目的 探討金匱腎氣丸聯(lián)合沙美特羅替卡松粉吸入劑治療慢性阻塞性肺疾病穩(wěn)定期的臨床療效。方法 選取天津市寧河區(qū)醫(yī)院在2018年1月-2019年10月收治的102例慢性阻塞性肺疾病穩(wěn)定期患者作為研究對(duì)象，根據(jù)隨機(jī)數(shù)字表法分為對(duì)照組和治療組，每組各51例。對(duì)照組霧化吸入沙美特羅替卡松粉吸入劑，1吸/次，1次/d。治療組患者在對(duì)照組治療的基礎(chǔ)上口服金匱腎氣丸，20粒/次，2次/d。兩組患者連續(xù)治療3個(gè)月。對(duì)比兩組的總有效率，評(píng)估兩組治療前后肺功能指標(biāo)、呼吸困難程度和免疫細(xì)胞水平。結(jié)果 治療后，治療組患者的總有效率比對(duì)照組高，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組的用力呼氣量（FVC）、第1秒用力呼氣容積（FEV1）/FVC、呼氣峰值流速（PEF）、FEV1占預(yù)計(jì)值百分比（FEV1 predicted）均明顯升高（P<0.05）；治療后治療組的FVC、FEV1/FVC、PEF、FEV1 predicted比對(duì)照組高，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組患者改良呼吸困難指數(shù)（mMRC）評(píng)分明顯低于治療前（P<0.05），治療后治療組的mMRC評(píng)分比對(duì)照組低，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組的Th17細(xì)胞、Th17細(xì)胞/Treg細(xì)胞比值均明顯低于治療前，Treg細(xì)胞明顯高于治療前（P<0.05）；治療后治療組的Th17細(xì)胞、Th17細(xì)胞/Treg細(xì)胞比值比對(duì)照組低，Treg細(xì)胞比對(duì)照組高，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 金匱腎氣丸聯(lián)合沙美特羅替卡松粉吸入劑治療慢性阻塞性肺疾病穩(wěn)定期具有較好的臨床療效，可減輕呼吸困難癥狀，改善肺功能，調(diào)節(jié)Th17細(xì)胞、Treg細(xì)胞的分泌，具有一定的臨床研究?jī)r(jià)值。

Objective To investigate the clinical effect of Jinkui Shenqi Pills combined with Salmeterol Xinafoate and Fluticasone Propionate Powder for inhalation in treatment of stable stage of chronic obstructive pulmonary disease. Methods Patients (102 cases) with stable stage of chronic obstructive pulmonary disease in Tianjin Ninghe Hospital from January 2018 to October 2019 were divided into control and treatment groups according to the random number table methods, and each group had 51 cases. Patients in the control group were inhalation administered with Salmeterol Xinafoate and Fluticasone Propionate Powder for inhalation, 1 suction/time, once daily. Patients in the treatment group were po administered with Jinkui Shenqi Pills on the basis of the control group, 20 pills/time, twice daily. Patients in two groups were treated for 3 months. After treatment, the total effective rate was compared, and the pulmonary function indexes, degree of dyspnea, and immune cell levels in two groups before and after treatment were evaluated. Results The total effective rate in the treatment group was higher than that in the control group (P<0.05). After treatment, the values of FVC, FEV1/FVC, PEF, and FEV1 predicted in the two groups were significantly increased, and the difference was statistically significant in the same group (P<0.05). After treatment, the values of FVC, FEV1/FVC, PEF, and FEV1 predicted in the treatment group were higher than those in the control group, with significant difference between two groups (P<0.05). After treatment, MMRC scores in two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05), and MMRC scores in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P<0.05). After treatment, the levels of Th17 cells and Th17 cells/Treg cells in two groups were significantly decreased, but the levels of Treg cells were significantly increased, and the difference was statistically significant in the same group (P<0.05). After treatment, Th17 cells and Th17 cells/Treg cells in the treatment group were lower than those in the control group, but Treg cells were higher than those in the control group, with significant difference between two groups (P<0.05). Conclusion Jinkui Shenqi Pills combined with Salmeterol Xinafoate and Fluticasone Propionate Powder for inhalation has clinical curative effect in treatment of stable stage of chronic obstructive pulmonary disease, can alleviate symptoms of dyspnea, improve pulmonary function, regulate the secretion of Th17 cells and Treg cells, which has a certain clinical application value.

R974

天津市科技計(jì)劃項(xiàng)目（16JCQNJC10600191072）