宣肺健脾汤治疗COPD稳定期伴肺脾气虚证的临床疗效及机制探讨

陶一青; 沈爱娟; 盛薇

doi:10.16766/j.cnki.issn.1674-4152.004335

宣肺健脾汤治疗COPD稳定期伴肺脾气虚证的临床疗效及机制探讨

doi: 10.16766/j.cnki.issn.1674-4152.004335

1.
嘉兴大学附属中医医院肺功能室, 浙江嘉兴 314001
2.
嘉兴大学附属中医医院肺病科

基金项目:

浙江省中医药科技计划项目 2025ZL129

详细信息

通讯作者:
陶一青, E-mail：523794926@qq.com

中图分类号: R563
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出版历程
- 收稿日期: 2025-07-18
- 网络出版日期: 2026-04-01

The mechanism of Xuanfei Jianpi Decoction in improving pulmonary function of stable COPD patients

1.
Pulmonary Function Room, Jiaxing University Affiliated TCM Hospital, Jiaxing, Zhejiang 314001, China

摘要

摘要: 目的观察宣肺健脾汤对COPD稳定期伴肺脾气虚证患者临床症状的改善作用，并探讨起效机制。方法纳入2023年1月—2025年6月嘉兴市中医医院收治的100例COPD稳定期伴肺脾气虚证患者，使用随机数字表法分为对照组和观察组, 各50例，对照组实施沙美特罗替卡松联合噻托溴铵吸入治疗，观察组增加宣肺健脾汤治疗。观察患者中医证候疗效水平、COPD症状、运动耐力和肺功能改善情况，检测血清炎症因子水平，分析辅助性T细胞17(Th17)/调节性T细胞(Treg)免疫平衡状态变化情况。结果治疗8周后，观察组治疗总有效率高于对照组[92.00%(46/50) vs. 72.00%(36/50), χ²=6.775，P=0.009]。观察组慢性阻塞性肺疾病评分(CAT)、改良呼吸困难量表(mMRC)评分和Borg评分均低于对照组(P＜0.001)，6分钟步行距离(6MWD)高于对照组。观察组第一秒用力呼气容积(FEV₁)、FEV₁/用力肺活量(FVC)和FVC占预计值百分比(FVC% Pred)等肺功能指标均高于对照组(P＜0.001)。观察组血清Th17、Treg和Th17/Treg均低于对照组(P＜0.001)。观察组血清肿瘤坏死因子-α、白细胞介素-1β和白细胞介素-17等炎症因子水平均低于对照组(P＜0.001)。结论宣肺健脾汤可有效缓解COPD稳定期伴肺脾气虚证患者中医证候和临床症状，提高肺功能和运动耐力，其机制与调节细胞免疫功能、抑制呼吸系统炎症反应相关。
- 慢性阻塞性肺疾病 /
- 稳定期 /
- 肺脾气虚证 /
- 宣肺健脾汤 /
- 细胞免疫
Abstract: Objective This paper observes the efficacy of Xuanfei Jianpi Decoction in mitigating the clinical symptoms exhibited by patients diagnosed with stable chronic obstructive pulmonary disease (COPD, with lung spleen qi deficiency syndrome) and the mechanism behind it. Methods A total of 100 stable COPD patients (with lung spleen qi deficiency syndrome) admitted Jiaxing Hostipal of TCM from January 2023 to June 2025 were randomly divided into two groups: a control group (50 cases) and an observation group (50 cases). The control group was administered a combination of inhaled salmeterol and fluticasone combined with tiotropium bromide, while the observation group was treated with the oral Xuanfei Jianpi Decoction. The curative effects on the traditional Chinese medicine syndome in patients were monitored along with COPD symptoms, exercise endurance, and improvement of lung function, The serum inflammatory factor levels were detected, and analyze changes in the T helper 17 cell (Th17)/ regulatory T cell (Treg) immune balance status were analyzed. Results Following a period of eight weeks, the overall effective rate was higher in the observation group than in the control group [92.00% (46/50) vs. 72.00% (36/50), χ²=6.775, P=0.009]. The COPD assessment test (CAT) score, modified medical research council (mMRC) score, and Borg score of the observation group were found to be lower than control group (P < 0.001), while the 6-min walk distance (6MWD) value was found to be higher in the observation group than in the control group. The values of lung function indicators such as forced expiratory volume in 1 sec (FEV₁), FEV₁/forced vital capacity (FVC), and FVC% Pred, were found to be higher in the observation group in comparison to the control group (P < 0.001). The detection values of Th17, Treg, and Th17/Treg in the serum of the observation group were lower than those in the control group (P < 0.001). The levels of inflammatory factors, including tumor necrosis factor-α, interleukin-1β and interleukin-17 in the serum of the observation group were lower than the control group (P < 0.001). Conclusion The Xuanfei Jianpi Decoction has been shown to effectively alleviate traditional Chinese medicine syndromes and clinical symptoms in patients with stable COPD (accompanied by lung spleen qi deficiency syndrome), improve lung function and exercise endurance. The pharmacological mechanism of the substance under investigation is closely related to the regulation of cellular immune function and the inhibition of respiratory inflammatory response.
- Chronic obstructive pulmonary disease /
- Stable period /
- Lung spleen qi deficiency syndrome /
- Xuanfei Jianpi Decoction /
- Cellular immunity

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表 1 2组COPD稳定期伴肺脾气虚证患者一般资料比较

Table 1. Comparison of general data of two groups of patients with stable COPD and lung-spleen deficiency syndrome

组别	例数	性别(例)		年龄(x±s，岁)	病程(x±s，年)	基础性疾病(例)
组别	例数	男性	女性	年龄(x±s，岁)	病程(x±s，年)	高血压	糖尿病
对照组	50	27	23	61.49±5.36	7.34±1.52	26	11
观察组	50	24	26	62.07±5.28	7.29±1.48	29	13
统计量		0.366^a		0.545^b	0.167^b	0.364^a	0.219^a
P值		0.548		0.587	0.868	0.546	0.641
注：^a为χ²值，^b为t值。

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表 2 2组COPD稳定期伴肺脾气虚证患者治疗前后COPD症状和运动耐力改善情况比较(x±s)

Table 2. Comparison of the improvement in COPD symptoms and exercise endurance before and after treatment in 2 groups of patients with stable COPD and lung-spleen deficiency syndrome(x±s)

组别	例数	CAT评分(分)		mMRC评分(分)		6MWD(m)		Borg评分(分)
组别	例数	治疗前	治疗8周	治疗前	治疗8周	治疗前	治疗8周	治疗前	治疗8周
对照组	50	18.34±1.93	12.27±1.54^b	2.71±0.58	1.94±0.51^b	268.57±19.54	419.36±28.54^b	6.51±0.64	4.27±0.51^b
观察组	50	18.69±2.04	9.62±1.06^b	2.76±0.61	1.53±0.48^b	263.42±18.76	465.81±31.06^b	6.39±0.66	3.48±0.49^b
统计量		0.482^a	17.254^c	0.416^a	11.847^c	0.435^a	21.426^c	0.527^a	16.741^c
P值		0.563	＜0.001	0.629	＜0.001	0.611	＜0.001	0.519	＜0.001
注：^a为t值，^c为F值；与同组治疗前比较，^bP＜0.05。

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表 3 2组COPD稳定期伴肺脾气虚证患者治疗前后肺功能指标比较(x±s)

Table 3. Comparison of pulmonary function indicators before and after treatment in two groups of patients with stable COPD and lung-spleen deficiency syndrome(x±s)

组别	例数	FEV₁(L)		FVC% Pred(%)		FEV₁/FVC(%)
组别	例数	治疗前	治疗8周	治疗前	治疗8周	治疗前	治疗8周
对照组	50	1.61±0.27	2.41±0.39^b	68.31±5.27	75.63±6.24^b	54.83±4.68	61.23±5.14^b
观察组	50	1.63±0.32	2.76±0.41^b	67.94±5.43	80.85±6.41^b	55.27±4.59	67.08±5.26^b
统计量		0.392^a	14.536^c	0.427^a	12.047^c	0.463^a	16.882^c
P值		0.664	＜0.001	0.631	＜0.001	0.592	＜0.001
注：^a为t值，^c为F值；与同组治疗前比较，^bP＜0.05。

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表 4 2组COPD稳定期伴肺脾气虚证患者治疗前后Th17/Treg免疫平衡状态比较(x±s)

Table 4. Comparison of Th17/Treg immune balance status before and after treatment in 2 groups of patients with stable COPD and lung qi deficiency syndrome(x±s)

组别	例数	Th17(%)		Treg(%)		Th17/Treg
组别	例数	治疗前	治疗8周	治疗前	治疗8周	治疗前	治疗8周
对照组	50	4.19±0.57	3.28±0.52^b	7.68±0.84	6.85±0.72^b	0.55±0.07	0.48±0.09^b
观察组	50	4.31±0.61	2.31±0.49^b	7.54±0.79	5.73±0.64^b	0.57±0.08	0.40±0.07^b
统计量		0.458^a	17.293^c	0.409^a	13.561^c	0.592^a	11.847^c
P值		0.597	＜0.001	0.647	＜0.001	0.563	＜0.001
注：^a为t值，^b为F值；与同组治疗前比较，^bP＜0.05。

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表 5 2组COPD稳定期伴肺脾气虚证患者治疗前后血清炎症因子水平比较(x±s)

Table 5. Comparison of serum inflammatory factor levels before and after treatment in two groups of patients with stable COPD and lung-spleen deficiency syndrome(x±s)

组别	例数	TNF-α(ng/L)		IL-1β(ng/L)		IL-17(ng/L)
组别	例数	治疗前	治疗8周	治疗前	治疗8周	治疗前	治疗8周
对照组	50	76.53±6.27	30.42±3.19^b	127.18±9.36	62.09±4.28^b	93.47±7.32	41.37±3.61^b
观察组	50	75.81±6.43	21.67±2.45^b	128.45±9.24	45.31±3.67^b	94.08±7.26	26.05±2.94^b
统计量		0.482^a	13.782^c	0.371^a	19.361^c	0.414^a	24.635^c
P值		0.574	＜0.001	0.685	＜0.001	0.642	＜0.001
注：^a为t值，^c为F值；与同组治疗前比较，^bP＜0.05。

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