| This article consists of two parts:literature review and clinical research.Literature review:The review of traditional Chinese medicine outlines the research progress of TCM on the stable phase of chronic obstructive pulmonary disease(COPD),the etiology and pathogenesis of acute exacerbations,and the treatment of prescriptions.The review of western medicine discusses the complex pathogenesis of COPD from the related studies of inflammatory response of chronic obstructive pulmonary disease,related studies of chronic obstructive pulmonary immune mechanisms,the relationship between chronic obstructive pulmonary inflammation and immune imbalance,and other pathogenesis of chronic obstructive pulmonary disease.Clinical study:Objective:To evaluate the clinical efficacy of Western medicine combined with Qingjinhuayu decoction in treatment of chronic obstructive pulmonary failure;to investigate the effect of Qingjin Huatan Decoction on the treatment of chronic obstructive pulmonary acute exacerbation of phlegm-heated lung syndrome through innate immunomodulatory inflammatory response The mechanism of action.Methods:According to the 2015 guidelines for chronic obstructive pulmonary disease diagnosis and treatment,and the 2011 version of the diagnostic criteria for the phlegm-dissolving lung syndrome,patients with chronic obstructive pulmonary disease with acute exacerbation during the acute exacerbation phase were randomly divided into treatment groups with a random number table.The control group and the treatment group were treated with conventional Western medical treatment + Qingjinhuayu decoction.The control group was treated with conventional western medical treatment.The treatment course was 7 days.The clinical symptom integral scale was filled in on the first and eighth days of treatment and peripheral blood was collected.Observed indicators:1 TCM symptom score 2 Detection of interleukin-8(abbreviation,IL-8)and tumor necrosis factor-a in peripheral blood(serum)by enzyme-linked immunosorbent assay(ELISA)TNF-?,neutrophil elastase(abbreviation,NE)concentration,detection of peripheral blood mononuclear cells nuclear transcription factor-?B(abbreviation,NF-?B)absorbance 3RT-PCR detection of peripheral blood(whole blood)Toll-like receptor 4 mRNA(abbreviation,TLR4 mRNA)expression.The scores of symptom scores and peripheral blood test indicators were compared between the two groups before and after treatment.Results:According to the row-ranking criteria,72 cases of patients with chronic obstructive pulmonary acute exacerbation of phlegm-heat syndrome,9 cases of shedding,and 63 cases of complete data were included in the study,including 33 cases in the treatment group and 30 cases in the control group.There was no statistical difference between the two groups before treatment,and they were comparable.The total effective rate of clinical symptoms improvement in the treatment group after 7 days of treatment was 94%,and the total effective rate in the control group was 83%,P>0.05.There was no significant difference in the results.The scores of the symptom scores in the treatment group decreased from(23.12±2.00)points before treatment to(11.61 ±2.89)points,and there was a statistical difference;after 7 days of treatment in the control group,the scores of the symptom score scales were(22.77± 1.98)points before treatment.Decline to(12.83±3.65)points,with statistical differences.The difference in scores after treatment between the two groups was statistically significant,P<0.05.Peripheral blood test:After treatment,serum IL-8,NE,and TNF-a levels in the treatment group,peripheral blood mononuclear cell extract NF-?B absorbance,and whole blood TLR4 mRNA expression were all decreased,P<0.05,statistically significant Difference;serum concentration of NE in the control group after treatment was not significantly lower than before treatment,P>0.05,no statistical difference,serum IL-8,TNF-a concentration,peripheral blood mononuclear cell extract NF-?B absorbance and whole blood TLR4 mRNA expression was decreased,P<0.05,with statistical difference.After treatment,the serum IL-8 concentration and the NF-?B absorbance of peripheral blood mononuclear cell extracts in the treatment group were comparable to those in the control group.The levels of serum NE,TNF-a and whole blood TLR4 mRNA expression were lower than those in the control group.Statistical differences,P<0.05.Conclusion:After 7 days of treatment,the clinical symptom scores of the treatment group and the control group all decreased,and the effective rate was comparable.There was no statistical difference between the two groups.There was a statistically significant difference between the scores before and after treatment in the two groups.Clinical symptoms in the treatment group The improvement was slightly better than the control group.After treatment,the levels of serum IL-8 and TNF-a,the absorbance of peripheral blood mononuclear cell extract NF-?B and the expression level of whole blood TLR4 mRNA in the treatment group and the control group were all lower than those in the treatment group and the pretreatment serum.The NE concentration decreased and no significant decrease was observed in the control group.The serum IL-8 concentration and the NF-?B absorbance of peripheral blood mononuclear cell extracts in the treatment group were comparable to those in the control group.The levels of serum NE,TNF-a and whole blood TLR4 mRNA were significantly lower than those in the control group.Qingjin Huatan Decoction may interfere with the acute exacerbation of chronic obstructive pulmonary inflammation through the TLR4-MyD88/TRIF-NF-?B signal transduction pathway and reduce the clinical symptoms of patients. |
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