雷火灸治疗慢性阻塞性肺疾病急性加重期的疗效观察及对外周血Th17/Treg免疫平衡的影响  

Therapeutic observation of thunder-fire moxibustion in treating acute exacerbation of chronic obstructive pulmonary disease and its effect on peripheral blood Th17/Treg immune balance

作　　者：潘小丹 林月华 黄玉龙 范良 郑靓 林承霞 潘燕蝶 张美萃 符秀曼 PAN Xiaodan;LIN Yuehua;HUANG Yulong;FAN Liang;ZHENG Liang;LIN Chengxia;PAN Yandie;ZHANG Meicui;FU Xiuman(Haikou Hospital of Traditional Chinese Medicine,Haikou 570216,China)

机构地区：[1]海口市中医医院,海口570216

出　　处：《上海针灸杂志》2024年第4期374-380,共7页Shanghai Journal of Acupuncture and Moxibustion

基　　金：海南省卫生健康行业科研项目(21A200014);国家中医药管理局全国名老中医药专家传承工作室建设项目[国中医药人教函(2022)75号]。

摘　　要：目的观察雷火灸辅助西医治疗慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)的临床疗效及对患者外周血辅助性T细胞17(T helper cell 17,Th17)/调节性T细胞(regulatory T cells,Treg)免疫平衡的影响。方法选取67例AECOPD患者为研究对象,采用信封随机法分为对照组(32例)和试验组(35例)。对照组予西医常规治疗,试验组予雷火灸辅助西医常规治疗。比较两组临床疗效,观察两组治疗前后中医证候积分、肺功能指标、肺血管阻力指标、血气指标、血清趋化因子配体18(CC-chemokine ligand 18,CCL18)、白介素-5(interleukin-5,IL-5)、白介素-10(interleukin-10,IL-10)和Th17/Treg免疫平衡的变化。比较两组随访1年内急性加重次数和单次急性加重持续时间。结果试验组总有效率高于对照组(P<0.05)。两组治疗后中医证候积分、Th17比例、Th17/Treg、血清CCL18水平、血清IL-5水平和肺血管阻力指标均低于同组治疗前(P<0.05),且试验组均低于对照组(P<0.05)。两组治疗后肺功能指标、血气指标、Treg比例和血清IL-10水平均高于同组治疗前(P<0.05),且试验组均高于对照组(P<0.05)。随访1年内,试验组急性加重次数少于对照组(P<0.05),单次急性加重持续时间短于对照组(P<0.05)。结论雷火灸辅助西医治疗AECOPD可改善患者血气指标,提高肺功能,促进Th17/Treg免疫平衡,减少急性加重次数,疗效优于单一西医治疗。Objective To observe the clinical efficacy of thunder-fire moxibustion in assisting Western medicine to treat acute exacerbation of chronic obstructive pulmonary disease(AECOPD)and its effect on the immune balance of T helper cell 17(Th17)/regulatory T cells(Treg).Method Sixty-seven AECOPD patients were recruited as subjects and divided into a control group(32 cases)and a trial group(35 cases)using the envelop randomization method.The control group was given routine Western medicine treatment,and the trial group received thunder-fire moxibustion to assist with the routine Western medicine treatment.The clinical efficacy was compared.The symptom score of traditional Chinese medicine(TCM),pulmonary function indicators,pulmonary vascular resistance indicators,blood gas parameters,CC-chemokine ligand 18(CCL18),interleukin(IL)-5,IL-10,and Th17/Treg immune balance were observed.The number of acute exacerbations and the duration of single attack during the 1-year follow-up were compared.Result The trial group had a higher total effective rate than the control group(P<0.05).After the treatment,the TCM symptom score,Th17 ratio,Th17/Treg,serum CCL18 level,serum IL-5 level,and pulmonary vascular resistance indicators dropped in both groups(P<0.05)and were lower in the trial group than in the control group(P<0.05).After the intervention,the pulmonary function indicators,blood gas indexes,Treg ratio,and serum IL-10 level increased in both groups(P<0.05)and were higher in the trial group than in the control group(P<0.05).During the 1-year follow-up,the number of acute exacerbations was smaller in the trial group compared with the control group(P<0.05),and the duration of a single attack was shorter in the trial group(P<0.05).Conclusion In the treatment of AECOPD with Western medicine,thunder-fire moxibustion can assist in improving the patient’s blood gas indexes,enhance pulmonary function,boost Th17/Treg immune balance,and reduce the number of acute exacerbations,producing more significant efficacy than the sole use of West

关 键 词：灸法 雷火灸 针药并用 慢性阻塞性肺疾病 急性期 咳嗽 胸闷 

分 类 号：R246.1[医药卫生—针灸推拿学]