宣肺降浊清肠汤治疗稳定期支气管扩张症疗效及对肠道微生态的影响  

Efficacy of decoction for diffusing lung,discharging turbid and calming panting on stable bronchiectasis and its effect on intestinal microecology

作　　者：朱汉平[1] 张志敏[1] 谢栩硕[1] 任培华[1] 王鹏[1] 李振球[1] ZHU Hanping;ZHANG Zhimin;XIE Xushuo;REN Peihua;WANG Peng;LI Zhenqiu(The First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,Guangdong,China)

机构地区：[1]广州医科大学附属第一医院,广东广州510120

出　　处：《现代中西医结合杂志》2024年第7期882-887,共6页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：广东省中医药局中医药科研项目(20221236,20231243)。

摘　　要：目的观察宣肺降浊清肠汤治疗稳定期支气管扩张患者的效果及对肠道微生态的影响。方法选取2022年1月—2023年1月广州医科大学附属第一医院收治的稳定期支气管扩张症痰湿蕴肺型患者90例为观察对象,随机分为西药组、中药组、中西医结合组,每组各30例;同时于广州医科大学附属第一医院体检中心随机选取30例健康者作为空白组,用于肠道菌群检测的对照。西药组给予氨溴索口服,中药组给予宣肺降浊清肠汤颗粒剂口服,中西医结合组给予宣肺降浊清肠汤联合氨溴索口服。连续治疗6个月后评估3组临床疗效,比较3组治疗前后肺功能指标[第一秒用力呼气容积(FEV_(1))、用力肺活量(FVC)、呼气峰值流速(PEF)]、支气管扩张严重程度指数(BSI)评分、24 h痰量、急性加重次数、咳嗽-咳痰评估问卷(CASA-Q)评分、圣乔治呼吸问卷(SGRQ)评分及粪便标本中直肠真杆菌、多形拟杆菌表达量(采用PCR扩增法测定)。结果治疗结束后,中西医结合组临床总有效率明显高于中药组、西药组[93.3%(28/30)比63.3%(18/30)、76.7%(23/30),P均<0.05]。与治疗前比较,治疗后3组FEV_(1)、FVC、PEF均明显提高,BSI评分、SGRQ评分均明显降低,24 h痰量、急性加重次数均明显减少,CASA-Q评分均明显升高,且中西医结合组各指标改善情况均明显优于中药组及西药组,西药组各指标改善情况均明显优于中药组,差异均有统计学意义(P均<0.05)。治疗后中西医结合组和中药组粪便中直肠真杆菌、多形拟杆菌表达量均较治疗前明显改善(P均<0.05),西药组粪便直肠真杆菌、多形拟杆菌表达量均无明显变化(P均>0.05);治疗后中药组和中西医结合组直肠真杆菌表达量均明显低于西药组(P均<0.05),多形拟杆菌表达量均明显高于西药组(P均<0.05),中药组和中西医结合组直肠真杆菌、多形拟杆菌表达量比较差异均无统计学意义(P均>0.05)。结论宣肺降Objective It is to observe the effect of decoction for diffusing lung,discharging turbid and calming panting on stable bronchiectasis and its effect on intestinal microecology.Methods Ninety patients with stable bronchiectasis of syndrome of phlegm-dampness accumulating lung treated in the First Affiliated Hospital of Guangzhou Medical University from January 2022 to January 2023 were selected as the observed subjects,and were randomly divided into western medicine group,Chinese medicine group,and combined traditional Chinese and western medicine group(combined group),with 30 cases in each group;meanwhile,30 healthy persons were randomly selected from the Physical Examination Center of the First Affiliated Hospital of Guangzhou Medical University as the blank group for the control of intestinal flora detection.The western medicine group was given ambroxol orally,the Chinese medicine group was given granules of decoction for diffusing lung,discharging turbid and calming panting orally,and the combined group was given decoction for diffusing lung,discharging turbid and calming panting combined with ambroxol orally.The clinical efficacy of the three groups was evaluated after 6 months of treatment,and the pulmonary function indexes[forced expiratory volume in one second(FEV_(1)),forced volume capacity(FVC),peak expiratory flow(PEF)],bronchodilatation severity index(BSI),24-h sputum volume,acute exacerbation frequency,cough and sputum assessment questionnaire(CASA-Q)scores,and St.George’s Respiratory Questionnaire(SGRQ)scores,and the expressions of Eubacterium rectale and Bacteroides thetaiotaomicron in fecal specimens(determined by PCR amplification)before and after treatment were compared among the three groups.Results At the end of treatment,the total clinical effective rate of the combined group was significantly higher than that of the traditional Chinese medicine group and western medicine group[93.3%(28/30)VS.63.3%(18/30),76.7%(23/30),all P<0.05].Compared with before treatment,FEV_(1),FVC and PEF were signif

关 键 词：支气管扩张 稳定期 痰湿蕴肺型 宣肺降浊清肠汤 肠道菌群微生态 

分 类 号：R562.22[医药卫生—呼吸系统]