Effect Of Li Huang Dao Tan Decoction On Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

Objective:To observe changes in hemorheology indices in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD), and to observe the effect of Li Huang Dao Tan Decoction on the exacerbation.Methods:A randomise, single-blind, blank control designed clinical trial was performed in our study. 48 patients met predetermined criteria for an acute exacerbation of COPD were consecutively enrolled and randomly distributed to two groups according to the lung function. The 24 patients in the treatment group were classified to three syndromes of traditional Chinese medicine (TCM) and treated with Li Huang Dao Tan Decoction combined with routine western medicine, while the 24 patients in the control group were treated only with routine western medicine. The hospitalization times, the improvement rate of health status score, and the improved values in lung function, artery blood gas and hemorheology indices were compared between the two groups. 14 healthy volunteers matched for age and sex were measured hemorheology indices for normal control.Results:The health status was improved more significantly in patients in the treatment group compared with the control (P<0.05, Ridit test), and it had no significant difference among the three TCM syndromes in the treatment group (P>0.05, Ridit test). In contrast, the length of stay did not differ between the two groups (11.8±5.0d vs. 13.4±9.9d, mean±SEM, P>0.05, paired t test). The increased values of FEV1%, MVV% and TLCO/VA% were higher in patients in the treatment group compared with the control (P<0.05, paired t test), the increased ratio of FEV1/FVC was indistinguishable between the two groups (P>0.05, paired t test). The increased value of PaO2 and the decreased value of P(A-a)O2 were higher in patients in the treatment group compared withthe control (P<0.05, paired t test), the decreased value of PaCO2 did not differ between the two groups (P>0.05, paired t test). The PH value was improved in both groups, but there had no significant difference (P>0.05, X2 test). In patients with an acute exacerbation of COPD, the values of blood viscosity in low shearing ratio (VBL), plasma viscosity (VP) and aggregation index of erythroctye (AIE) were higher compared with the normal control (P<0.01, paired t test), while the value of blood viscosity in high shearing ratio(VBH) had no significant difference (P>0.05, paired t test). The decreased value of VBL, VP and AIE were higher in patients in the treatment group compared with the control (P<0.05, paired t test), however, there had no significant change in VBH in both the two groups (P>0.05, paired t test).Conclusion:1. Li Huang Dao Tan Decoction combined with western medicine has favorable effect on acute exacerbation of COPD, and it can be prescribed to all the three TCM syndromes mentioned in this article. 2. The decoction can increase FEV1%, MVV%, TLCO/VA%, increase PaO2, decrease PaCO2, P(A-a)O2, and redress the acid-base disturbance. 3. In our study, the VBL, VP and AIE in patients with an acute exacerbation of COPD are higher than normal, and the decoction can decrease these indices. 4. It suggests the contribution of this decoction to the therapeutic effect may have been breath muscle strengthening, pulmonary ventilation and gas exchange improving, blood gas and acid-base disturbance redressing, blood viscosity and erythroctye aggregation index decreasing, etc., which in TCM saying, eliminating phlegm and dispelling pathogenic factors so as to facilitate the functional activities of pulmonary qi.