芪麦芩蒌饮治疗老年社区获得性肺炎非重症气阴两虚、痰热阻肺证的临床疗效  

Clinical Efficacy of Qimai Qinlou Prescription in Treating Elderly Community-acquired Pneumonia(Non-severe)with Qi and Yin Deficiency and Phlegm-heat Obstructing Lung Syndrome

作　　者：刘亿淑 黄秋月 朱欢 黎汉娇 韦若珩 LIU Yishu;HUANG Qiuyue;ZHU Huan;LI Hanjiao;WEI Ruoheng(The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine(TCM),Guiyang 550001,China;The Second Affiliated Hospital of Hainan Medical College,Haikou 572600,China;Sinan County People's Hospital of Guizhou Province,Tongren 565100,China;Guizhou University of TCM,Guiyang 550001,China)

机构地区：[1]贵州中医药大学第一附属医院,贵阳550001 [2]海南医学院第二附属医院,海口572600 [3]贵州思南县人民医院,贵州铜仁565100 [4]贵州中医药大学,贵阳550001

出　　处：《中国实验方剂学杂志》2023年第15期88-95,共8页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：贵州省科技计划项目(黔科合LH字[2017]7135号)。

摘　　要：目的:评价芪麦芩蒌饮治疗老年社区获得性肺炎(CAP)非重症气阴两虚、痰热阻肺证的临床疗效及其对免疫炎症因子的影响。方法:将120例符合要求的患者随机分为观察组(60例)和对照组(60例)。两组均给予注射用头孢西丁钠,观察组患者口服芪麦芩蒌饮,对照组患者口服芪麦芩蒌饮模拟药。疗程为14 d。记录主要临床症状和体征消失时间,比较中医证候评分和肺炎的医生报告结局量表(CAP-CRO),进行肺部电子计算机断层扫描(CT)检查,检测外周血降钙素原(PCT)、白细胞介素-6(IL-6)、血清淀粉样蛋白A(SAA)、超敏C反应蛋白(hs-CRP)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平,记录患者住院期间转为重症率和出院后30 d内再入院率,进行安全性评价。结果:治疗后,观察组发热、咳嗽、咳痰和肺部湿罗音消失时间均显著短于对照组(P<0.01)。与本组治疗前比较,两组患者中医证候评分、CAP-CRO各维度评分及总分均显著降低(P<0.01);治疗后与对照组比较,观察组降低更显著(P<0.01)。与本组治疗前比较,两组患者PCT、IL-6、SAA和hs-CRP水平显著降低(P<0.01);治疗后与对照组比较,观察组降低更显著(P<0.01)。与本组治疗前比较,对照组患者CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)变化差异无统计学意义,观察组患者CD4^(+)、CD4^(+)/CD8^(+)显著升高(P<0.01),CD8^(+)显著降低(P<0.01);治疗后与对照组比较,观察组CD4^(+)、CD4^(+)/CD8^(+)显著升高(P<0.01),CD8^(+)显著降低(P<0.01)。在治疗后7、10、14 d,观察组患者疾病愈显率为53.33%(32/60)、85.00%(51/60)、91.67%(55/60),对照组为31.67%(19/60)、61.67%(37/60)、68.33%(41/60),观察组疾病愈显率均高于对照组,差异具有统计学意义(χ^(2)=5.763,8.352,10.208,P<0.05)。治疗后,观察组患者影像学疗效总有效率为93.33%(56/60),对照组为80.00%(48/60),观察组高于对照组,差异具有统计学意义(χ^(2)=4.615,P<0.05)。观察组住院期间转重症率为3.33%(2/6Objective:To evaluate the clinical efficacy of Qimai Qinlou prescription in the treatment of elderly community-acquired pneumonia(CAP)(non-severe)with Qi and Yin deficiency and phlegm-heat obstructing lung syndrome and its impact on immune-inflammatory factors.Method:A total of 120 eligible patients were randomly divided into an observation group(60 cases)and a control group(60 cases).Both groups received intravenous cefoxitin sodium.In addition,the observation group received oral Qimai Qinlou prescription,while the control group received an oral placebo simulating Qimai Qinlou prescription.The treatment course was 14 days.The disappearance time of major clinical symptoms and signs was recorded.Traditional Chinese medicine(TCM)syndrome scores and the Clinical Research Outcome(CAP-CRO)scale scores for pneumonia of the two groups were compared.Chest computed tomography(CT)scans were performed,and peripheral blood levels of procalcitonin(PCT),interleukin-6(IL-6),serum amyloid A(SAA),high-sensitivity C-reactive protein(hs-CRP),CD4^(+),CD8^(+),and CD4^(+)/CD8^(+)were measured.The conversion rate to severe condition during hospitalization,readmission rate within 30 days after discharge,and safety evaluation were recorded.Result:After treatment,the observation group showed significantly shorter time of fever,cough,expectoration,and disappearance time of lung moist rales than the control group(P<0.01).The TCM syndrome scores,CAP-CRO scores in all dimensions,and total scores in both groups were significantly reduced as compared with those before treatment(P<0.01).After treatment,the observation group had a more significant reduction than the control group(P<0.01).The levels of PCT,IL-6,SAA,and hs-CRP in both groups were significantly reduced as compared with those before treatment(P<0.01).After treatment,the observation group showed a more significant reduction than the control group(P<0.01).There was no statistically significant difference in the changes of CD4^(+),CD8^(+),and CD4^(+)/CD8^(+)in the control group before a

关 键 词：社区获得性肺炎 老年 气阴两虚、痰热阻肺 芪麦芩蒌饮 贝母瓜蒌散 免疫功能 炎症因子 

分 类 号：R2-031[医药卫生—中西医结合] R259[医药卫生—中医学] R563.1R441.5