卢世秀 尹李虎 李步满 向平超 张二明 王雪京 屈毓敏 郑玉琴 刘培红 庞磊

摘要：目的 观察调中益肺方联合西药对脾肺不足、气阴两虚型咳嗽变异性哮喘（CVA）缓解期的临床疗效。方法 将90例CVA缓解期患者随机分为中药组、西药组、中西组各30例。中药组予调中益肺方，每日1剂，早晚分服；西药组给予沙美特罗替卡松粉吸入剂，每次1吸，每日2次，吸入；中西组予调中益肺方合沙美特罗替卡松粉吸入剂，用法同上。连续治疗12周。观察3组治疗前后中醫症状积分及中医疗效、治疗后3个月的复发率和感冒次数、外周血嗜酸性粒细胞计数（EOS）、IgE、肺功能及安全性指标。结果 治疗后3组中医症状积分均降低（P<0.05）；治疗后中药组、中西组与西药组比较差异有统计学意义（P<0.05）。中药组中医疗效总有效率为96.67%（29/30），中西组为100.00%（30/30），与西药组76.67%（23/30）比较，差异有统计学意义（P<0.05）。治疗后3个月，中药组、中西组、西药组分别复发1、0、11例，差异有统计学意义（P<0.001）；与西药组比较，中药组、中西组感冒次数明显减少（P<0.05）。与治疗前比较，中西组IgE下降明显（P<0.05）；3组EOS治疗前后组内、组间比较差异均无统计学意义（P>0.05）。中西组最大呼气流量较治疗前提高，治疗后与西药组比较差异有统计学意义（P<0.01），其余肺功能指标比较差异无统计学意义（P>0.05）。中西组轻度不良反应1例，其余未见明显不良反应。结论 调中益肺方治疗CVA具有较好的临床疗效。

关键词：咳嗽变异性哮喘；缓解期；调中益肺方

DOI：10.3969/j.issn.1005-5304.2017.07.009

中图分类号：R259.622 文献标识码：A 文章编号：1005-5304（2017）07-0036-04

Abstract： Objective To observe the clinical efficacy of Tiaozhong Yifei Prescription combined with Western therapy for treatment of cough variant asthma （CVA） remission. Methods Totally 90 patients with CVA remission were randomly divided into TCM group， Western therapy group and TCM and Western therapy group， 30 cases in each group. TCM group was given Tiaozhong Yifei Prescription， 1 dose per day， morning and evening； Western therapy group was given salmeterol xinafoate and fluticasone propionate powder for inhalation， each 1 suction， 2 times a day， inhalation； a mixture of Tiaozhong Yifei Prescription and xinafoate and fluticasone propionate powder for inhalation was given to TCM and Western therapy group， the same as above， continuous treatment for 12 weeks. TCM syndrome score， EOS， IgE， pulmonary function and safety index were observed in the three groups before and after treatment. The recurrence rate and the number of colds after three-month treatment were observed. Results TCM syndrome scores in the three groups decreased after treatment （P<0.05）. There was statistical significance between TCM group and TCM and Western therapy group after treatment （P<0.05）. The total effective rate of TCM group was 96.67% （29/30）， 100.00% （30/30） of Western therapy group， 76.67% （23/30） of TCM and Western therapy group， with statistical significance （P<0.05）. After three-month treatment， 1， 0 and 11 cases relapsed in TCM group， TCM and Western therapy group and Western therapy group， respectively， with statistical significance （P<0.001）. Compared with the Western therapy group， the number of colds in the TCM group and TCM and Western therapy group

significantly decreased （P<0.05）. Compared with before treatment， IgE decreased significantly （P<0.05）. There was no significant difference in EOS among the three groups before and after treatment （P>0.05）. After treatment， the maximum expiratory flow in TCM and Western therapy group was higher than that before treatment and lower than that in the Western therapy group （P<0.01）， and the other lung function indexes were not statistically significant （P>0.05）. 1 mild adverse reaction was found in the TCM and Western therapy， and no obvious adverse reactions were found in other groups （P<0.05）. Conclusion Tiaozhong Yifei Prescription has good clinical efficacy for CVA.

Key words： cough variant asthma； remission； Tiaozhong Yifei Prescription

咳嗽变异性哮喘（cough variant asthma，CVA）为不典型哮喘，以咳嗽作为唯一或主要临床表现。CVA为我国慢性咳嗽的首要病因，如不积极治疗，部分患者可发展为典型哮喘。对于CVA急性期的治疗研究已成为中西医呼吸界热点，CVA预防研究尚未受到重视。全球哮喘防治创议（GINA）自2006年提出“哮喘控制”概念后，2014年又强调哮喘的治疗目标是实现“哮喘的总体控制”，既要达到当前控制又要降低未来风险[1]。笔者采用调中益肺方对CVA缓解期进行治疗，观察临床疗效及复发情况，现报道如下。……