Systematic Review Of Tonifying Lung And Kidney Therapy On Patients With Stable COPD And The Experiment Research Of Bufei Pill's Effect On TLR4 / NF-?B Pathway

Objective1.Systematic review:Based on the evidence-based method,to evaluate the effectivity and safety of tonifying lung and kidney therapy on the stable COPD.2.Experimental study:To observe the effect of Bufei Pill on COPD rats,and explore its possible mechanisms.Method1.Systematic review:According to the method of searching,the tonifying lung and kidney therapy on the stable COPD randomized controlled trials were searched in the Chinese and English electronic literature database?CBM,CNKI,WANF-ANG,VIP,PubMed,EMBASE?.These files were screened by inclusion and exclusion criteria and determined by Cochrane bias risk table.Valid data were extracted and analyzed by RevMan 5.3.2.Experimental study:The rat COPD model was established by cigarette smoke exposure combined with lipopolysaccharide injection.The rats were randomly divided into three groups:the model group,the Bufei pill group and the montelukast group.18 rats were randomly divided into control group.Lung tissues and BALF were collected after 32 days treatment.To observe the general condition of the rats,the changes of body weight,HE staining of lung tissue pathological sections.The protein expression of TLR4,MyD88 and NF-?B in lung tissue were determined by immunohistochemistry.The levels of NF-?B in BALF were determined by ELISA.Result1.Systematic review:A total of 25 RCTs involving 2111 patients were included Compared with the control group,tonifying lung and kidney therapy or combined with Western medicine basic treatment,can reduce the number of acute exacerbation of COPD?[MD]=-1.44,95%CI[-1.57,-1.30],P<0.0001?,reduce its clinical symptoms?Total efficiency[RR]=1.22,95%CI[1.16,1.28],P<0.00001?,improve their quality of life?SGOR[MD]=-9.41,95%CI[-13.00,-5.82],P<0.00001,BMI[MD]=0.70,95%CI[0.35,1.05],P<0.0001?,Increase blood oxygen partial pressure?PaO₂[MD]=4.64,95%CI[3.11,6.18],P<0.00001?,Reduce the partial pressure of carbon dioxide?[MD]=-4.75,95%CI[-5.42,-4.08],P<0.00001;[MD]=-3.37,95%CI[-3.81,-2.92],P<0.00001?,to a certain extent,improve COPD patients with stable lung function status?FEV1[MD]=0.24,95%CI[0.17,0.31],P<0.0001,FVC[MD]=0.30,95%CI[0.20,0.40],P<0.00001?,with no obvious adverse reactions.2.Experimental study:The lung tissue in model rats is consistent with the performance of COPD.The levels of NF-?B in the BALF of the model group rats were significantly higher than those in the control group?P<0.01?.The levels of NF-?B in BALF of the Bufei pill group and the montelukast group rats were significantly decreased compared with COPD model group?P<0.05?.The protein expression of TLR4,MyD88 and NF-?B in the lung tissue of the COPD model group were significantly higher than those in the blank group?P<0.01?.The protein expression of TLR4 and NF-?B in lung tissue of western medicine group and pills group were significantly decreased compared with COPD model group?P<0.05?.There was no significant difference in the protein expression of MyD88 in the montelukast group and the Bufei pills group compared with the model group?P>0.05?.Conclusion1.Systematic review:the combination of tonifying lung and kidney therapy and western medicine shows the effectivity and safety in the treatment of stable COPD.But limite to the quality of the included studies,the results still need to be confirmed by further researchs.2.Experimental study:Bufei Pills have a good effect on COPD model rats,through the TLR4/NF-?B non-MyD88-dependent pathway possibly.