| Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases of respiratory system. It is a major cause of disability and fatal in our country, and it has becom a hot spot of respirtory disease research. This thesis incloud following three parts:1Article reviewPathogenesis and pathology, therapeutic principle, mechanism of COPD prevention-treatment by traditional Chinese medicine (TCM) and Western medicine therapy were systematic reviewed in this study. The previous studies showed that TCM have a beneficial effect on improving clinical symptoms, health-related quality of life, and reducing the frequence of COPD acute exacerbation.2Theoretical explorationsCombining the pathogenesis and pathology from TCM theory with the progress on the pathophysiology research of Wstern medicine, we put forward a new hypothesis that stasis and toxicity blocking collaterals is one of the etiology and pathogenesis of COPD. We also presented a preliminary discuss on the formation of the stasis and toxin form during the course of COPD, reciprocal transformation, pathogenic characteristic and therapeutic method.3Clinical studyObjective To evaluate Quyu Jiedu Decoction on the treatment of COPD patients in stable stage, based on the changes of the lung function and symptom integral before and after treatment, COPD assessment test (CAT) questionnaire score, BODE index, levels and frequency of AECOPD. Methods66phase Ⅱ-Ⅲ COPD patients with Stasis and Toxicity Blocking Collaterals Syndrome (STBCS) were recruited. They were randomly assigned to the treatment group (33cases) and the control group (33cases) without blind method. Patients in the control group were treated in line with the treatment guidance set by Chinese Medical Association, while those in the treatment group were additionally treated by Quyu Jiedu Decoction. After4-week treatment, comparison the changes of CAT score, BODE index, levels and frequency of AECOPD, the lung function and symptom integral before and after treatment. Results There was no statistical difference in base line data between the treatment group and the control group before treatment. After4weeks treatment,2patients withdrew in the treatment group and3patients withdrew in the control group. The efficiency of disease was87.1%and the efficiency of TCM syndrome was90.32%in the treatment group, which was60%and66.67%in the control group, with statistical difference between the two groups (P<0.05). The total symptom integral, cough, expectoration, chest distress, dark facial complexion, dyspnea score of the treatment group were better than the control group (P<0.01, P<0.05). There was no statistical difference in the integrals changes of panting, cyanosis, spontaneous sweating, tiredness and so on. There was no statistical difference in each post-treatment index of pulmonary function between the two groups. But compared with before treatment, FEV1of two groups were improved (P<0.01). The total CAT score decreased in the two groups, and treatment group score was better than control group (P<0.05). The sleep score and confident score of treatment group was better than control group after treatment (P<0.05). The scores of cough, expectoration, tight, breathless of two groups was better than them before treatment (P<0.01, P<0.05). There was no statistical difference between two groups. As for changes in each index of BODE, there was no statistical difference between the two groups. But compared with before treatment, scores of obstruction, dyspnea and total BODE were improved in two groups (P<0.01). And distance of6MWT was improved in two groups (P<0.01). During4-week follow up period, there were2patients mild exacerbation in the treatment group, but2patients mild and1patient serious exacerbation in the control group. After4weeks follow up period, the total CAT score and each of single index of the treatment group were better than before treatment (P<0.01, P<0.05). And in the control group, the total CAT score, cough, phlegm, breathless, tight and activities scores were better than before treatment (P<0.01, P<0.05). Conclusions Quyu Jiedu Decoction combined with western medicine in the treatment of stable COPD, the efficiency is superior to that of simple western medicine treatment. Quyu Jiedu Decoction can be more effective in relieving cough, expectoration, chest pain, dyspnea, darkish complexion of the clinical symptoms and signs. Quyu Jiedu Decoction can improve the patients’health-related quality of life. It showed that Quyu Jiedu Decoction can make patients’sleep quality better, develop confidence of departure, reduce patients’risk of death. The patients’ health-related quality of life is positively correlated with body mass index,6minutes walking distance and Chinese medicine treatment, negative correlated with age and smoking. The FEV1%PRE was negatively related with age and smoking, positively correlated with6minutes walking distance. The efficiency of TCM syndrome is positively correlated with Chinese medicine treatment, and negatively related to frequence of acute exacerbation and smoking. |
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