玄参甘桔汤合三拗汤加减治疗燥热伤肺型感染后咳嗽的疗效观察  

Efficacy Observation of Addition and Subtraction Therapy of Xuanshen Ganju Tang Combined with Sanniutang to Post-infection Cough with Lung Injury Caused by Dryness and Heat

作　　者：黄惠芬 范良 傅汝梅 林月华 陈荣 林承霞 HUANG Hui-fen;FAN Liang;FU Ru-mei;LIN Yue-hua;CHEN Rong;LIN Cheng-xia(Haikou Hospital of Traditional Chinese Medicine,Haikou 570216,China)

机构地区：[1]海口市中医医院

出　　处：《中国实验方剂学杂志》2019年第3期125-130,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家中医药管理局2013年度全国名老中医专家传承工作室建设项目(2013-47);海南科技厅社会发展处基金项目(ZDYF2017109);海南自然科学基金项目(20168321)

摘　　要：目的:观察玄参甘桔汤合三拗汤加减治疗感染后咳嗽(PIC)燥热伤肺证的临床疗效及对变应性炎症和神经源性炎症介质的影响。方法:将180例符合要求的PIC患者,根据就诊先后随机按2∶1分为观察组122例和对照组58例。对照组口服复方甲氧那明胶囊,2粒/次,3次/d,观察组内服玄参甘桔汤合三拗汤加减辨证,1剂/d。两组疗程均连续治疗7 d。进行咳嗽症状积分(日间和夜间咳嗽情况)、咳嗽视觉模拟评分(VAS)和燥热伤肺证评分;记录止咳起效时间、咳嗽缓解时间、咳嗽消失时间和咳嗽复发情况;采用咳嗽专用生活质量问卷(CQLQ)评价患者生活质量;检测治疗前后变应性炎症介质肿瘤坏死因子-α(TNF-α),白细胞介素-1β(IL-1β),IL-6,IL-8和痰液神经源性炎症介质P物质(SP),神经肽A(NKA),降钙素原基因相关肽(CGRP)水平。结果:经Ridit分析,观察组临床疗效优于对照组(P<0. 05);治疗后观察组日间咳嗽积分、夜间咳嗽积分,VAS评分和燥热伤肺证积分均低于对照组(P<0. 01);观察组止咳起效时间、咳嗽缓解时间和咳嗽消失时间均短于对照组(P<0. 01);观察组咳嗽缓解率、咳嗽消失率均高于对照组,咳嗽复发率低于对照组(P<0. 05);观察组CQLQ除情感健康和人身安全恐惧外其它维度评分和总分均低于对照组(P<0. 01);观察组患者血清TNF-α,IL-1β,IL-6,IL-8水平均低于对照组(P<0. 01);观察组患者痰液SP,NKA,CGRP水平均明显低于对照组(P<0. 01)。结论:玄参甘桔汤合三拗汤加减治疗PIC燥热伤肺证患者能控制咳嗽等症状,缩短咳嗽病程、减少复发,提高患者的生活质量,并能抑制变应性炎症和神经源性炎症,临床疗效优于复方甲氧那明治疗。Objective: To observe the clinical efficacy of addition and subtraction therapy of Xuanshen Ganju Tang combined with Sanniutang to post infection cough( PIC) with lung injury caused by dryness and heat,and investigate its effects on allergic inflammation and neurogenic inflammatory mediators. Method: One hundred and eighty eligible patients with PIC were randomly divided into control group( 58 cases) and observation group( 122 cases) according to the visiting sequence. Patients in control group got compound methoxyphenamine capsules,2 capsules/time and tid. Patients in observation group got addition and subtraction therapy of Xuanshen Ganju Tang,combined with Sanniutang,1 dose/day. The treatment course was 7 days in both groups. Symptom scores for cough( day and night),visual analogue scale of coughing( VAS) and scores for lung injury caused by dryness and heat injury were graded. Time to relieve a cough,time to relieve symptoms,time to vanish cough,and cough recurrence were recorded. Life quality was evaluated by cough-specific quality of life questionnaire( CQLQ),and the levels of tumor necrosis factor-α( TNF-α),interleukin-1β( IL-1β),IL-6,IL-8 and substance P in sputum neurogenic inflammatory mediators( SP),neuropeptide A( NKA) and calcitonin gene related peptide( CGRP) were detected. Result: Ridit analysis showed that the clinical efficacy in observation group was better than that in control group( P< 0. 05). After treatment,scores of coughing at daytime and night,VAS and lung injury caused by dryness and heat were all lower than those in control group( P< 0. 01). Time to relieve a cough,time to relieve symptoms,and time to vanish cough were all shorter than those in control group( P< 0. 01).Remission rate of cough and vanishing rate of cough in observation group were higher,while recurrence rate of cough was lower than those in control group( P< 0. 05). Expect for emotional health and fear of personal safety,scores of other items in CQLQ,the total score and levels of TNF-α,IL-1β,IL-6,IL-8,SP,NKA and CG

关 键 词：感染后咳嗽 玄参甘桔汤 三拗汤 燥热伤肺证 变应性炎症 神经源性炎症 

分 类 号：R25[医药卫生—中医内科学] R256[医药卫生—中医学]