加味苓甘五味姜辛汤对支气管哮喘慢性持续期痰哮证患者炎症因子的影响

Effect of Modified Linggan Wuwei Jiangxintang on Inflammatory Factors in Patients with Chronic Persistent Bronchial Asthma

摘要:

目的：观察加味苓甘五味姜辛汤联合舒利迭治疗支气管哮喘慢性持续期痰哮证的临床疗效及对白细胞介素（IL）-4，IL-10，IL-13，IL-17水平的影响。方法：将140例患者采用随机数字表法分为观察组（71例）和对照组（69例）。对照组给予氧疗、化痰、解痉、控制感染等措施，沙美特罗替卡松粉吸入剂（舒利迭），50/250 μg/次，早晚各1吸；重度持续者可加服复方甲氧那明胶囊，2粒/次，3次/d，内服，共7 d。观察组在对照组的基础上，加用加味苓甘五味姜辛汤，1剂/d，内服。疗程均为12周。进行治疗前后肺功能检测，记录第1秒用力呼气容积占预计值百分比（FEV₁）和最大呼气流量占正常预计值的百分比（PEF）；采用哮喘控制测试（ACT）进行治疗前后哮喘控制情况评价；进行治疗前后痰哮证评分；检测治疗前后IL-4，IL-10，IL-13，IL-17水平。结果：观察组疾病疗效总有效率为95.77%，高于对照组的85.51%（P<0.05）。观察组中医证候疗效总有效率为94.37%，高于对照组的79.71%（P<0.01）。经Ridit分析观察组哮喘控制情况优于对照组（P<0.05）。治疗后两组FEV₁和PEF均较治疗前升高（P<0.01），治疗后观察组FEV₁和PEF均高于对照组（P<0.01）。治疗后观察组患者血清IL-4，IL-13和IL-17水平低于对照组，IL-10高于对照组（P<0.01）。结论：加味苓甘五味姜辛汤联合舒利迭治疗支气管哮喘慢性持续期痰哮证患者，能进一步的控制哮喘发作情况，减轻临床症状，改善肺功能，提高临床疗效，其作用机制可能与调节IL-4，IL-10，IL-13和IL-17等因子有关。

Abstract:

Objective: To observe the clinical efficacy of modified Linggan Wuwei Jiangxintang combined with seretide in treating chronic persistent bronchial asthma and investigate its effects on levels of interleukin-4 (IL-4), interleukin-10 (IL-10), interleukin-13 (IL-13), and interleukin-17 (IL-17). Method: One hundred and forty patients were randomly divided into control group (69 cases) and observation group (71 cases) by random number table. Patients in control group received treatment of oxygen therapy, reducing phlegm, spasmolysis and infection control, and they took salmeterol xinafoate and fluticasone propionate powder for inhalation (seretide) for every morning and night, 50/250 μg/time; for severe patients, compound Methoxyphenamine capsules were added for 7 days, 2 capsules/time, 3 times/day. Based on the treatment in control group, patients in observation group added modified Linggan Wuwei Jiangxintang, 1 dose/day. The treatment course was 12 weeks for both groups. Before and after treatment, lung function was detected; forced expiratory volume in one second account for predicted value (FEV₁), and maximal expiratory flow account for normal reference value (PEF) were recorded, score of the asthma was graded by asthma control test (ACT), and score of phlegm wheezing was also graded. Levels of IL-4, IL-10, IL-13 and IL-17 were also detected before and after treatment. Result: The total effective rate was 95.77% in observation group, higher than 85.51% in control group (P<0.05). The total effective rate for TCM symptoms was 94.37% in observation group, higher than 79.71% in control group (P<0.01). In Ridit analysis, the controlling situation for asthma in observation group was superior to that in control group (P<0.05). After treatment, the levels of FEV₁ and PEF were increased in both groups (P<0.01), and these levels in observation group were higher than those in control group (P<0.01). The levels of IL-4, IL-13 and IL-17 in observation group were lower than those in control group, and level of IL-10 was higher than that in control group after treatment (P<0.01). Conclusion: Modified Linggan Wuwei Jiangxintang combined with seretide can control asthmatic attack, relieve clinical symptoms, ameliorate lung function, and improve clinical efficacy in treatment of chronic persistent bronchial asthma, and the mechanism of action may be associated with regulating levels of IL-4,IL-10, IL-13 and IL-17.