中医药治疗稳定期慢性阻塞性肺疾病研究进展  

Progress of TCM Treatment of Chronic Obstructive Pulmonary Disease in Stable Phase

作　　者：闫香桂 吴国芳[1] 黄芬[1] 戴鹏[1] 纪金霞[1] 

机构地区：[1]上海中医药大学附属曙光医院松江分院,上海201600

出　　处：《中医学报》2016年第9期1284-1288,共5页Acta Chinese Medicine

基　　金：上海市松江区科技攻关项目(14SJGGYY05);曙光医院松江分院重点专项(FTZD201401)

摘　　要：中医药治疗稳定期慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)研究存在以下问题:1由于我国南北气候存在明显地域差异,辨证分型、辨证治疗也存在区别,COPD研究中的地域和研究中心较为单一,缺乏多中心联合的大规模随机对照研究。2COPD的研究水平参差不齐,对临床方药缺乏统一筛选,试验的选择、疾病的诊断、辨证分型、疗效的判定缺乏统一标准;缺乏符合中医药特色的COPD动物模型。3中药作用机制复杂,但目前中药毒理学研究、机理探讨缺乏针对性,对引起气道慢性炎症的炎症介质和细胞因子作用的研究罕见。4研究方法比较单一,临床疗效评估停留在对短期症状改善的观察水平上,缺乏终点指标(如再住院率、生存率等)的统计。今后努力方向:1进一步提高COPD的中医药防治水平,提高患者生活质量,减少社会经济负担。对研究中药多靶点、多途径、多环节、个体化治疗COPD提供更强大的理论依据。2明确COPD疾病诊断及分期分型标准,加强疾病分期分型与中医主证的研究,对古代文献关于COPD类似疾病的资料进行尽量全面的整理,建立符合中医特色、更接近临床病例特点的动物模型,进一步深化中医关于COPD病因病机的认识。3在今后的研究中应采用多中心、盲法、大样本研究,除了要观察短期症状改善,更要重视中药在治疗COPD再住院率、生存率等方面的作用,认真探索本病的中医病机转化规律,辨证与辨病相结合,科学制订中医药治疗本病的疗效评定标准,筛选出有效的方剂或药物,制定合理有效的综合治疗方法。The followings are the current problems in the study of TCM treatment of Stable Chronic Obstructive Pulmonary Disease （COPD） ：① Due to the significant regional differences in climate of north and south China,TCM treatments of COPD based on syndrome differentiation are different. However, in recent years COPD research centers are quite few and there is a lack of large- scaled multi-centered randomly controlled studies. ② There are different research levels in treatment COPD,without standard pre- scriptions based on clinical screening, test selection, diagnosis, syndrome differentiation, and clinical efficacy determination. There is also a lack of standard COPD animal model in line with the characteristics of Chinese medicine. ③ The working mechanism of Chinese medicine is quite complicated. There is a lack of qualified TCM toxicology studies in exploration of the mechanism of the disease. Especially,there is a serious lack of studies on the specific inflammatory mediators and cytokines, which can cause the chronic inflammation of the airways.④ There is a relatively simple study method,in which only the clinical efficacy of the short-term of symptom improvement was observed. There is a lack of end-points statistics such as readmission rates and survival rates, etc. Future efforts should be made in the following aspects ： ① To further improve the levels of the TCM prevention and treatment of COPD, improve the quality of patients＇ life and reduce the economic burden of the society. To provide more theoretical basis of the multi-target, multi-channel, multi-link individualized TCM study and treatment of COPD. ② Make it clear that the standards of the diagnosis and stage classification of COPD by strengthening the researches of stage classification and TCM main syndromes of the disease and fully sorting out the ancient literature and data of COPD and other similar diseases. To establish the animal model in compliance with the TCM clinical characteristics and deepen the understanding of the etiolog

关 键 词：慢性阻塞性肺疾病 中医药 肺气亏虚 脾肾不足 本虚标实 从肺论治 从脾论治 从肾论治 肺脾同治 肺肾同治 肺脾肾同治 从痰瘀论治 

分 类 号：R259.63[医药卫生—中西医结合]