刘克琴 蒋晨露 刘海霞 张潇月

摘要 目的：觀察清金化痰汤序贯治疗对慢性阻塞性肺疾病（COPD）患者预后的影响。方法：选取2017年1月至2018年12月南京中医药大学第二附属医院住院收治的慢性阻塞性肺疾病急性加重期（AECOPD）患者90例作为研究对象，按照随机数字表法分为对照组、短疗程观察组和长疗程观察组，每组30例，对照组给予西医常规治疗、短疗程观察组采用清金化痰汤联合治疗（治疗7～10 d），长疗程观察组采用序贯治疗（治疗28 d）。比较3组患者临床疗效、中医证候积分（TCMSS）以及年再入院次数;采集患者第1、7、28天血清及痰标本，测定血清中肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）和黏蛋白5AC（MUC5AC）水平及痰半定量培养。结果：在临床疗效、中医证候积分及血清学指标方面，观察组均优于对照组（P<0.05），长疗程观察组优于短疗程观察组（P<0.05）;在耐药菌清除方面，长疗程观察组优于对照组和短疗程观察组（P<0.05）;长疗程观察组的年再入院次数少于短疗程和对照组，差异有统计学意义（P<0.05）。结论：清金化痰汤序贯治疗能够有效的改善患者临床症状，减轻气道炎症反应，降低耐药菌定植风险。

关键词 慢性阻塞性肺疾病急性加重期;清金化痰汤;气道黏液高分泌;耐药菌;黏蛋白5AC;中医证候积分;白细胞介素-1β;肿瘤坏死因子-α

Effect of Sequential Therapy with Qingjin Huatan Decoction on Patients with Chronic Obstructive Pulmonary Disease

LIU Keqin1，JIANG Chenlu2，LIU Haixia1，ZHANG Xiaoyue1

（1 The Second Affiliated Hospital of Nanjing University of Chinese Medicine/the Second Traditional Chinese Medicine Hospital of Jiangsu Province，Nanjing 210017，China; 2 Nanjing University of Chinese Medicine，Nanjing 210017，China）

Abstract Objective：To observe the effect of sequential therapy of Qingjin Huatan Decoction on clinical effects with chronic obstructive pulmonary disease （COPD）.Methods：A total of 90 patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） admitted to the Second Affiliated Hospital of the Nanjing University of Chinese Medicine from January 2017 to December 2018 were selected as the research objects.According to the random number table，they were divided into a control group （given conventional Western medicine treatment），a short course observation group （given Qingjin Huatan Decoction for 7～10 days），and a long course observation group （given sequential treatment for 28 days），with 30 cases in each group.The clinical efficacy，TCM score （TCMSS） and annual readmissions were compared among the three groups.Samples of serum and sputum were collected on the 1st，7th and 28th day，and serum levels of TNF-α，IL-1β and MUC5AC were measured before and after treatment.At the same time，sputum samples were collected for semi-quantitative culture to evaluate the drug-resistant bacterial load.Results：In clinical curative effect，TCMSS and serological index，the treatment group was better than the control group （P<0.05），and the long course group was better than the short course group （P<0.05）.In terms of drug-resistant bacteria removal，the long course of treatment group was better than that of the control group and the short course group （P<0.05）.And the long course group had less annual readmission than the short course and the control group，and which had statistically significant （P<0.05）.Conclusion：The sequential treatment of Qingjin Huatan Decoction can effectively improve the clinical symptoms and reduce the airway inflammation and the risk of drug-resistant bacteria colonization.

Keywords Acute exacerbation of chronic obstructive pulmonary disease （AECOPD）; Qingjin Huatan Decotion; Airway mucus hypersecretion; Drug-resistant bacteria; MUC5AC; TCM score; IL-1β; TNF-α

中图分类号：R256.1文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.06.019

慢性阻塞性肺疾病（Chronic Obstructive Pulmonary Disease，COPD）是较常见的呼吸系统疾病，反复呼吸道症状及气道持续性气流受限是其主要特征。COPD病情较长、呈进行性加重且容易反复，具有高发病率、高死亡率的特点。2020年在全球病死率上将上升至第3位，其致残率也将上升至全球第5位[1]。据统计，中国40岁以上人群患COPD的概率为8.2%，即大约有4千万人患COPD，其中男性和女性分别为12.4%和5.1%[2]。COPD患病率与年龄的增长正相关。由此可见，COPD是威胁人类健康的全球重大问题。对COPD急性加重期（Acute Exacerbation of Chronic Obstructive Pulmonary Disease，AECOPD），临床上常经验性给予抗生素治疗，住院期间抗生素使用比率高达98.12%。……