Ma Xing Shi Gan Decoction Combined Antibiotic Therapy In Elderly Community-acquired Pneumonia

Community acquired pneumonia (CAP) is a kind of common disease which has high risk of aged people. It is easer to get pneumonia for aged people with the development of age, retrogradation of organs and immune function, and more basic diseases. Aged people who get pneumonia are easy to get decompensation of organs, then to result in severe complication, which will make the pathogenetic condition aggravate rapidly. In this condition, the risk of death is higher. Although a lot of active antibiotics have been used in clinic these years, case fatality rate of pneumonia, especially severe cases, doesn't slow down obviously. The purpose of this investigation is to research the therapeutic effect and mechanism of combined treatment of traditional Chinese medicine (TCM) and western medicine on aged people with CAP through observing the therapeutic effect of antibiotics and maxingshigan decoction in the treatment on these cases.The method is prospective random control study. The object is 60 aged people with CAP who got inpatient care in respiration department of China Meitan General Hospital from March 2009 to August 2010. They are divided into two groups with 2:1,39 cases in treatment group treated with TCM and western medicine,20 cases in control group treated with western medicine, including 10 cases in severe treatment group and 9 cases in severe control group. In hospital, Patients got antibiotics, supportive treatment. The patients in treatment group still got maxingshigan decoction determination of treatment based in pathogenesis obtained through differentiation of symptoms and signs. Record patients' clinical manifestation, blood routine, immunoglobulin (IgG,IgA,IgM),Tcell subgroup (CD3+,CD4+,CD8+,CD4+/D8+), LPO and SOD before and 1 week later of treatment to investigate the mechanism of determination of treatment based in pathogenesis obtained through differentiation of symptoms and signs.The 39 aged people with CAP in treatment group are divided into 4 types:①8 cases of pulmonary impairment of pathogen, including 7 cases of pulmonary impairment of wind-heat and 1 case of pulmonary impairment of wind dryness;②19 cases of phlegm-heat obstructing in the lung;③3 cases of pulmonary stagnation of phlegm;④9 cases of asthenia healthy qi and sthenia pathogen factor syndrome, including 4 cases of insufficiency of lung-Qi and 5 cases of Yin-deficiency of the lung and kidney. Aged people with severe CAP are divided into 2 types:①5 cases of phlegm-heat obstructing in the lung;②9 cases of asthenia healthy qi and sthenia pathogenic factor syndrome, including 4 cases of insufficiency of lung-Qi and 1 case of Yin-deficiency of the lung and kidney.As a result, compared with control group, the decrease of neutrophil, increase of lymphocyte, platelet, T cell CD4+, IgA and IgM of aged people with severe CAP in treatment group have conspicuous statistical significance after 1 week (P<0.05)Conclusion:combined treatment of TCM and western medicine on aged people with severe CAP can be useful in decreasing platelet aggregation, improving hypercoagulabale state, regulating nonspecific immunity and defense, cellular immune and humoral immunity function by the influence on neutrophil, increasing lymphocyte, T cell CD4+,IgA and IgM, regulating the balance between oxidation and antioxidation and decreasing inflammatory reaction to increase therapeutic effect.