治疗前1日和治疗后第7日。

2.4.4. 肺功能指标

包括呼气峰流量(PEF)、第1 s用力呼气容积(FEV1)、呼出25%肺活量时最大呼气流量(FEF25%)、呼出50%肺活量时最大呼气流量(FEF50%)和最大呼气中段流速(MMEF)，检测时间为治疗前1日和治疗后第7日。

2.5. 统计学方法

本研究均采用SPSS23.0统计学软件分析数据，计量资料以均数±标准差(x ± s)表示，采用t检验处理；单项有序资料采用秩和检验，计数资料以率或者构成比表示，数据处理采用χ²检验，P < 0.05则差异有统计学意义。

3. 结果 3.1. 两组患者治疗前后主要中医证候积分的比较

治疗前，两组患者各项证候积分和总积分差异无统计学意义(P > 0.05)。治疗后，对照组咯痰、气短证候积分较治疗前显著下降，差异有统计学意义；余项证候积分和总积分无显著变化。治疗后，治疗组咯痰、气短、自汗、纳呆、神疲、痞满六项证候积分和总积分均显著性下降，差异有统计学意义，且治疗组显著低于对照组，差异有统计学意义(P < 0.05)。见表1。

Table 1 The comparison of the main TCM syndrome scores of the two groups of patients before and after treatmen

组别	咯痰		气短		自汗		纳呆		神疲		痞满		总积分
组别	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组(n = 30)	2.43 ± 0.32	1.76 ± 0.63^a	1.63 ± 0.12	1.15 ± 0.23^a	2.13 ± 0.32	2.16 ± 0.60	2.23 ± 0.32	2.76 ± 0.63	1.88 ± 0.62	1.96 ± 0.23	1.93 ± 0.54	1.76 ± 0.25	12.11 ± 3.44	11.81 ± 5.08
治疗组(n = 30)	2.55 ± 0.51	0.97 ± 0.33^a,b	1.84 ± 0.47	0.87 ± 0.31^a,b	2.39 ± 0.56	1.97 ± 0.33^a,b	2.45 ± 0.51	0.97 ± 0.37^a,b	2.05 ± 0.59	0.97 ± 0.33^a,b	2.25 ± 0.51	1.27 ± 0.16^a,b	13.19 ± 4.26	7.11 ± 2.44^a,b

表1. 两组患者治疗前、后主要中医证候积分的比较

注：与治疗前比较，^aP < 0.05；与对照组比较，^bP < 0.05。

3.2. 两组患者治疗期间的急性加重次数的比较

在6个月治疗期间，治疗组急性加重次数为(1.58 ± 0.4)人次，对照组急性加重次数为(0.68 ± 0.2)人次，经方差分析，差异有统计学意义(F = 2.14, P = 0.01)。

3.3. 两组患者治疗前后炎症指标的比较

治疗前，两组患者的CRP、IL-6、PCT差异无统计学意义。治疗后，两组患者的PCT较治疗前无显著性变化；CRP、IL-6较治疗前下降，差异具有统计学意义(P < 0.05)，且治疗组显著低于对照组，差异具有统计学意义(P < 0.05)。见表2。

Table 2 Comparison of inflammatory indicators in the two groups of patients before and after treatmen

组别	CRP (mg/L)		IL-6 (pg/ml)		PCT (ug/L)
组别	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组 (n = 30)	5.41 ± 0.39	4.76 ± 1.20^a	18.43 ± 2.87	13.43 ± 1.30^a	0.05 ± 0.02	0.04 ± 0.01
治疗组 (n = 30)	4.89 ± 0.70	2.67 ± 0.27^a,b	17.89 ± 4.32	11.77 ± 2.18^a,b	0.05 ± 0.01	0.04 ± 0.02

表2. 两组患者治疗前、后炎症指标的比较

注：与治疗前比较，^aP < 0.05；与对照组比较，^bP < 0.05。

3.4. 两组患者治疗前后肺功能指标的比较

治疗前，两组患者的PEF、FEV1、FEF50%、FEF25%和MMEF差异无统计学意义。治疗后，两组患者的PEF、FEV1变化无显著性差异；FEF50%、FEF25%和MMEF均较治疗前升高，差异具有统计学意义(P < 0.05)，且治疗组显著高于对照组，差异具有统计学意义(P < 0.05)。见表3。

4. 讨论

《共识》 [ 7 ] 指出长期抗菌治疗可以有效清除病原菌，可以降低急性加重风险和全因死亡率，推荐使用小剂量大环内酯类抗生素用于抑制支气管扩张症患者呼吸道定植菌的生物被膜形成。但也有研究 [ 11 ] 显示长期小剂量红霉素治疗造成支气管扩张症患者呼吸道菌群耐药率升高，尤其是对大环内酯类药物，且急性加重次数并没有减少。因此，长期抗菌治疗在改善支气管扩张症患者预后方面并非优选。

Table 3 Comparison of pulmonary function indexes between the two groups of patients before and after treatmen

组别	FEV1 (L)		PEF (L/min)		FEF50% (L/s)		FEF25% (L/s)		MMEF (L/s)
组别	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
对照组 (n = 30)	20.50 ± 0.51	20.74 ± 0.63	60.23 ± 0.44	60.47 ± 0.67	30.16 ± 0.34	40.42 ± 0.29^a	10.63 ± 0.21	20.54 ± 0.15^a	20.83 ± 0.37	30.38 ± 0.34^a
治疗组 (n = 30)	20.72 ± 0.37	20.81 ± 0.50	60.00 ± 0.45	60.40 ± 0.67	30.18 ± 0.22	40.18 ± 0.10^a,b	10.45 ± 0.31	20.31 ± 0.17^a,b	20.75 ± 0.29	30.45 ± 0.51^a,b

表3. 两组患者治疗前、后肺功能指标的比较

注：与治疗前比较，^aP < 0.05；与对照组比较，^bP < 0.05。

支气管扩张症属中医“咳嗽”“肺络张”等范畴。大部分现代医家认为肺虚是该病根本病因病机。梁直英教授 [ 12 ] 认为支气管扩张的病机以肺虚为本，痰、热、瘀为标，稳定期以“益气养阴，补虚固本”为法。王会仍教授 [ 13 ] 亦认为肺气虚是造成支气管扩张症急性加重的主要原因。“扶正祛邪”是支气管扩张症稳定期治疗关键，中医“肝心脾肺肾”对应五行中的“木火土金水”，根据五行相生相克理论，土生金，即补脾益肺。《医学从众录》 [ 14 ] 曰：“肺虚者，本脏自虚，治节不行，而痰聚之。或从脾以治之，为扶土生金之法……”。玉屏风散是培土生金的代表方，出自宋朝张松《究原方》，在《世医得效方》、《医方类聚》、《丹溪心法》等古医书籍中均有记载，由黄芪、白术、防风组成。有大量研究证实玉屏风散能抑制炎性因子，增强机体局部黏膜免疫功能 [ 15 ] [ 16 ]。金荞麦性凉，不仅能清热化痰，符合肺清凉本性，又能健脾消食、活血化瘀，与玉屏风散配伍能调养肺脾胃，又能邪有出路。李国勤、徐敏华教授均喜用金荞麦治疗支气管扩张 [ 17 ] [ 18 ]。本研究采用加味玉屏风散治疗支气管扩张症稳定期肺脾气虚证，方中黄芪甘温，补肺脾以实卫为君。白术甘温，健脾益气，助黄芪为臣。防风辛温，走表祛风。佐之金荞麦清热化痰、健脾消食。该方以补为主，药简效专。本研究发现加味玉屏风散可显著改善支气管扩张症患者证候积分，减少急性加重风险，显著提高临床疗效。同时还可以减少各种炎症因子，改善肺功能，尤其是小气道功能，这可能与减少呼吸道细菌、减轻气道分泌物阻塞有关。后续团队将开展动物实验进一步研究加味玉屏风散对支气管扩张症呼吸道微生态环境的影响及免疫机制。

文章引用

魏萍,陈志斌,李大治,施金晶. 基于培土生金理论探讨加味玉屏风散治疗支气管扩张症的临床疗效Clinical Study of Modified Yupingfeng Powder in the Treatment of Bronchiectasis Based on the Theory of Spleen Invigorating and Lung Benefiting[J]. 中医学, 2023, 12(01): 311-316. https://doi.org/10.12677/TCM.2023.121049

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