摘要
目的:观察参苓白术散加减治疗卒中相关性肺炎(SAP)肺脾气虚证的临床疗效及对炎症因子和免疫功能的调节作用。方法:将110例患者按随机数字表法分为观察组和对照组各55例。对照组注射用哌拉西林钠他唑巴坦钠,4.5 g/次,缓慢静脉滴注,3次/d,并根据药物结果重新选择抗生素,连续注射7~10 d;盐酸氨溴索注射液,30 mg/次,慢速静脉输注,2次/d,疗程连续注射10 d,并给予营养支持及对症综合治疗。观察组西医治疗措施同对照组,并内服参苓白术散加减,1剂/d,共连续治疗10 d。进行临床肺部感染评分(CPIS),记录CPIS<6分时间、咳嗽消失时间、体温恢复时间、白细胞恢复正常、肺部湿啰音消失时间;进行治疗前后肺脾气虚证评分;检测治疗前后降钙素原(PCT),γ-干扰素(IFN-γ),肿瘤坏死因子-α(TNF-α),高敏C反应蛋白(hs-CRP)水平;检测治疗前后免疫球蛋白A(IgA),免疫球蛋白G(IgG),免疫球蛋白M(IgM),T淋巴细胞亚群(CD4^+,CD8^+,CD4^+/CD8^+)水平。结果:采用秩和检验分析,观察组患者临床疗效好于对照组(Z=2.106,P<0.05);观察组患者CPIS,肺脾气虚证积分均低于对照组(P<0.01);观察组患者CPIS<6分时间、咳嗽消失时间、体温恢复时间、白细胞恢复正常、肺部湿啰音消失时间均短于对照组(P<0.01);观察组PCT,TNF-α,hs-CRP水平均低于对照组(P<0.01),IFN-γ水平高于对照组(P<0.01);观察组IgA和IgM水平均高于对照组(P<0.05);观察组CD4^+,CD4^+/CD8^+均高于对照组(P<0.05),CD8^+低于对照组(P<0.05)。结论:在抗感染等综合治疗的基础上,参苓白术散加减治疗SAP肺脾气虚证患者,可进一步控制病情程度,减轻症状,并能调节炎症因子表达,增强机体免疫功能,提高综合疗效。
Objective:To observe the clinical efficacy of modified Shenling Baizhusan on strokeassociated pneumonia(SAP)with lung-Qi deficiency syndrome and its regulatory effect on inflammatory factors and immune function.Method:One hundred and ten patients were randomly divided into control group(55 cases)and observation group(55 cases)by random number table.Patients in control group got piperacillin sodium and tazobactam sodium for slow intravenous injection,4.5 g/time,3 times/days,for 7^-10 days,and new antibiotic was chose by drug outcomes,ambroxol hydrochloride injection for low intravenous infusion,30 mg/time,2 times/days,for 10 days,and nutritional support and symptomatic comprehensive treatment.In addition to the therapy in control group,patients in observation group were added with modified Shenling Baizhusan,1 dose/day,for 10 days.And scores of pulmonary infection(CPIS),time of CPIS<6 time of disappearance of cough,time of recovery of temperature,time of recovery of leukocyte,and time of disappearance of lung rales were recorded.And before and after treatment,lung-Qi deficiency syndromes were scored,and levels of procalcitonin(PCT),γ-interferon(IFN-γ),tumor necrosis factor-α(TNF-α),high-sensitivity C-reactive protein(hs-CRP),immunoglobulin A(IgA),immunoglobulin G(IgG),immunoglobulin M(IgM),T Lymphocyte subsets(CD4^+,CD8^+and CD4^+/CD8^+)were all detected.Result:By rank sum test,the clinical effect in control group was better than that in control group(Z=2.106,P<0.05).Scores of CPIS and lung-Qi deficiency syndromes were lower than those in control group(P<0.01).And time of CPIS<6,time of disappearance of cough,time of recovery of temperature,time of recovery of leukocyte,and time of disappearance of lung moist rales were all shorter than those in control group(P<0.01).And levels of PCT,TNF-α,hs-CRP and CD8^+were lower than those in control group(P<0.01,P<0.05),while levels of IFN-γ,IgA,IgM,CD4^+and CD4^+/CD8^+were all higher than those in control group(P<0.01,P<0.05).Conclusion:In addition to the comprehensive anti-infection therapy,modified Shenling Baizhusan can control the degree of illness,alleviate symptoms,regulate the expressions of inflammatory factors,increase the immune function of the body,and improve the comprehensive efficacy.
作者
李德需
张新文
LI De-xu;ZHANG Xin-wen(Affiliated Hospital of Hebei University,Baoding 071015,China)
出处
《中国实验方剂学杂志》
CAS
CSCD
北大核心
2020年第5期75-80,共6页
Chinese Journal of Experimental Traditional Medical Formulae
基金
河北省医学科学研究重点课题计划项目(20170146).
关键词
卒中相关性肺炎
肺脾气虚证
炎症因子
免疫球蛋白
T淋巴细胞亚群
参苓白术散
stroke-related pneumonia
lung-spleen deficiency syndrome
inflammatory factors
immunoglobulin
T lymphocyte subsets
Shenling Baizhusan
