基于经方化裁的消瘀散结方治疗痰瘀互结型中危肺结节的临床研究  

Clinical Study on Xiaoyu Sanjie Prescription Derived from Classical Prescriptions in Treating Middle-Risk Lung Nodules of Phlegm Blended with Blood Stasis Type

作　　者：张鑫 周钰浩 刘文华 刘俊[3] 满俊 万鹏 ZHANG Xin;ZHOU Yuhao;LIU Wenhua;LIU Jun;MAN Jun;WAN Peng(Dept.of Gerontology,Chongqing Hospital,the First Affiliated Hospital of Guangzhou University of Chinese Medicine,Chongqing 400700,China;School of Graduate,Guangzhou University of Chinese Medicine,Guangzhou 510006 Guangdong,China;Dept.of Integrated Chinese and Western Medicine,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Dept.of Oncology,Chongqing Changshou District Chinese Medicine Hospital,Chongqing 401220,China)

机构地区：[1]广州中医药大学第一附属医院重庆医院老年病科,重庆400700 [2]广州中医药大学研究生院,广东广州510006 [3]重庆医科大学附属第一医院中西医结合科,重庆400016 [4]重庆市长寿区中医院肿瘤科,重庆401220

出　　处：《广州中医药大学学报》2025年第1期101-107,共7页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：重庆市卫生健康委中医药科研计划项目(编号:2024ZYZD003)。

摘　　要：【目的】观察基于经方柴胡桂枝干姜汤和活络效灵丹化裁的消瘀散结方治疗痰瘀互结型中危型肺结节的临床疗效。【方法】将104例符合纳入标准的痰瘀互结型中危型肺结节患者按随机数字表法随机分为试验组和对照组,每组各52例,因疫情等原因,最终共完成97例,其中试验组48例,对照组49例。在健康宣教基础上,对照组仅给予定期随访,试验组给予消瘀散结方汤药治疗,疗程为3个月。观察2组患者治疗前后中医证候积分及最大肺结节面积的变化情况,并评估2组患者整体上和不同结节类型的中医证候疗效和西医疗效。【结果】(1)中医证候积分方面,治疗后,试验组的中医证候积分分布情况较治疗前明显改善(P <0.01),而对照组较治疗前无明显改善(P> 0.05);治疗后组间比较,试验组对中医证候积分分布情况的改善作用明显优于对照组(P <0.01)。(2)中医证候疗效方面,从整体上来看,试验组的总有效率为81.25%(39/48),对照组为20.41%(10/49),组间比较(秩和检验),试验组的整体中医证候疗效明显优于对照组(P <0.01)。从结节类型来看,试验组对多发性结节、混合实性结节、纯磨玻璃结节、实性结节的中医证候疗效均优于对照组,其中以多发性结节和混合实性结节的疗效更为显著,差异均有统计学意义(P <0.05或P <0.01)。(3)最大肺结节面积方面,治疗后,试验组的最大肺部结节面积较治疗前明显缩小(P <0.01),而对照组较治疗前无明显缩小(P> 0.05);组间治疗后及治疗前后差值比较,差异均有统计学意义(P <0.05或P <0.01),提示试验组对最大肺结节面积的缩小作用明显优于对照组。(4)西医疗效方面,从整体上来看,试验组的总有效率为45.83%(22/48),对照组为6.12%(3/49),组间比较(秩和检验),试验组的整体西医疗效明显优于对照组(P <0.01)。从结节类型来看,试验组在治疗多发性结节方面的西医疗效优于对照组(P Objective To observe the clinical efficacy of Xiaoyu Sanjie Prescription,which is derived from classical prescriptions Chaihu Guizhi Ganjiang Tang and Huoluo Xiaoling Dan,in treating middle-risk lung nodules of phlegm blended with blood stasis type.Methods A total of 104 cases of patients with middle-risk lung nodules of phlegm blended with blood stasis type who met the inclusion criteria were randomly divided into the trial group and the control group,with 52 cases in each group.Eventually,a total of 97 cases completed the trial for epidemic outbreak,of which 48 cases were in the trial group and 49 cases were in the control group.Both groups received health training,and then the control group was only given regular follow-up,while the trial group was treated with Xiaoyu Sanjie Prescription orally.The course of treatment covered three months.The changes in traditional Chinese medicine(TCM)syndrome scores and the area of maximum lung nodule of patients in the two groups before and after treatment were observed.After treatment,overall TCM syndrome efficacy and overall western medicine efficacy as well as their efficacies for various nodules types in the two groups were assessed.Results(1)After treatment,the distribution of the grade of TCM syndrome scores in the trial group was improved significantly when compared with that before treatment(P<0.01),while that in the control group showed no significant improvement(P>0.05),and the intergroup comparison after treatment showed that the improvement in the trial group was significantly superior to that in the control group(P<0.01).(2)The total effective rate of overall TCM syndrome efficacy in the trial group was 81.25%(39/48),and that in the control group was 20.41%(10/49);the intergroup comparison(tested by rank sum test)showed that the overall TCM syndrome efficacy in the trial group was significantly superior to that in the control group(P<0.01).In terms of the efficacy for various nodule types,the trial group had stronger TCM syndrome efficacy for multiple nodules,m

关 键 词：中危型肺结节 痰瘀互结 经方 柴胡桂枝干姜汤 活络效灵丹 消瘀散结方 

分 类 号：R259.63[医药卫生—中西医结合]