世界中医药

作者	单位
付强恒1，杨洪静2，谢娟1，周波1	1 四川省达州市中西医结合医院重症医学科，达州，635000； 2 成都中医药大学，成都,610072

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中文摘要:

目的：分析千金苇茎汤加减辨治重症肺炎患者临床疗效，探究部分临床疗效机制，为重症肺炎治疗方案选择提供参考。方法：选取2016年1月至2018年1月达州市中西医结合医院收治的重症肺炎患者106例作为研究对象，按照就诊顺序编号，采用单双号分组法，单号为对照组，双号为观察组，每组53例。2组患者均采用重症肺炎常规治疗：予以经验性抗感染治疗、目标性抗感染治疗、氧疗和辅助呼吸治疗、糖皮质激素治疗。观察组在对照组治疗基础上，再根据患者中医证型予以千金苇茎汤加减辨治，2组患者均连续治疗2周。比较2组患者治疗前、治疗后临床症状相关指标（CURB-65、APACHEⅡ评分）、炎性反应指标（白细胞计数（WBC）、降钙素原（PCT）、C反应蛋白（CRP））呼吸功能指标：（氧合指数、氧分压（PaO2）、二氧化碳分压（PaCO2））、免疫平衡调节因（CD4+CD25+Treg细胞、IFN-γ、IL-4、IFN-γ/IL-4）的变化。判定2组患者临床疗效并比较。比较2组患者治疗过程中药物不良反应发生情况。结果：治疗2周后，观察组患者临床治疗有效率明显高于对照组(P<0.05)。治疗后，2组患者CURB-65评分、APACHEⅡ评分均较治疗前明显降低，且观察组低于对照组，差异有统计学意义（P<0.05）。治疗后，2组患者IFN-γ较治疗前无明显变化，IL-4、CD4+CD25+Treg细胞较治疗前明显下降，IFN-γ/IL-4较治疗前上升，差异有统计学意义（P<0.05），且观察组患者IL-4、CD4+CD25+Treg细胞低于对照组，IFN-γ/IL-4高于对照组，差异有统计学意义（P<0.05）。治疗后，2组患者WBC、PCT、CRP均较治疗前明显下降，且观察组患者明显低于对照组患者（P<0.05）。治疗后2组患者氧合指数、PaO2均较治疗前明显缩升高，且观察组高于对照组，差异有统计学意义（P<0.05）；PaCO2较治疗前明显降低，且观察组低于对照组，差异有统计学意义（P<0.05）。2组患者治疗过程中药物不良反应率比较,差异无统计学意义（P>0.05）。结论：千金苇茎汤通过恢复重症肺炎患者免疫平衡，降低患者炎性反应，提升患者呼吸功能，达到效改善重症肺炎患者临床症状，提升临床疗效的作用，且不增加药物不良反应，具有较高的临床价值。

English Summary:

To analyze the clinical efficacy of modified Qianjin Weijing Decoction in the treatment of severe pneumonia,and to explore the mechanism of the clinical efficacy,and to provide reference for the choice of therapy in severe pneumonia.Methods：A total of 106 cases of severe pneumonia admitted to Dazhou Integrated Traditional Chinese and Western Medicine Hospital in January 2016 to January 2018 were selected as research objects.According to the number of the patients,the odd-even grouping method was used.The odd was control group,and the even was observation group,with 53 cases in each group.The 2 groups were given routine treatment for severe pneumonia：empiric anti-infection treatment,target anti-infection treatment,oxygen therapy and auxiliary respiratory therapy and glucocorticoid therapy.On the basis of the treatment in the control group,the observation group was treated with modified Qianjin Weijing Decoction according to the patient's traditional Chinese medicine(TCM）syndrome.The 2 groups of patients were treated for 2 weeks.Clinical symptom-related indexes like scores of CURB-65 and APACHE Ⅱ,inflammatory response indexes like white blood cell(WBC),procalcitonin(PCT）and C-reactive protein(CRP),respiratory function indexes like oxygenation index,oxygen partial pressure(PaO2）and carbon dioxide partial pressure(PaCO2),and regulatory factors of immune balance like CD4+CD25+Treg cells,IFN-γ,IL-4 and IFN-γ/IL-4 of the patients in the 2 groups before and after the treatment were compared.The clinical efficacy of the 2 groups was determined and compared.Adverse drug reactions during the treatment were compared between the 2 groups.Results：1）After 2 weeks of the treatment,the total effective rate of the observation group was significantly higher than that of the control group(P<0.05). 2）After the treatment,the scores of CURB-65 and APACHE II in the 2 groups were significantly lower than those before the treatment,and the scores in the observation group were lower than those in the control group(P<0.05). 3）After the treatment,there was no obvious change in the IFN-γ of the 2 groups.The IL-4 and CD4+CD25+Treg cells were significantly lower than those before the treatment,and the IFN-γ/IL-4 was higher than that before the treatment(P<0.05).The IL-4 and CD4+CD25+Treg cells in the observation group were lower than those in the control group,and the IFN-γ/IL-4 was higher than that in the control group(P<0.05). 4）After the treatment,WBC,PCT and CRP of the 2 groups were significantly lower than those before the treatment,and those in the ovservation group were significantly lower than those in the control group(P<0.05). 5）After the treatment,the oxygenation index and PaO2 in the 2 groups were significantly higher than those before the treatment,and those in the observation group were higher than those in the control group(P<0.05); PaCO2 was significantly lower than that before the treatment,and that in the observation group was lower than that in the control group(P<0.05). 6）There was no significant difference in the rate of adverse drug reactions between the 2 groups(P>0.05).Conclusion：Qianjin Weijing Decoction can restore the immune balance of patients with severe pneumonia,reduce the inflammatory response and improve the respiratory function of the patients,so as to improve the clinical symptoms of severe pneumonia,improve the clinical efficacy,and do not increase the adverse drug reaction.It has high clinical value.

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