目的 探討清肺消炎丸聯(lián)合沙丁胺醇治療慢性阻塞性肺疾病急性加重期（AECOPD）的臨床效果。方法 選取2019年3月—2020年10月天津市人民醫(yī)院收治的106例AECOPD患者，使用隨機數(shù)字表法將其隨機分成對照組（n=53）和治療組（n=53）。對照組給予氧氣驅(qū)動霧化吸入硫酸沙丁胺醇霧化吸入溶液，2.5 mg/次，3次/d。治療組在對照組基礎上口服清肺消炎丸，60丸/次，3次/d。兩組均連續(xù)治療14 d。觀察兩組的臨床療效，比較兩組典型癥狀緩解時間、改良版英國醫(yī)學研究委員會呼吸問卷（mMRC）評分、慢性阻塞性肺疾病患者自我評估測試（CAT）評分、肺功能相關參數(shù)、中性粒細胞與淋巴細胞比值（NLR），血清淀粉樣蛋白A（SAA）、基質(zhì)金屬蛋白酶（MMP）-9、基質(zhì)金屬蛋白酶抑制劑-1（TIMP-1）水平及MMP-9/TIMP-1比值。結(jié)果 治療后，治療組總有效率為94.3%，顯著高于對照組的81.1%（P<0.05）。治療組咳嗽、咳痰、喘息和肺部哮鳴音的緩解時間較對照組均顯著縮短（P<0.05）。治療后，兩組mMRC評分及CAT評分均顯著低于本組治療前（P<0.05）；且治療后治療組以上評分的降低作用較對照組更顯著（P<0.05）。治療后，兩組第1秒用力呼氣容積（FEV₁）占預計值、FEV₁與用力肺活量比值（FEV₁/FVC）均較本組治療前顯著升高，但殘氣容積與肺總量比值（RV/TLC）則均顯著降低（P<0.05）；且治療后，治療組肺功能參數(shù)改善優(yōu)于對照組（P<0.05）。治療后，兩組NLR及血清SAA、MMP-9、TIMP-1水平和MMP-9/TIMP-1比值均較本組治療前顯著下降（P<0.05）；且治療后，治療組NLR和血清學指標改善優(yōu)于對照組（P<0.05）。結(jié)論 清肺消炎丸聯(lián)合沙丁胺醇治療AECOPD的總體療效滿意，能安全有效且迅速地控制患者癥狀和體征，改善其肺通氣功能，并可進一步減輕患者體內(nèi)炎癥反應、糾正其MMP-9/TIMP-1失衡。

Objective To investigate the clinical effect of Qingfei Xiaoyan Pills combined with salbutamol in treatment of acute exacerbation of chronic obstructive pulmonary disease. Methods A total of 106 AECOPD patients admitted to Tianjin People's Hospital from March 2019 to October 2020 were randomly divided into control group (n=53) and treatment group (n=53) by random number table method. Patients in the control group were given oxygen driven atomized inhalation of Salbutamol Sulfate Nebules Inhalation Solution, 2.5 mg/time, 3 times daily. Patients in the treatment group were po administered with Qingfei Xiaoyan Pills on the basis of the control group, 60 pills/time, 3 times daily. Both groups were treated for 14 d. The clinical efficacy of the two groups was observed. Typical symptom relief time of two groups, improved version of the medical research council respiratory questionnaire (mMRC), chronic obstructive pulmonary disease patients self assessment test (CAT) score, pulmonary function related parameters, neutrophils and lymphocytes ratio (NLR), serum amyloid A (SAA), matrix metalloproteinases (MMP)-9, matrix metalloproteinase-1 (TIMP-1) level and MMP-9/TIMP-1 ratio in two groups were compared. Results After treatment, the total effective rate in the treatment group was 94.3%, significantly higher than that in the control group (81.1%) (P< 0.05). The relief time of cough, expectoration, wheezing and pulmonary wheezing in treatment group was significantly shorter than that in control group (P < 0.05). After treatment, mMRC score and CAT score in two groups were significantly lower than before (P < 0.05). After treatment, the effect of above score in treatment group was more significant than that in control group (P < 0.05). After treatment, forced expiratory volume in the first second (FEV₁)% and the ratio of FEV₁ to forced vital capacity (FEV₁/FVC) in both groups were significantly increased compared with before treatment, but the ratio of residual gas volume to total lung volume (RV/TLC) was significantly decreased in both groups (P < 0.05). After treatment, the improvement of lung function parameters in the treatment group was better than that in the control group (P < 0.05). After treatment, NLR, serum SAA, MMP-9, TIMP-1 levels, and MMP-9/TIMP-1 ratio in two groups was significantly decreased compared with before treatment (P< 0.05). After treatment, NLR and serological indexes in the treatment group were improved better than those in the control group (P < 0.05). Conclusion Qingfei Xiaoyan Pills combined with salbutamol has satisfactory overall efficacy in the treatment of AECOPD, and can safely, effectively and quickly control the symptoms and signs of patients, improve their lung ventilation function, and can further reduce the inflammatory response in the patients' body and correct their MMP-9/TIMP-1 imbalance.

R974

天津市衛(wèi)生和計劃生育委員會科研基金資助項目（2017KZ009）