血府逐瘀汤对自身免疫性肺泡蛋白沉积症疗效及机制  

EFFECT OF XUEFU ZHUYU DECOCTION ON AUTOIMMUNE PULMONARY ALVEOLAR PROTEINOSIS AND RELATED MECHANISM

作　　者：潘登 肖宝红 成炜[1] 李金凤[1] 闫伟华[2] 王芳芳[1] PAN Deng;XIAO Baohong;CHENG Wei;LI Jinfeng;YAN Weihua;WANG Fangfang(Department of Respiratory and Critical Care Medicine,The Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院呼吸与危重症医学科,山东青岛266003 [2]青岛大学附属医院病理科,山东青岛266003

出　　处：《青岛大学学报（医学版）》2022年第2期263-268,共6页Journal of Qingdao University(Medical Sciences)

基　　金：青岛市民生科技计划项目(18-6-1-87-nsh)。

摘　　要：目的 探讨血府逐瘀汤治疗自身免疫性肺泡蛋白沉积症(aPAP)的效果及其机制。方法 纳入2012年1月—2017年11月青岛大学附属医院呼吸与危重症医学科收治的9例aPAP病人,根据治疗方法分为全肺灌洗组(WLL组,5例)及血府逐瘀汤组(XFZYD组,4例)。比较两组病人治疗前后胸部CT表现、动脉血气分析和肺功能指标、血清标志物及血脂指标的变化。结果 与治疗前比较,治疗后两组肺受累面积百分比、肺泡动脉血氧分压差(P(A-a)O;)、癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)均显著降低,差异有统计学意义(F=8.25~98.17,P<0.05);但XFZYD组比WLL组降低的更明显(F=11.53~43.54,P<0.05)。与治疗前比较,治疗后两组的动脉血氧分压(PaO;)、用力肺活量占预计值百分比(FVC%Pred)、一氧化碳弥散量占预计值百分比(DLCO%Pred)均显著增高,差异有统计学意义(F=18.40~133.01,P<0.05);但XFZYD组比WLL组增高的更明显(F=2.93~86.26,P<0.05)。与治疗前比较,治疗后两组血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平显著降低(F=15.77~21.22,P<0.05),而血清三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)水平无明显变化(P>0.05);治疗后XFZYD组血清TC、TG水平显著低于WLL组,HDL-C水平显著高于WLL组,差异有统计学意义(F=11.62~21.33,P<0.05)。结论 血府逐瘀汤治疗aPAP是有效的,其机制可能与减轻病人的高脂血症有关。Objective To investigate the effect of Xuefu Zhuyu Decoction in the treatment of autoimmune pulmonary alveolar proteinosis(aPAP) and its mechanism. Methods A total of 9 patients with aPAP who were admitted to Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Qingdao University, from January 2012 to November 2017 were enrolled, and according to the treatment method, they were divided into whole lung lavage group(WLL group with 5 patients) and Xuefu Zhuyu Decoction group(XFZYD group with 4 patients). The two groups were compared in terms of the changes in chest CT findings, arterial blood gas parameters, pulmonary function parameters, serum markers, and blood lipid parameters after treatment. Results After treatment, both groups had significant reductions in the percentage of lung involvement, alveolar-arterial oxygen partial pressure difference, carcinoembryonic antigen, and neuron-specific enolase(F=8.25-98.17,P<0.05), and the XFZYD group had significantly greater reductions than the WLL group(F=11.53-43.54,P<0.05). After treatment, both groups had significant increases in the arterial partial pressure of oxygen, the percentage of forced vital capacity in predicted value, and the percentage of diffusing capacity for carbon monoxide in predicted value(F=18.40-133.01,P<0.05), and the XFZYD group had significantly greater increases than the WLL group(F=2.93-86.26,P<0.05). After treatment, both groups had significant reductions in the serum levels of total cholesterol(TC) and low-density lipoprotein cholesterol(F=15.77-21.22,P<0.05), while there were no significant changes in the serum levels of triglyceride(TG) and high-density lipoprotein cholesterol(HDL-C)(P>0.05). Compared with the WLL group after treatment, the XFZYD group had significantly lower serum levels of TC and TG and a significantly higher serum level of HDL-C(F=11.62-21.33,P<0.05). Conclusion Xuefu Zhuyu Decoction is effective in the treatment of aPAP, possibly by alleviating hyperlipidemia.

关 键 词：肺泡蛋白沉积症 自身免疫疾病 血府逐瘀汤 支气管肺泡灌洗 治疗结果 

分 类 号：R563.9[医药卫生—呼吸系统] R289.793[医药卫生—内科学]