加味桔梗元参汤配合常规疗法改善慢性鼻-鼻窦炎伴鼻息肉术后黏膜水肿及作用机制  

Modified Jiegeng Yuansentang Combined with Conventional Therapy Improves Postoperative Mucosal Edema of Chronic Rhinosinusitis Patients with Nasal Polyps and Its Mechanism of Action

作　　者：陈璐璐 李静波[1] 王俊杰[1] 贺星华 CHEN Lu-lu;LI Jing-bo;WANG Jun-jie;HE Xing-hua(Henan Province Hospital of Traditional Chinese Medicine,Zhengzhou 450002,China)

机构地区：[1]河南省中医院,郑州450002

出　　处：《中国实验方剂学杂志》2021年第18期94-100,共7页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：河南省中医药科学研究专项(2018ZY1010,20-21ZY1004)。

摘　　要：目的:观察加味桔梗元参汤配合常规疗法对慢性鼻-鼻窦炎伴鼻息肉肺气郁闭证患者术后黏膜水肿的疗效,探讨其作用机制。方法:90例患者随机分为对照组和观察组,各45例。所有患者在鼻腔镜术后均给予常规抗感染疗法治疗,对照组同时给予鼻喷糠酸莫米松联合克拉霉素,观察组同时给予加味桔梗元参汤内服和鼻腔冲洗,疗程均为6周。观察两组治疗前后鼻腔鼻窦结局测试-20(SNOT-20),鼻内窥镜黏膜形态(Lund-Kennedy),患者生命质量评价量表(RQLQ),中医证状,血清及鼻分泌液中炎性因子肿瘤坏死因子-α(TNF-α),白细胞介素-1β(IL-1β),白细胞介素-5(IL-5),白细胞介素-17(IL-17);血清蛋白水通道蛋白-1(AQP-1),水通道蛋白-3(AQP-3),水通道蛋白-5(AQP-5),纤维连接蛋白(Fn)。比较两组临床症状,安全性及随访12个月复发情况。结果:观察组总有效率97.73%(43/44),高于对照组的80.95%(34/42)(χ^(2)=4.726,P<0.05)。随访至少12个月,观察组复发率4.65%(2/43),低于对照组的32.35%(11/34()χ^(2)=4.129,P<0.05)。与对照组治疗后比较,观察组SNOT-20,Lund-Kennedy,RQLQ,中医证状,TNF-α,IL-1β,IL-5,IL-17,AQP-5明显降低(P<0.05),AQP-1,AQP-3,Fn明显升高(P<0.05)。观察组不良反应发生率2.27%(1/44),低于对照组的57.14%(24/42)(χ^(2)=5.243,P<0.05)。结论:加味桔梗元参汤可明显改善慢性鼻-鼻窦炎伴鼻息肉肺气郁闭证患者术后黏膜水肿,其作用机制可能与调节血清及鼻分泌液中炎性因子水平有关。Objective: To explore the curative effect and mechanism of modified Jiegeng Yuansentang combined with conventional therapy for postoperative mucosal edema in patients with cchronic rhinosinusitis with nasal polyps due to pulmonary Qi stagnation,and to explore its mechanism of action. Method: The 90 patients were randomly divided into control group and observation group,45 cases in each group. All patients were given conventional therapy after nasal endoscopy. Patients in control group were also given mometasone furoate combined with clarithromycin, and patients in observation group were given modified Jiegeng Yuansentang for internal administration and local irrigation. The course of the treatment was 6 weeks. The sino nasal outcome test-20(SNOT-20), nasal situation Lund-Kennedy, rhinoconjunctivitis quality of life questionnaire(RQLQ), traditional Chinese medicine(TCM) syndrome, serum and nasal secretions inflammatory cytokines[tumor necrosis factor-alpha(TNF-α),interleukin-1β(IL-1β),interleukin-5(IL-5),interleukin-17(IL-17)],serum protein[aquaporin-1(AQP-1),aquaporin-3(AQP-3),aquaporin-5(AQP-5),fibronectin(Fn)] were observed before and after treatment in two groups. The clinical symptoms,safety and recurrence after a follow-up of 12 months were compared between two groups. Result: The total effective rate was 97.73%(43/44)in observation group,which was higher than 80.95%(34/42)in control group(χ^(2)=4.726,P<0.05). The patients were followed up for at least 12 months,and the recurrence rate was 4.65%(2/43)in observation group,which was lower than 32.35%(11/34)in control group(χ^(2)=4.129,P<0.05).Compared with control group after treatment,the SNOT-20,Lund-Kennedy,RQLQ,TCM syndrome,TNF-α,IL-1β,IL-5,IL-17,AQP-5 were significantly decreased in observation group(P<0.05),while AQP-1,AQP-3,Fn were significantly increased in observation group(P<0.05). The incidence of adverse reactions was 2.27%(1/44)in observation group,lower than 57.14%(24/42)in control group(χ^(2)=5.243,P<0.05). Conclusion: Modified Jiegeng Y

关 键 词：加味桔梗元参汤 慢性鼻-鼻窦炎伴鼻息肉 肺气郁闭证 作用机制 

分 类 号：R22[医药卫生—中医基础理论] R242[医药卫生—中医学]