Clinical And Experimental Study On The Effect Of Qingjin Huatan Decoction On The Secretion Of AECOPD Airway Mucosal By Neutrophil Elastic Protease

Experimental researchObjective To explore Qingjinhuatan decoction’s mechanism on Chronic Obstrucive Pulmonary Disease airway mucus hypersecretion on neutrophil elastase -epidermal growth factor receptor-mitogen-activated protein kinase signal pathway.Methods Using dripping LPS in bronchus and smoking cigarette to build COPD airway mucus hypersecretion rat model.Clean level Wistar strain rats(n=50) are randomly divided into Blank control group,model group,Qingjinhuatan decoction group,Clarithromycin group and Jieduqingfei group. Model group,Qingjinhuatan decoction group,Clarithromycin group and Jieduqingfei group rats are separately raised by 0.9% sodium chloride solution,Qingjinhuatan decoction,Clarithromycin tablets and Jieduqingfei mixture by in tragastric administration method for 30 days,at the same time blank control group rat are raised normally.All rats are killed on 31th day,each group randomly selectes six rats,and observing pathological changes of lung tissue and mucous glands hyperplasia by HE staining method,goblet cell hyperplasia by Alcian blue and periodic acid Schiff staining,NEmRNA,EGFRmRNA,MUC5ACmRNA expression on lung tissue by RT-PCR method,NE,P-EGFR,P-ERK,P-JNK,P-p38,MUC5AC protein expression on pulmonary tissue and airway epithelium by immunohistochemical method.Results Compared with blank control group,Model group rats’mucous glands hyperplasia on airway epithelium,goblet cell numbers,NEmRNA and MUC5ACmRNA expression on lung tissue,NE,P-EGFR,P-ERK,P-JNK,P-p38 and MUC5AC protein expression on airway epithelium significantly increased.Compared with Model group, Qingjinhuatan decoction group mucous glands hyperplasia on airway epithelium,goblet cell numbers,NEmRNA,EGFRmRNA,MUC5ACmRNA expression on lung tissue,NE,P-ERK,P-p38,MUC5AC protein expression on airway epithelium significantly decreased, and inhibit the expression of NEmRNA,EGFRmRNA,MUC5ACmRNA,NE protein is better than Clarithromycin group; Compared with Model group,P-JNK expression on airway epithelium in Qingjinhuatan decoction group is significantly increased, but decreased in Clarithromycin group, the difference has statistical significance.Compared with Model group,both Qingjinhuatan decoction group and Clarithromycin group have no effect on the expression of P-EGFR protein in airway epithelium.Conclusion Qingjinhuatan decoction can reduce airway mucus hepersecrection of chronic obstructive pulmonary disease by inhibition NE,ERK and p38 signal pathway in the downstream of EGFR.Clinical researchObjective To explore the qingjinhuatan decoction’s effect on acute exacerbation of chronic obstructive pulmonary disease(lung phlegm heat syndrome)airway mucus hypersecretion by regulating NE.Methods The patients that meet the inclusion criteria of acute exacerbation of COPD (lung phlegm heat syndrome) are randomly divided into treatment group and control group by using a random number table.A total of 156 patients with 21 cases of loss,complete data and statistical significance of 135 cases,71 cases in the treatment group,64 cases in the control group.The control group on the basis of conventional western medicine treatment programs of AECOPD,are given Tanreqing Injection 30ml intravenous drip,1 times a day.The treatment group on the basis of conventional western medicine treatment programs of AECOPD,are given Qingjinhuatan decoction granules orally,2 times a day,each time 1 bags for seven days as a course.Observation index:(1)Detection of arterial blood gas in patients with PaO2, PaCO2,SpO2 and pH before treatment;(2)observating cough frequency, sputum viscosity,sputum color,sputum volume.wheezing,chest tightness,dyspnea symptoms and white blood cell count,neutrophil percentage.C reactive protein laboratory indexes respectively on the first and seven days in the treatment;(3)detecting patieants’s serum NE and MUC5AC content on the first and seventh days by Elisa method.Results (1)135 cases of patients with AECOPD,67 males (49.63%),68 females (50.37%);(2)135 cases of patients with AECOPD,the minimum age of 46 years,the maximum age of 97 years old,the average age (75.81± 9.88) years old,the largest distribution in the 81-90 years old (43.70%), followed by 71-80 years old (28.15%),61-70 years old (17.78%),51-60 years old (7.41%),>90 years old (2.22%) and 40-50 years old (0.74%);(3)135 cases of patients with AECOPD,77 people in smokers (57.04%),58 peopleof no smoking history (42.97%);(4)135 cases of patients with AECOPD in medical history,from high to low followed by hypertension(52.59%),coronary atherosclerotic heart disease(45.93%),Diabetes(22.96%),hyperlipidemia(20.74%),reflux esophagitis(17.78%),fatty liver(16.30%),arrhythmia(12.59%),cerebral infarction (11.11%),renal failure (8.15%),gastritis (7.41%)and thyroid disease(4.44%);(5)135 cases of hospitalized patients with AECOPD,the largest population in pulmonary function in III group (45.19%), followed by lung function in Ⅱ group (34.07%), lung function in I population (20.74%);(6)compared with pretherapy,cough frequency, sputum color, sputum viscosity, sputum volume, wheezing, chest tightness,mMRC score, dry mouth,yellow urine,dry stool individual symptom scores were significantly decreased in two groups after treatment (P<0.01),and the Qingjinhuatan decoction group in improving COPD patients’cough frequency,sputum color, sputum viscosity, sputum volume was significantly better than control group (P<0.01); (7)Compared with pretherapy,serum NE,MUC5AC content,N% and CRP were significantly decreased in two groups after treatment (P<0.01),And the Qingjinhuatan decoction group in reducing the secretion of mucin MUC5AC is significant better than control group (P<0.01);compared with pretherapy,the Qingjinhuatan decoction group significantly decreased TWBC after treatment (P<0.01),While the control group WBC has no difference before and after treatment (P>0.05);(8)Compared with pretherapy, the total syndrome scores of the two groups was significantly reduced after treatment (P<0.01), and the Qingjinhuatan decoction group was better than the control group (P<0.01).Conclusion Chinese medicine clearing heat and eliminating phlegm (Qingjinhuatan decoction and Tanreqing injection)combine with western medicine can significantly improve clinical symptoms and laboratory indexes of patients with AECOPD. Qingjinhuatan decoction combine with western medicine can significantly improve clinical symptoms of patients with AECOPD,especially in improving cough frequency, viscous sputum, sputum color, sputum volume, is better than Tanreqing injection combined with western medicine treatment group;Qingjinhuatan decoction combine with western medicine can significantly decrease levels of serum NE,MUC5AC,plasma WBC,N% and CRP in patients with AECOPD,and the effect on reducing MUC5AC level is significant better than Tanreqing injection combined with western medicine treatment group.