固本调平汤辅助提高支气管哮喘吸入糖皮质激素降阶梯治疗成功率临床研究  

Clinical study of Guben-Tiaoping Decoction in improving the success rate of inhaled corticosteroid stepwise treatment in asthma

作　　者：高伟[1] 武维屏[2] 苏惠萍[2] 罗頔 李扬帆[4] 宿芳[1] 陈敏华[1] 李雨[1] Gao Wei;Wu Weiping;Su Huiping;Luo Di;Li Yangfan;Su Fang;Chen Minhua;Li Yu(Department of Internal Medicine,Chaoyang District TCM Hospital of Beijing,Beijing 100020,China;Department of Respiratory,Dongzhimen Hospital Affiliated to Beijing University of Traditional Chinese Medicine,Beijing 100700,China;Graduate School,Beijing University of Traditional Chinese Medicine,Beijing 100029,China;Department of Chinese Medicine,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]北京市朝阳区中医医院内科,100020 [2]北京中医药大学东直门医院呼吸科,100700 [3]北京中医药大学研究生院,100029 [4]首都医科大学附属北京友谊医院中医科,100050

出　　处：《国际中医中药杂志》2021年第10期954-959,共6页International Journal of Traditional Chinese Medicine

基　　金：北京市中医管理局专项资助(JJ2018-12);第六批全国老中医药专家学术继承工作项目(2017年)。

摘　　要：目的探讨联用固本调平汤对支气管哮喘(哮喘)患者吸入糖皮质激素(inhaled corticosteroids,ICS)降阶梯治疗成功率及生活质量的影响。方法将符合入选标准的2018年7月-2019年12月3个研究中心76例正在使用ICS的哮喘缓解期肺脾气虚证患者按随机数字表法分为2组,每组38例。2组患者均按2017年"全球哮喘防治创议"(global initiative for asthma,GINA)方案中推荐的降阶梯方案进行ICS减量,治疗组在此基础上加用固本调平汤。2组均治疗12周。统计顺利完成降阶梯治疗的患者例数;分别于治疗前后进行中医证候评分,并采用哮喘控制测试表(Asthma Control Test,ACT)评估哮喘控制情况,采用圣乔治医院呼吸问题调查问卷(St George’s Respiratory Questionnaire,SGRQ)评价患者生活质量,采用肺功能仪检测FEV1、FVC、最高呼气流速(PEF),观察药物安全性及治疗期间的不良反应,评价临床疗效。结果治疗组总有效率为89.5%(34/38),对照组为78.9%(30/38),2组比较差异有统计学意义(χ^(2)=14.862,P=0.001)。治疗组治疗后日常活动受限、呼吸困难频率、早醒频率、急救药物使用频率、整体控制情况评分及总分均高于对照组(t值分别为-3.860、-2.732、-2.262、-6.994、-9.562,P<0.01或P<0.05);胸闷气短(动则加重)、神疲乏力、自汗易感、纳差食少、腹胀便溏评分及总分均低于对照组(t值分别为2.265、13.175、8.350、14.750、6.950、22.344,P<0.05或P<0.01);SGRQ评分低于对照组(t=5.094,P<0.01)。治疗组治疗后PEF水平[(6.92±1.71)L比(5.84±1.22)L,t=-2.880]高于对照组(P<0.01)。结论固本调平汤可辅助提高哮喘ICS降阶梯治疗的成功率,有效改善哮喘缓解期肺脾气虚证患者的生活质量。Objective To evaluate the effect of combined use of Guben-Tiaoping Decoction on the success rate of stepwise treatment and life quality of asthma patients.Methods A total of 76 patients with asthma in remission stage who were using ICS were divided into treatment group(38 cases)and control group(38 cases)according to random number table.Both groups were treated with ICS reduction based on the 2017 Gina Protocol.The treatment group was treated with Guben-Tiaoping Decoction for 12 weeks.The number of patients who were able to successfully complete the stepwise treatment after the end of the trial was calculated,the relevant indexes of Asthma Control Test(ACT),TCM Syndrome score,St.George’s respiratory questionnaire(SGRQ)and lung function were collected before and after treatment.Result After 12 weeks’treatment,the success rate of stepwise was 89.5%(34/38)in the treatment group and 78.9%(30/38)in the control group(χ^(2)=14.862,P=0.001).Meanwhile,the ACT score of the treatment group were better than those in the control group(Daytime symptoms t=-3.860,P=0.001,Dyspnea t=-2.007,P=0.40,Night waking t=-2.732,P=0.009,Reliever needed for symptoms t=-2.262,P=0.031,Control situation t=-6.994,P=0.001,Total Score t=-9.562,P=0.001).The score of TCM Syndrome in the treatment group was significantly lower than that of the control group(P=0.001);PEF in treatment group[(6.92±1.71)L vs.(5.84±1.22)L;t=-2.880,P=0.005]was significantly better than that of the control group.Conclusion Guben-Tiaoping Decoction is helpful to improve the success rate of ICS stepwise treatment and the life quality of patients.

关 键 词：哮喘 糖皮质激素 投药 吸入 降阶梯治疗 固本调平汤 中医药疗法 

分 类 号：R256.12[医药卫生—中医内科学]