Evaluation Of The Clinical Efficacy Of Sugarcane-derived Cellulose In The Treatment Of Stable Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease(COPD),a common preventable and treatable disease,is characterized persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases.Exacerbations and comorbidities contribute to the overall severity in individual patients."The lung andthelargeintestinebeinginterior-exteriorlyrelated" is one of the classical theories of TCM,the lung and the intestine are related physiologically and conducted pathologically.This study was based on the relevant literature and theory research.Explore the COPD risk assessment of risk factors for disease,the correlation between the pulmonary symptoms and intestine symptoms,the curative effect and safety of using purgation for COPD.The paper is totally divided into three parts:The first part:the literature review.Summarize the theoretical source of "The lung andthelargeintestinebeinginterior-exteriorlyrelated" at the perspective of meridian and doctrine of viscera state;generalize the laboratory research progress of the mechanism research of "The lung andthelargeintestinebeinginterior-exteriorlyrelated";conclude the diverse therapeutic method based on "The lung andthelargeintestinebeinginterior-exteriorlyrelated" theory.Summarize the modern research and therapeutic of modern medicine and Chinese medicine in COPD,and the basic theory and clinical application of the treatment from lung and intestine.We based on Global strategy for the diagnosis,management and prevention of Chronic Obstructive Pulmonary Disease Revised 2011(GOLD 2011)and made inflammatory cytokines as a key,elaborate on the epidemiology,about this disease of modern medicine pathology,pathogenesis and clinical treatment.The second part:theoretical discussionTake theclinical therapeutic and prescription in Treatise on Febrile Diseases as a clue and summarize the prescription and pattern of syndrome of "purgation method".Investigate the using of purgation method for respiratory system disease.According to the principles and methods of evidence-based medicine,proceed a system evaluation and meta analysis of the safety and curative effect of Dachengqi Decoction treating the acute exacerbation of chronic obstructive pulmonary disease(AECOPD).The third part:clinical research1.Epidemiologic studyObjective:By studying the patients with COPD disease history and family history,occupational history,smoking history and correlation between COPD risk assessment,discusses a risk factor for COPD assessment of high risk.Methods:Using population-based case-control study methods in four cities across China hospital charge COPD patients with respiratory,for distribution features at high risk of developing COPD and COPD risk related influencing factors were studied.Results:The Logistic regression analysis showed thatabdominal distension and constipation syndromeare associated with high risk of COPD,OR:3.127,95%CI:[1.689-5.789].Smoking is associated with high risk of COPD,the OR:2.191,95%CI:[1.227-3.192].Family genetic factors associated with obvious high risk of COPD;OR:1.793,95%CI:[1.029-3.124].Coronary heart disease associated with high risk of COPD is apparent,OR:2.9275 95%CI:1.155-7.418]diabetes associated with high risk of COPD,OR 2.927,95%CI:[1.155-7.418];Apparent relationshipbetween periodontosis disease and higher risk of COPD,the OR value is 2.720,95%CI:[1.065-6.943].COPD assessment of high risk and low risk showed no significant difference in gender,dust exposure history,childhood respiratory disease history,allergic rhinitis,chronic bronchitis,cerebrovascular disease,reflux esophagitis,tuberculosis.Conclusion:Through the experiment,a risk factor for COPD assessment of risk are:abdominal distension constipation,smoking,family heredity,coronary heart disease,diabetes and periodontal disease.2.Correlation studyObjective:By studying comparatively COPD patients with lower respiratory tract symptoms or signs of change,to explore with the main symptoms,lung COPD patients with acute onset,the relationship between the quality of life,provide reference for clinical prevention and treatment of COPD.Methods:Using the canonical correlation analysis methods to analyze the digestive tract main symptoms(abdominal distension,constipation)and lung main symptoms(cough,cough up phlegm,wheezing),frequency of COPD exacerbations,st George’s respiratory questionnaire.Results:Abdominal distension and constipation group in patients with pulmonary symptoms integral were higher than patients with abdominal distension and constipation group(p<0.01);Abdominal distension and constipation group in COPD acute amount is less than the asymptomatic group(p<0.01),6 minutes walking distance,abdominal distension and constipation group is shorter than the asymptomatic group(p<0.05,p<0.01);St George’s questionnaire symptoms of sections,activities and influence score,comparison,abdominal distension and constipation group score were significantly higher in patients with COPD patients with asymptomatic group(p<0.05);Correlation analysis aspect,bloating symptoms and pulmonary symptoms,acute episodes,6 minutes walking distance,has a significant correlation between the quality of life scores(p<0.01),constipation and lung symptoms,acute,has a significant correlation between the quality of life(p<0.01),associated with acute episodes.Conclusion:Patients with COPD pulmonary symptoms(cough,cough up phlegm,shortness of breath)and abdominal symptoms(abdominal distension,constipation)are significant correlation whileCOPD patients with bloating,constipation symptoms had severe symptoms in frequency of COPD exacerbations,quality of life,6 minutes walking distance than patients with less abdominal distension constipation..3.Evaluation of clinical curative effectObjective:To study the efficacy and safety of using sugarcane source of cellulose in treating the people with COPD in stable period.Provide new method forthe treatment of COPD.Methods:Conduct randomized,double-blind,placebo-controlled study.Divided COPD patients in stable period into treatment group and control group randomly.The treatment group were given conventional western medicine treatment and sugarcane source of cellulose while control group were given conventional western medicine treatment and placebo.The outcome measures are the lung and the intestinal symptoms scores,St George’s respiratory questionnaire(SGRQ),dyspnea rating scale(mMRC)and safety.Results:No significant differences in lung symptom score,intestine symptoms score and mMRCbetween treatment group and control group(p>0.05);After treatmentthe treatment group had lower scores than the control group in active part,affect part and total part of SGRQ(p<0.05);After treatmentthe both group had a lower score than prior treatment in lung symptom score and intestine symptoms score(p<0.05);No difference between the two groups in safety indicates.(p>0.05)Conclusion:Sugarcane source of cellulose can improve the lung and intestine symptoms score,improve patient quality of life of thepatients with COPD and are highly safety.