Effect Of Acupuncture Combined With Qingfei Qutan Decoction On Immune Function Of Patients With Stroke-related Pneumonia(SAP)and Its Curative Effect

1 ObjectiveTo observe the clinical efficacy of acupuncture combined with Qingfei Qutan decoction（清肺祛痰汤,QFQTD）in the treatment of stroke associated pneumonia（SAP）with phlegm-heat retention in the lung,and explore its possible mechanism of action,in order to provide more reliable clinical data for acupuncture combined with traditional Chinese medicine（TCM）in the treatment of SAP in the future.2 Methods99 SAP patients with phlegm-heat retention in the lung from the Department of Encephalopathy of the Second Affiliated Clinical Medical College of Anhui University of TCM were randomly divided into acupuncture group,TCM group and combination of acupuncture and TCM group（referred to as combination group）,with 33 patients in each group.All patients were given routine medical treatment for stroke.The acupuncture group was treated with acupuncture once a day and 6 times a week.TCM group was treated with QFQTD,1 dose per day.The combination group was treated with acupuncture combined with QFQTD.2 weeks is a course of treatment,a total of 2courses.The levels of clinical pulmonary infection score（CPIS）,inflammatory related indicators（neutrophil/lymphocyte ratio）,procalcitonin,C-reactive protein,tumor necrosis factor-αand interleukin-6,immune related indexes（cellular immune function（CD₃⁺,CD₄⁺,CD₈⁺and CD₄⁺/CD₈⁺ratio）and humoral immune function（Ig A,Ig G,Ig M））were compared before and after treatment.Observe the clearance of pathogenic bacteria before and after treatment,evaluate the clinical efficacy,and follow up the clinically cured patients after 3 months.3 Results3.1 General clinical data:Baseline data such as sex and age are comparable（P>0.05）.3.2 Clinical effect indicators:The levels of CPIS score,CD₈⁺and inflammation-related indexes in the three groups after intervention were lower than those before treatment（P<0.05）,and the levels of CD₃⁺,CD₄⁺,CD₄⁺/CD₈⁺and humoral immune function were significantly higher than those before treatment;Among them,the CPIS score,cellular and humoral immune function levels in the acupuncture and drug groups were improved more significantly than those in the acupuncture and drug groups,and the difference was significant（P<0.05）,indicating that the three intervention methods could improve lung infection,and the improvement in the acupuncture and drug group was more obvious.3.3 Clinical efficacy and pathogenic bacteria clearance:There was no significant difference in the clearance rate of pathogenic bacteria among the three groups before and after the intervention（P>0.05）.3.4 Follow-up of clinically cured patients after 3 months:Three months later,a total of 1 case recurred in the three groups of clinically cured patients,of which 1 case recurred in the acupuncture and drug group of 7 cured patients,and 2 cases in the TCM group did not recurrence.4 Conclusions4.1 Both acupuncture combined with QFQTD and independent treatment can reduce CPIS score and TNF-α,IL-6,CD₈⁺,NLR,PCT,CRP and other inflammatory levels,increase the levels of CD₃⁺,CD₄⁺,CD₄⁺/CD₈⁺,Ig A,Ig M,Ig G and other immune functions to improve pulmonary infection.Among them,acupuncture combined with QFQTD has a more significant clinical effect on SAP patients with phlegm-heat obstructing lung syndrome.It is suggested that the mechanism of acupuncture combined with QFQTD in treating SAP with phlegm-heat obstructing lung syndrome may be related to enhancing the immune function of the body and reducing the level of inflammatory reaction,but further mechanism research is still needed to prove.4.2 It is preliminarily found that acupuncture combined with QFQTD may not improve the clinical symptoms of SAP patients with phlegm-heat obstructing lung by clearing pathogenic bacteria.