摘要
目的:探讨扶正化瘀方治疗气虚血瘀型特发性肺纤维化(IPF)的临床疗效。方法:纳入气虚血瘀型IPF患者80例,随机分为对照组和治疗组,每组各40例。治疗组采用吡非尼酮联合扶正化瘀方治疗,对照组采用吡非尼酮联合安慰剂治疗。两组均治疗3个月,比较两组患者治疗前后的中医证候积分、呼吸困难指数(博格评分)、胸部影像学变化、肺功能变化、炎症及免疫功能相关指标、肺纤维化相关细胞因子表达水平等方面的差异。结果:(1)对照组和治疗组的总有效率分别为77.5%和92.5%,两组比较差异有统计学意义(P<0.05)。(2)与对照组比较,治疗后治疗组患者的CD4^(+)/CD8^(+)T淋巴细胞比值、白介素(IL)-10水平显著升高(P<0.05),IL-4、IL-6、IL-17、基质金属蛋白酶-2(MMP-2)、组织金属蛋白酶抑制物-1(TIMP-1)、结缔组织生长因子(CTGF)、血小板衍生生长因子(PDGF)、转化生长因子(TGF)-β1水平显著降低(P<0.05),但治疗后两组间肿瘤坏死因子-α(TNF-α)、γ干扰素(INF-γ)、IL-2水平的差异无统计学意义(P>0.05)。结论:扶正化瘀方在IPF治疗方面与吡非尼酮具有协同增效作用,与吡非尼酮单独使用相比,两药联合使用效果更显著。其机制可能与抑制炎症因子、纤维化相关细胞因子、调节CD4^(+)T淋巴细胞亚群分化方向有关,TGF-β/Smads信号通路可能在其中发挥了关键作用。
Objective:To explore the clinical efficacy of Fuzheng Huayu Formula in the treatment of idiopathic pulmonary fibrosis(IPF) with type of blood stasis due to qi deficiency.Methods:A total of 80 IPF patients with type of blood stasis due to qi deficiency were randomly divided into control group and treatment group,with 40 cases in each group.The treatment group was treated with pirfenidone combined with Fuzheng Huayu Formula,and the control group was treated with pirfenidone combined with placebo.The two groups were treated for 3 months,and the differences of traditional Chinese medicine(TCM) syndrome symptom scores,dyspnea indexes(Borg score),chest imaging changes,lung function changes,inflammation and immune function related indicators,and expression levels of pulmonary fibrosis related cytokines before and after treatment were compared between the two groups.Results:(1)The total effective rate of the control group and the treatment group was 77.5 % and 90%,and the difference between the two groups was statistically significant(P<0.05).(2)Compared with the control group,CD4^(+)/CD8^(+) T lymphocytes ratio and interleukin(IL)-10 level in the treatment group were significantly increased after treatment(P<0.05),and the levels of IL-4,IL-6,IL-17,matrix metalloproteinase-2(MMP-2),tissue metalloproteinase-1(TIMP-1),connective tissue growth factor(CTGF),platelet-derived growth factor(PDGF) transforming growth factor(TGF)-β1 in the treatment group were significantly decreased(P<0.05).And there was no significant difference in tumor necrosis factor-α(TNF-α),interferon-γ(INF-γ) and IL-2 levels between the two groups after treatment(P>0.05).Conclusion:Fuzheng Huayu Formula has synergistic effect with pirfenidone in the treatment of IPF.The combination of both drugs was more effective than pirfenidone alone.The mechanism may be related to inhibition of inflammatory factors and fibrosis-related cytokines,and regulation of the differentiation direction of CD4^(+) T lymphocyte subset,in which TGF-β/Smads signaling pathway
作者
李莉
申燕华
苑兴华
张善芳
黄婧怡
杭宇
马伟
张秀莲
陈瑜
LI Li;SHEN Yanhua;YUAN Xinghua;ZHANG Shanfang;HUANG Jingyi;HANG Yu;MA Wei;ZHANG Xiulian;CHEN Yu(Department of Respiratory Critical Care,Baoshan Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai201999,China;Clinical Research Institute of Integrated Traditional Chinese and Western Medicine,Yueyang Hospital Affiliatedto Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China)
出处
《上海中医药大学学报》
CAS
2024年第1期52-60,共9页
Academic Journal of Shanghai University of Traditional Chinese Medicine
基金
上海市自然科学基金资助项目(21ZR1447700)
上海市卫健委科研项目(202140234)。
