养肺通络方辅助治疗新型冠状病毒感染后肺纤维化的回顾性分析  

Retrospective Analysis of Yangfei TongluoFormula(养肺通络方) in the Adjuvant Treatment of Post-COVID-19 Pulmonary Fibrosis

作　　者：张梦云 丁晓娟 肖静静 伍伟 俞桥 杨文超 刘琳 黄河颂 江子汉 张勇 ZHANG Mengyun;DING Xiaojuan;XIAO Jingjing;WU Wei;YU Qiao;YANG Wenchao;LIU Lin;HUANG Hesong;JIANG Zihan;ZHANG Yong(PLA General Hospital of Central Theatre Command,Wuhan,430070;Wuhan University of Science and Technology)

机构地区：[1]中部战区总医院,湖北省武汉市430070 [2]武汉科技大学

出　　处：《中医杂志》2022年第23期2252-2258,共7页Journal of Traditional Chinese Medicine

基　　金：湖北省卫生健康委员会中医药科研立项项目(ZY2021M020);武汉市科技计划项目(2020020601012243)。

摘　　要：目的观察养肺通络方辅助治疗新型冠状病毒感染后肺纤维化(PCPF)的临床疗效,并探讨其可能作用机制。方法回顾性收集2020年1月1日至4月1日中部战区总医院PCPF患者临床资料60例,依据治疗方式分为治疗组36例(常规西医治疗基础上加用养肺通络方)和对照组24例(常规西医治疗),均治疗4周。采集两组患者的一般资料,治疗前后肺部CT评分、6分钟步行试验(6MWT)相关数据[包括6分钟步行距离(6MWD),步数,步行前后的呼吸频率(RR)、心率(HR)、经皮血氧饱和度(SpO_(2)),并对患者疲劳程度和呼吸困难程度进行评分],血清转化生长因子β1(TGF-β1)水平及信号转导蛋白2(Smad2)、信号转导蛋白3(Smad3)、信号转导蛋白7(Smad7)转录水平,以及治疗后Smad2、Smad3、Smad7蛋白表达水平。结果两组患者治疗后肺部CT评分均较本组治疗前下降,治疗组治疗前后肺部CT评分差值改善优于对照组(P<0.05)。与本组治疗前比较,治疗组治疗后6MWD、步数增加,步行前后RR差值、HR差值、SpO_(2)差值减少;对照组治疗后6MWD增加,步行前后RR差值、SpO_(2)差值减少(P<0.05)。治疗后治疗组较对照组6MWD增加,步行前后RR差值、SpO_(2)差值、疲劳程度评分差值、呼吸困难程度评分差值减少(P<0.05)。治疗后两组患者血清TGF-β1表达水平均较本组治疗前下降,且治疗组低于对照组(P<0.05);治疗组患者Smad2、Smad3转录及蛋白表达水平均低于对照组,Smad7转录及蛋白表达水平均高于对照组(P<0.05)。结论养肺通络方可改善PCPF患者肺纤维化程度、提升日常生活运动耐量,其作用机制可能与抑制TGF-β1/Smad信号通路有关。Objective To investigate the clinical efficacy of Yangfei Tongluo Formula(养肺通络方)in adjuvant treatment of post-COVID-19 pulmonary fibrosis(PCPF),and to explore the possible mechanism.Methods Data of sixty patients hospitalized in the PLA General Hospital of Central Theatre Command from January 1st to April 1st,2020 were retrospectively collected,and were divided into a control group(24 cases)with conventional western medicine,and an observation group(36 cases)with additional Yangfei Tongluo Formula,both for four weeks.The general data of both groups were collected,and lung CT score before and after treatment was assessed;6-minute walk test(6MWT)was applied to collect data on 6-minute walk distance(6MWD),number of steps,respiratory rate(RR),heart rate(HR)and transcutaneous oxygen saturation(SpO_(2))before and after walking,patient fatigue and dyspnea score.Serum transforming growth factorβ1(TGF-β1)level and signal transduction protein 2(Smad2),signal transduction protein 3(Smad3),signal transduction protein 7(Smad7)transcription levels,and Smad2,Smad3,Smad7 protein expression level after treatment were evaluated.Results After treatment,the lung CT scores of both groups decreased,and more changes were found in the observation group than in the control group(P<0.05).In the observation group,6MWD and number of steps increased after treatment,and the difference of RR,HR and SpO_(2) before and after walking decreased;in the control group,6MWD increased after treatment,and the difference of RR and SpO_(2) changes before and after walking decreased(P<0.05).Compared to those in the control group,6MWD in the observation group increased,while difference of RR,SpO_(2),fatigue and dyspnea score were reduced(P<0.05).The level of TGF-β1 decreased after treatment in both groups,and more change was found in the observation group(P<0.05).The transcription and protein expression levels of Smad2 and Smad3 were significantly lower in the observation group than those in the control group,while the Smad7 transcription and p

关 键 词：新型冠状病毒肺炎 肺纤维化 养肺通络方 6分钟步行试验 转化生长因子Β1 信号转导蛋白 

分 类 号：R259[医药卫生—中西医结合]