活血化瘀法治療結(jié)核性胸膜炎胸膜增厚的療效觀察及對(duì)TNF-α和FIB的影響
發(fā)布時(shí)間：2018-08-28 20:27
【摘要】：目的： 觀察活血化瘀法治療結(jié)核性胸膜炎胸膜增厚的療效以及對(duì)胸水中腫瘤壞死因子(TNF-α)和纖維蛋白原(FIB)的影響。 方法： 將60例符合條件的患者隨機(jī)分為治療組和對(duì)照組,住院期間治療組用常規(guī)治療(抗結(jié)核藥物+胸腔穿刺抽液術(shù))+活血化瘀的中藥,對(duì)照組用常規(guī)治療(抗結(jié)核藥物+胸腔穿刺抽液術(shù)),療程2周±7天,出院后治療組用抗結(jié)核藥物+活血化瘀成藥(血府逐瘀沖劑1包,tid),對(duì)照組只用抗結(jié)核藥物,療程8周±7天,觀察兩組治療前后胸水中腫瘤壞死因子TNF-α,纖維蛋白原(FIB)的變化,患者癥狀和肺功能改善情況以及胸膜厚度的改變。 成果： 1.中醫(yī)證候療效方面：治療前兩組患者各項(xiàng)主要中醫(yī)癥狀比較,無顯著性差異,(p0.05),具有可比性。治療后,治療組各項(xiàng)癥狀與治療前相比,均有顯著性差異,(p0.05),而對(duì)照組僅在咳嗽,氣促,發(fā)熱,咯血方面,同治療前相比有顯著差異,其余指標(biāo)均無顯著的差異,說明單純常規(guī)的方法治療僅能改善結(jié)核性胸膜炎部分癥狀,而聯(lián)合活血化瘀的中藥可明顯改善患者主要中醫(yī)癥狀,而且兩組治療后比較,治療組在除氣促,發(fā)熱外,其余癥狀均較對(duì)照組明顯改善(p0.05),且治療后兩組中醫(yī)療效比較,治療組顯效,有效的例數(shù)和總有效率明顯高于對(duì)照組(p0.05),說明治療組在改善結(jié)核性胸膜炎患者中醫(yī)證候方面明顯優(yōu)于對(duì)照組。 2.肺功能檢查：治療前,兩組患者FVC, FEV1/FVC%, VC, FEV1比較無顯著性差異(p0.05),具有可比性。治療2周±7天,8周±7天,兩組患者FVC, VC,均較治療前有顯著的提高,而FEV1無明顯變化(p0.05),FEV1/FVC%下降(p0.05)。兩組治療前后有顯著的差異(p0.05),兩組組間比較,治療組VC較對(duì)照組有顯著的提高,FEV1/FVC%下降(p0.05),而FEV1, FVC無顯著的差異(p0.05),說明兩組組間治療有顯著性的差異,治療組在改善患者肺功能方面明顯優(yōu)于對(duì)照組。 3.胸水腫瘤壞死因子(TNF-α):治療前兩組患者的胸水中腫瘤壞死因子的含量比較無顯著的差異(p0.05),經(jīng)過相同療程治療后,2周±7天兩組患者胸水中腫瘤壞死因子,較治療前均有顯著的減少(p0.05)。治療后兩組之間相比,具有顯著性差異(p0.05),說明治療組的療效明顯優(yōu)于對(duì)照組。 4.胸水纖維蛋白原(FIB)：治療前兩組患者的胸水中纖維蛋白原比較無顯著差異(p0.05),經(jīng)過相同療程治療后,2周±7天兩組患者胸水中纖維蛋白原,較治療前均有顯著的減少(p0.05)。治療后兩組之間相比,具有顯著性差異(p0.05)說明治療組的療效明顯優(yōu)于對(duì)照組。 5.胸膜厚度：治療前兩組患者的胸膜厚度的比較無顯著的差異(p0.05),經(jīng)過相同療程的治療,2周±7天后治療組與對(duì)照組患者胸膜的厚度相比,具有顯著性差異(p0.05)：8周±7天后兩組相比,具有顯著性的差異(p0.05),說明治療組的療效明顯優(yōu)于對(duì)照組。 6.安全性指標(biāo)：兩組治療前后血分析,大便檢查,尿組合,ALT, AST,尿素氮及肌酐對(duì)比,兩組治療前無顯著的差異(p0.05),兩組治療2周±7天,8周±7天與治療前比較均無顯著的差異(p0.05) 結(jié)論： 本病從“懸飲病”后期多以氣滯水飲瘀血互結(jié)為主要證型的臨床實(shí)際出發(fā),以“津虧血瘀”的中醫(yī)病理理論為指導(dǎo),以結(jié)核性胸膜炎患者為受試對(duì)象,采用常規(guī)治療(抗結(jié)核藥物+胸腔穿刺術(shù))+活血化瘀中藥治療,與常規(guī)治療(抗結(jié)核藥物+胸腔穿刺術(shù))相比,能有效降低胸水中腫瘤壞死因子(TNF-α)和纖維蛋白原(FIB)的含量以及能夠明顯減少患者胸膜增厚的程度,改善患者肺功能的情況,從而改善患者臨床癥狀,明顯改善疾病的預(yù)后。
[Abstract]:Objective:
Objective To observe the effect of Huoxue Huayu method on pleural thickening in tuberculous pleurisy and the effect on tumor necrosis factor-alpha (TNF-alpha) and fibrinogen (FIB) in pleural effusion.
Method:
Sixty eligible patients were randomly divided into treatment group and control group. During hospitalization, the treatment group was treated with routine treatment (anti-tuberculosis drugs + pleural puncture aspiration) + traditional Chinese medicine for activating blood circulation and removing blood stasis. The control group was treated with routine treatment (anti-tuberculosis drugs + pleural puncture aspiration). The treatment course was 2 weeks (+ 7 days). After discharge, the treatment group was treated with anti-tuberculosis drugs + traditional Chinese medicine for activating blood circulation Xuefu Zhuyu Granule 1 pack, tid, the control group only used anti-tuberculosis drugs, course of treatment 8 weeks (+ 7 days), to observe the changes of tumor necrosis factor TNF-a, fibrinogen (FIB) in pleural effusion before and after treatment, the improvement of symptoms and lung function and pleural thickness.
Achievements:
1. TCM syndromes: before treatment, the two groups of patients with the main symptoms of TCM, no significant difference (p0.05), comparable. After treatment, the treatment group compared with before treatment, the symptoms have significant differences (p0.05), while the control group only in cough, shortness of breath, fever, hemoptysis, compared with before treatment, there is a significant difference, the rest of the fingers. There was no significant difference between the two groups, indicating that only routine treatment can improve some symptoms of tuberculous pleurisy, and the combination of traditional Chinese medicine can significantly improve the main symptoms of patients with tuberculous pleurisy, and two groups after treatment, the treatment group in addition to shortness of breath, fever, the other symptoms were significantly improved compared with the control group (p0.05), and after treatment in both groups. Compared with the control group, the number of effective cases and the total effective rate in the treatment group were significantly higher than those in the control group (p0.05), indicating that the treatment group was superior to the control group in improving the TCM syndrome of tuberculous pleurisy patients.
2. Pulmonary function examination: Before treatment, FVC, FEV1 / FVC, VC, FEV1 were not significantly different between the two groups (p0.05), with comparability. 2 weeks (+ 7 days), 8 weeks (+ 7 days), two groups of patients with FVC, VC, were significantly improved than before treatment, but no significant changes in FEV1 (p0.05), FEV1 / FVC% decreased (p0.05). There was a significant difference between the two groups before and after treatment (p0.05). Compared with the control group, VC in the treatment group was significantly improved, FEV1/FVC% decreased (p0.05), while FEV1 and FVC had no significant difference (p0.05), indicating that there was a significant difference between the two groups. The treatment group was significantly better than the control group in improving lung function.
3. Tumor necrosis factor-alpha in pleural effusion: There was no significant difference in the content of TNF-alpha in pleural effusion between the two groups before treatment (p0.05). After the same course of treatment, the level of TNF-alpha in pleural effusion of the two groups was significantly lower than that before treatment (p0.05). There was a significant difference between the two groups after treatment (p0.05). 05), indicating that the curative effect of the treatment group is obviously better than that of the control group.
4. Fibrinogen in pleural effusion (FIB): There was no significant difference between the two groups before treatment (p0.05). After the same course of treatment, the fibrinogen in pleural effusion of the two groups decreased significantly (p0.05). There was significant difference between the two groups after treatment (p0.05). The curative effect is obviously better than that of the control group.
5. Pleural thickness: before treatment, there was no significant difference in pleural thickness between the two groups (p0.05). After the same course of treatment, the pleural thickness between the treatment group and the control group after 2 weeks (+ 7 days) was significantly different (p0.05). After 8 weeks (+ 7 days), there was a significant difference between the two groups (p0.05), indicating that the treatment group had a significant effect. It was better than the control group.
6. Safety indicators: two groups before and after treatment blood analysis, stool examination, urine combination, ALT, AST, urea nitrogen and creatinine comparison, two groups before and after treatment no significant difference (p0.05), two groups of treatment 2 weeks (+ 7 days), 8 weeks (+ 7 days) compared with before treatment no significant difference (p0.05).
Conclusion:
Based on the clinical practice of Qi stagnation, water retention and blood stasis as the main syndromes in the late stage of "suspended drinking disease", and guided by the pathological theory of "Jin deficiency and blood stasis", the patients with tuberculous pleurisy were treated with routine treatment (anti-tuberculosis drugs + thoracic puncture) + traditional Chinese medicine for activating blood circulation and removing blood stasis, and routine treatment (anti-tuberculosis drugs) Compared with thoracentesis, it can effectively reduce the levels of tumor necrosis factor-alpha (TNF-alpha) and fibrinogen (FIB) in pleural effusion, significantly reduce the degree of pleural thickening and improve the pulmonary function of patients, thereby improving the clinical symptoms and prognosis of the disease.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R521.7
[Abstract]:Objective:
Objective To observe the effect of Huoxue Huayu method on pleural thickening in tuberculous pleurisy and the effect on tumor necrosis factor-alpha (TNF-alpha) and fibrinogen (FIB) in pleural effusion.
Method:
Sixty eligible patients were randomly divided into treatment group and control group. During hospitalization, the treatment group was treated with routine treatment (anti-tuberculosis drugs + pleural puncture aspiration) + traditional Chinese medicine for activating blood circulation and removing blood stasis. The control group was treated with routine treatment (anti-tuberculosis drugs + pleural puncture aspiration). The treatment course was 2 weeks (+ 7 days). After discharge, the treatment group was treated with anti-tuberculosis drugs + traditional Chinese medicine for activating blood circulation Xuefu Zhuyu Granule 1 pack, tid, the control group only used anti-tuberculosis drugs, course of treatment 8 weeks (+ 7 days), to observe the changes of tumor necrosis factor TNF-a, fibrinogen (FIB) in pleural effusion before and after treatment, the improvement of symptoms and lung function and pleural thickness.
Achievements:
1. TCM syndromes: before treatment, the two groups of patients with the main symptoms of TCM, no significant difference (p0.05), comparable. After treatment, the treatment group compared with before treatment, the symptoms have significant differences (p0.05), while the control group only in cough, shortness of breath, fever, hemoptysis, compared with before treatment, there is a significant difference, the rest of the fingers. There was no significant difference between the two groups, indicating that only routine treatment can improve some symptoms of tuberculous pleurisy, and the combination of traditional Chinese medicine can significantly improve the main symptoms of patients with tuberculous pleurisy, and two groups after treatment, the treatment group in addition to shortness of breath, fever, the other symptoms were significantly improved compared with the control group (p0.05), and after treatment in both groups. Compared with the control group, the number of effective cases and the total effective rate in the treatment group were significantly higher than those in the control group (p0.05), indicating that the treatment group was superior to the control group in improving the TCM syndrome of tuberculous pleurisy patients.
2. Pulmonary function examination: Before treatment, FVC, FEV1 / FVC, VC, FEV1 were not significantly different between the two groups (p0.05), with comparability. 2 weeks (+ 7 days), 8 weeks (+ 7 days), two groups of patients with FVC, VC, were significantly improved than before treatment, but no significant changes in FEV1 (p0.05), FEV1 / FVC% decreased (p0.05). There was a significant difference between the two groups before and after treatment (p0.05). Compared with the control group, VC in the treatment group was significantly improved, FEV1/FVC% decreased (p0.05), while FEV1 and FVC had no significant difference (p0.05), indicating that there was a significant difference between the two groups. The treatment group was significantly better than the control group in improving lung function.
3. Tumor necrosis factor-alpha in pleural effusion: There was no significant difference in the content of TNF-alpha in pleural effusion between the two groups before treatment (p0.05). After the same course of treatment, the level of TNF-alpha in pleural effusion of the two groups was significantly lower than that before treatment (p0.05). There was a significant difference between the two groups after treatment (p0.05). 05), indicating that the curative effect of the treatment group is obviously better than that of the control group.
4. Fibrinogen in pleural effusion (FIB): There was no significant difference between the two groups before treatment (p0.05). After the same course of treatment, the fibrinogen in pleural effusion of the two groups decreased significantly (p0.05). There was significant difference between the two groups after treatment (p0.05). The curative effect is obviously better than that of the control group.
5. Pleural thickness: before treatment, there was no significant difference in pleural thickness between the two groups (p0.05). After the same course of treatment, the pleural thickness between the treatment group and the control group after 2 weeks (+ 7 days) was significantly different (p0.05). After 8 weeks (+ 7 days), there was a significant difference between the two groups (p0.05), indicating that the treatment group had a significant effect. It was better than the control group.
6. Safety indicators: two groups before and after treatment blood analysis, stool examination, urine combination, ALT, AST, urea nitrogen and creatinine comparison, two groups before and after treatment no significant difference (p0.05), two groups of treatment 2 weeks (+ 7 days), 8 weeks (+ 7 days) compared with before treatment no significant difference (p0.05).
Conclusion:
Based on the clinical practice of Qi stagnation, water retention and blood stasis as the main syndromes in the late stage of "suspended drinking disease", and guided by the pathological theory of "Jin deficiency and blood stasis", the patients with tuberculous pleurisy were treated with routine treatment (anti-tuberculosis drugs + thoracic puncture) + traditional Chinese medicine for activating blood circulation and removing blood stasis, and routine treatment (anti-tuberculosis drugs) Compared with thoracentesis, it can effectively reduce the levels of tumor necrosis factor-alpha (TNF-alpha) and fibrinogen (FIB) in pleural effusion, significantly reduce the degree of pleural thickening and improve the pulmonary function of patients, thereby improving the clinical symptoms and prognosis of the disease.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R521.7
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本文編號(hào)：2210521
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