目的 探討慢性阻塞性肺疾病急性加重期應(yīng)用疏風(fēng)解毒膠囊聯(lián)合硫酸特布他林霧化液治療的臨床效果。方法 選取2017年1月-2018年12月北京市大興區(qū)中西醫(yī)結(jié)合醫(yī)院收治的309例慢性阻塞性肺疾病急性加重期患者，采取隨機(jī)數(shù)字表法將其隨機(jī)分成對(duì)照組（n=154）和治療組（n=155）。對(duì)照組霧化吸入硫酸特布他林霧化液（5 mg/次，3次/d），治療組在此基礎(chǔ)上口服疏風(fēng)解毒膠囊（2.08 g/次，3次/d），所有患者均治療14 d。比較兩組臨床療效及主要癥狀、體征的緩解時(shí)間。治療前后，使用改良版英國(guó)醫(yī)學(xué)研究委員會(huì)呼吸問(wèn)卷（mMRC）評(píng)估兩組患者呼吸困難的嚴(yán)重程度，采用慢性阻塞性肺疾病患者自我評(píng)估測(cè)試問(wèn)卷（CAT）對(duì)受試者綜合癥狀進(jìn)行評(píng)價(jià)，常規(guī)測(cè)定肺功能參數(shù)[第1秒用力呼氣容積（FEV1）與用力肺活量（FVC）比值（FEV1/FVC）、FEV1占預(yù)計(jì)值百分比（FEV1占預(yù)計(jì)值%）]及呼出氣一氧化氮（FeNO）濃度，分別選用酶聯(lián)免疫法、免疫透射比濁法檢測(cè)血清白介素（IL）-8、C反應(yīng)蛋白（CRP）水平，再利用流式細(xì)胞儀測(cè)定外周血輔助性T細(xì)胞（Th）1、Th2占CD⁴⁺ T細(xì)胞的比例。并統(tǒng)計(jì)兩組藥物不良事件發(fā)生情況。結(jié)果 治療組總有效率為95.5%，顯著高于對(duì)照組（86.4%），兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療組主要癥狀（咳嗽、咳痰、喘息）及肺部哮鳴音的緩解時(shí)間較對(duì)照組均顯著縮短（P<0.05）。兩組治療后mMRC、CAT評(píng)分均顯著低于治療前（P<0.05），而FEV1/FVC、FEV1占預(yù)計(jì)值%值均顯著更高（P<0.05）；且治療后，治療組以上問(wèn)卷評(píng)分及肺功能指標(biāo)的改善效果較對(duì)照組同期均更顯著（P<0.05）。與治療前對(duì)比，兩組治療后FeNO濃度及血清IL-8、CRP水平和外周血Th1、Th2細(xì)胞比例均顯著降低（P<0.05）；但治療組上述指標(biāo)的改善效果均更顯著（P<0.05）。對(duì)照組和治療組的不良反應(yīng)發(fā)生率分別是2.6%、3.2%，兩組比較差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論 疏風(fēng)解毒膠囊聯(lián)合特布他林治療慢性阻塞性肺疾病急性加重期的整體療效確切，可迅速穩(wěn)定患者病情，緩解氣流受限，減輕氣道炎癥與系統(tǒng)性炎癥，抑制免疫過(guò)激，具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To investigate the clinical effect of Shufeng Jiedu Capsules combined with terbutaline in treatment of acute exacerbation of chronic obstructive pulmonary disease. Methods A total of 309 patients with acute exacerbation of chronic obstructive pulmonary disease admitted to Beijing Daxing District Integrated Traditional Chinese and Western Medicine Hospital from January 2017 to December 2018 were randomly divided into control group (n=154) and treatment group (n=155). The control group was given Terbutaline Sulphate Solution for nebulization, 5 mg/time, three times daily. The treatment group was po administered with Shufeng Jiedu Capsules, 2.08 g/time, three times daily. All patients were treated for 14 d. The clinical efficacy and the relief time of the main symptoms and signs were compared between two groups. Before and after treatment, the modified British Medical Research Council Respiratory Questionnaire (mMRC) was used to assess the severity of dyspnea in both groups. The self-assessment test questionnaire (CAT) for patients with chronic obstructive pulmonary disease was used to evaluate the syndrome of the subjects. Pulmonary function parameters[1st forced expiratory volume (FEV1) and forced vital capacity (FVC) ratio (FEV1/FVC), FEV1 as a percentage of predicted value (FEV1 as predicted value)] and exhaled nitric oxide (FeNO) serum interleukin (IL)-8 and C-reactive protein (CRP) levels were determined by enzyme-linked immunosorbent assay and immunoturbidimetric assay, respectively. The proportion of helper T cells (Th) 1 and Th2 in CD4⁺ T cells in peripheral blood was determined by flow cytometry. And the incidence of adverse drug events in the two groups was calculated. Results The total effective rate of the treatment group was 95.5%, which was significantly higher than that of the control group (86.4%), and there were differences between two groups (P < 0.05). The remission time of the main symptoms (cough, cough, wheezing) and lung wheezing in the treatment group was significantly shorter than that in the control group (P < 0.05). The scores of mMRC and CAT were significantly lower in the two groups than before treatment (P < 0.05), while the values of FEV1/FVC and FEV1 were significantly higher (P < 0.05). After treatment, the above questionnaire scores and lung function indexes were more significant than those of the control group (P < 0.05). Compared with before treatment, the levels of FeNO, serum IL-8, CRP and the ratio of Th1 and Th2 cells in peripheral blood were significantly lower (P < 0.05). However, the improvement of the above indicators in the treatment group was more significant (P < 0.05). After treatment, the adverse reaction rates in the control and treatment group were 2.6% and 3.2%, respectively, and there was no difference between two groups. Conclusion Shufeng Jiedu Capsules combined with terbutaline has overall effect in treatment of acute exacerbation of chronic obstructive pulmonary disease, and can quickly stabilize the patients' condition, and relieve airflow limitation, reduce airway inflammation and systemic inflammation, and suppress immune hyperactivity, which has a certain clinical application value.

R974