發(fā)布時(shí)間：2018-05-09 13:13

  本文選題：放射性肺炎 + 清金化痰湯��； 參考：《遼寧中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:觀察清金化痰湯聯(lián)合激素治療急性放射性肺炎的臨床療效。急性放射性肺炎的中醫(yī)病機(jī)為熱邪郁肺氣陰兩虛,造成肺宣降失常,臨床中可根據(jù)放射性肺炎患者的證型進(jìn)行治療。本試驗(yàn)應(yīng)用清金化痰湯聯(lián)合激素治療熱邪郁肺氣陰兩虛型急性放射性肺炎,探究并分析患者的生活質(zhì)量評(píng)分、血TGF-β1水平、肺功能、影像學(xué)的變化。材料與方法:采用單盲前瞻性隨機(jī)對(duì)照臨床試驗(yàn)設(shè)計(jì),鞍鋼總醫(yī)院2014年10月至2016年10月收治的急性放射性肺炎患者60例,中醫(yī)辨證分型均為熱邪郁肺氣陰兩虛型。將患者隨機(jī)分為試驗(yàn)組和對(duì)照組,入組患者均符合納入標(biāo)準(zhǔn),不符合排除標(biāo)準(zhǔn),病人自愿參加試驗(yàn)并簽署知情同意書。對(duì)照組患者激素強(qiáng)的松30-50 mg/d口服,試驗(yàn)組使用強(qiáng)的松30-50 mg/d加清金化痰湯加減口服,兩組患者均治療4周。通過生活質(zhì)量評(píng)分、肺功能、血中TGF-β水平(酶聯(lián)免疫法)、胸部CT幾個(gè)方面判定療效。最后經(jīng)SPSS 21.0進(jìn)行統(tǒng)計(jì)分析并得出結(jié)果。結(jié)果:總有效率:治療后,試驗(yàn)組符合有效標(biāo)準(zhǔn)的患者(28)例,無效(2例),總有效率93.33%。對(duì)照組符合有效標(biāo)準(zhǔn)的患者(22)例,無效(8)例,總有效率73.33%。試驗(yàn)組總有效率高于對(duì)照組,經(jīng)χ2檢驗(yàn)差異有統(tǒng)計(jì)學(xué)意義(P0.05);TGF-β1水平:治療前試驗(yàn)組和對(duì)照組TGF-β1水平為(37.90±4.91)和(38.71±4.01);治療后試驗(yàn)組和對(duì)照組TGF-β1水平(26.24±5.37)和(30.26±5.51)。試驗(yàn)組對(duì)TGF-β1水平的降低優(yōu)于對(duì)照組,兩組血TGF-β1的降低效果的差異有統(tǒng)計(jì)學(xué)意義(P0.05);KPS評(píng)分:治療前試驗(yàn)組及對(duì)照組患者KPS評(píng)分為(67.00±5.96)和(65.00±5.72)。治療后試驗(yàn)組及對(duì)照組KPS評(píng)分為(85.00±8.20)和(78.30±10.31)。兩組患者治療前后在KPS平分提高方面的差異有統(tǒng)計(jì)學(xué)意義(P0.05),相較對(duì)照組,試驗(yàn)組的KPS評(píng)分在治療后提高更優(yōu)(P0.05);肺功能:治療前試驗(yàn)組和對(duì)照組的FEV1為(1.33±0.13)和(1.31±0.15),FEV1%為(64.03±2.10)和(63.11±1.68)。治療后試驗(yàn)組和對(duì)照組FEV1為(1.86±0.28)和(1.57±0.25),FEV1%為(76.35±4.50)和(71.50±4.31)。治療后試驗(yàn)組的肺功能的恢復(fù)情況明顯優(yōu)于對(duì)照組,兩組在放射性肺炎造成的肺損傷恢復(fù)效果方面的差異有統(tǒng)計(jì)學(xué)意義(P0.05);。結(jié)論:1.放射性肺炎在使用清金化痰湯加減聯(lián)合激素治療后能夠獲得更顯著的療效,能夠有效改善患者的生活質(zhì)量,明顯減輕患者胸部CT陰影、顯著改善患者的肺功能,比單純激素治療放射性肺炎效果更好。2.清金化痰湯聯(lián)合激素治療能夠顯著的降低TGF-β1的水平,進(jìn)一步抑制患者免疫因子的聚集和浸潤,使患者肺組織炎癥得到減輕,使患者的肺部損傷降到最低。
[Abstract]:Objective: to observe the clinical effect of Qingjin Huatan decoction combined with hormone in the treatment of acute radiation pneumonia. The TCM pathogenesis of acute radiation pneumonia is heat evil stagnation of lung qi and yin deficiency of both lung qi and yin, which results in abnormal declaration of the lung, which can be treated according to the syndromes of patients with radiation pneumonia. In this experiment, Qingjin Huatan decoction combined with hormone was used to treat acute radiation pneumonia with heat evil, stagnation of lung qi and yin deficiency. The quality of life score, blood TGF- 尾 1 level, pulmonary function and imaging changes were investigated and analyzed. Materials and methods: 60 patients with acute radiation pneumonia treated in Angang General Hospital from October 2014 to October 2016 were divided into two types: heat evil stagnation of lung qi and yin deficiency. Patients were randomly divided into experimental group and control group. The patients in the group met the inclusion criteria and did not meet the exclusion criteria. The patients volunteered to participate in the test and sign the informed consent. The patients in the control group were treated with prednisone for 30 to 50 mg/d, the test group was treated with prednisone 30-50 mg/d plus Qingjinhuatan decoction for 4 weeks. Quality of life score, lung function, blood TGF- 尾 level (enzyme linked immunosorbent assay, chest CT) were used to evaluate the curative effect. Finally, the statistical analysis was carried out by SPSS 21. 0 and the results were obtained. Results: total effective rate: after treatment, 28 patients in the test group met the effective standard, 2 patients were ineffective and the total effective rate was 93.33. In the control group, 22 patients met the effective standard and 8 patients failed. The total effective rate was 73.33. The total effective rate of the trial group was higher than that of the control group (蠂 2 test). The levels of TGF- 尾 1 in the test group and the control group were 37.90 鹵4.91 and 38.71 鹵4.01 respectively, and the TGF- 尾 1 levels in the experimental group and the control group were 26.24 鹵5.37) and 30.26 鹵5.51 respectively. The decrease of TGF- 尾 1 level in the trial group was better than that in the control group. There was significant difference in the effect of TGF- 尾 1 reduction between the two groups. The KPS scores of the patients in the trial group and the control group were 67.00 鹵5.96 and 65.00 鹵5.72 respectively before treatment. After treatment, the KPS scores of the experimental group and the control group were 85.00 鹵8.20 and 78.30 鹵10.31 respectively. There was significant difference between the two groups in improving the KPS score before and after treatment. Compared with the control group, the KPS score of the test group was better than that of the control group, and the pulmonary function of the experimental group and the control group was 1.33 鹵0.13) and 1.31 鹵0.15% (64.03 鹵2.10) and 63.11 鹵1.68%, respectively. After treatment, the FEV1 of the experimental group and the control group were 1.86 鹵0.28) and 1.57 鹵0.25% respectively. The FEV1% was 76.35 鹵4.50) and the FEV1 was 71.50 鹵4.31%. After treatment, the recovery of lung function in the experimental group was significantly better than that in the control group, and the difference between the two groups in the recovery effect of lung injury caused by radiation pneumonia was statistically significant (P 0.05). Conclusion 1. After using Qingjin Huatan decoction combined with hormone therapy, radiation pneumonia can obtain more significant curative effect, can effectively improve the quality of life of patients, obviously alleviate the chest CT shadow of patients, and significantly improve the pulmonary function of patients. Treatment of radiation pneumonia is better than hormone alone. 2. 2. Qingjinhuatan decoction combined with hormone therapy can significantly reduce the level of TGF- 尾 1, further inhibit the accumulation and infiltration of immune factors, reduce the inflammation of lung tissue and minimize the lung injury.
【學(xué)位授予單位】：遼寧中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R273

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