The Theory And Clinical Study Of Treating Chronic Obstructive Pulmonary Disease In Acute Stage From Phlegm-heat Obstructing Lung

Objective Chronic obstructive pulmonary disease(COPD)is an independent risk factor of lung cancer,which is closely related to the occurrence and development of lung cancer.In the part of theoretical research,we reviewed the literature about diagnosis and treatment of COPD and lung cancer,and reviewed the clinical data of COPD and lung cancer.The therapeutic principle of acute attack of COPD was discussed from the pathogenesis of phlegm-heat obstructing lung.In the part of clinical research,we observed the effect of Jiawei Qingjin Huatan Decoction on Clinical Curative Effect,Serum Inflammatory Index and tumor markers in patients with phlegm-heat obstructing Lung Syndrome in acute exacerbation of chronic obstructive pulmonary disease,to explore the possible mechanism of the treatment of acute exacerbation of chronic obstructive pulmonary disease.Method Retrospective Study:from 2017 to 2018,50 patients with acute exacerbation of COPD and 50 patients with COPD and lung cancer were admitted to the oncology department,Emergency Department and Aspiration Department of the Second Affiliated Hospital of Nanjing University of Chinese Medicine.Draw up and finish the epidemiological investigation,compare and analyze the general data,clinical symptoms and signs,the classification of lung function,the distribution of Tcm Syndrome,and explore the correlation between COPD and lung cancer.Prospective Study:from February 2019 to January 2020,90 patients with phlegm-heat Syndrome in acute exacerbation stage of chronic obstructive pulmonary disease(COPD)were collected from the emergency ward of the Second Affiliated Hospital of Nanjing University of Chinese Medicine.The patients were randomly divided into control group and treatment group with 45 cases each.The control group was treated with anti-infection,anti-asthma and other conventional Western medicine and symptomatic treatment.The Treatment Group was treated with modified Qingjin Huatan decoction.Before and after treatment,the TCM Syndrome score(TCMSS)of the two groups were compared.Plasma samples were collected before treatment and 10 days after treatment,the levels of Serum Carcinoembryonic Antigen(CEA),Neuron Specific Enolase(NSE)and Cytokeratin 19(CYFRA21-1),serum levels of inflammatory index(TNF-),Interleukin 17(IL-17),metalloproteinase(MMP-9)and Tumor Index(CEA)were measured before and after treatment in both groups.The clinical effect of the two groups was compared.Result Retrospective Study:1.Comparison of risk factors:The smoking index of COPD patients with lung cancer was(567±374.66),which was higher than that of COPD patients(410±294.17),and the difference was statistically significant(p<0.05).2.Comparison of clinical symptoms:The symptoms of cough(48vs47 cases),expectoration(44vs42 cases)and asthma(38vs44 cases)were not significantly different between COPD and COPD patients with lung cancer,however,hemoptysis(25vs3 cases),chest pain(24vs7 cases),fatigue(24vs 10 cases)and emaciation(28vs4 cases)were more common in COPD patients with lung cancer,and the difference was statistically significant(p<0.05).3.Comparison of pulmonary function classification:There were 41 cases with grade i-ii pulmonary function in COPD patients with lung cancer,and 21 cases with grade i-ii pulmonary function in simple copd patients,the difference was statistically significant(p<0.05)4.Comparison of distribution of syndromes in traditional Chinese medicine:There were 7 cases and 3 cases of wind-cold attacking Lung Syndrome,4 cases and 3 cases of external cold and internal fluid syndrome,13 cases and 11 cases of phlegm-dampness obstructing Lung Syndrome,21 cases and 25 cases of phlegm-heat Obstructing Lung Syndrome,there were 5 and 8 cases of phlegm-meng-shen-qiao Syndrome,and most of them were phlegm-heat obstructing Lung Syndrome.Prospective Study:1.Comparison of integration of TCM syndromes:After treatment,both groups decreased significantly(p<0.01),which indicated that the condition of the patients was obviously alleviated.The difference before and after treatment in the control group was significantly greater than that in the Control Group(p<0.01).It is suggested that the improvement of the treatment group is better than that of the control group.2.Comparison of Comprehensive Curative Effect:In the control group,the effective rate was 9.52%,and the total effective rate was 80.95%.In the treatment group,the effective rate was 39.53%,and the total effective rate was 93.02%.The significant efficiency of the two groups was compared,p<0.05,suggesting that the treatment group was superior to the Control Group.3.Comparison of inflammatory markers:The levels of TNF-,IL-17 and MMP-9 decreased significantly in the two groups,and the difference between the Treatment Group and the control group was greater than that of the Control Group(p<0.01).It is suggested that modified Qingjin Huatan decoction can improve the inflammatory index to some extent.4.Comparison of tumor markers:The difference of CEA,NSE and CYFRA21-1 levels between the two groups before and after treatment was not significant(p<0.05)5.Comparison of safety indicators:The function of heart,liver and kidney were observed before and after treatment.It is suggested that the modified Qingjin Huatan decoction is safe and reliable,and has no toxic and side effects.Conclusions Retrospective Study:The occurrence of COPD and lung cancer is closely related to smoking;the more smoking,the more likely that COPD will become cancerous.No significant difference was found in the symptoms of cough,sputum and asthma in COPD patients with or without lung cancer.When COPD patients presented with hemoptysis,chest pain,weakness and emaciation,it was necessary to guard against the occurrence of lung cancer.The classification of pulmonary function in COPD patients with lung cancer was mostly from mild to moderate.Prospective Study:Jiawei Qingjin Huatan Decoction is effective in treating COPD patients with acute attack of phlegm-heat obstructing lung,and it can obviously improve the clinical symptoms.The mechanism may be to inhibit the expression of inflammatory factors,and improve the body's immunity.