| Background:Chronic Obstructive Pulmonary Disease(COPD)is a common disease of respiratory which characterized by incomplete reversible airflow constraints.The latest research shows that the prevalence of COPD among people aged 40 and over in China is as high as 13.7%.The occurrence of COPD is related to smoking,air pollution and biofuel use.With the effect of chronic airway inflammation,oxidative stress,protease-antiprotease imbalance,COPD would occur airway remodeling finally.Acute Exacerbation of Chronic Obstructive Pulmonary Disease(AECOPD)means the acute exacerbation of respiratory symptoms and needs extra treatment.AECOPD is highly valued for its occurrence leads to accelerated decline in lung function,worse long-term prognosis and more frequent acute exacerbations.Morden multi-center and large-sample cross sectional investigation of syndrome shows that syndrome of phlegm-heat obstructing lung is the common syndrome of AECOPD.TCM believes "the lung and the large intestine being interior-exteriorly related",the lung-heat can lead to constipation.Based on the academic thought of "preventing measures taken before the occurrence of disease" and "preventing disease from exacerbating",the methods of treating lung-intestine together and clearing intestine to purge lung-heat are mostly used in the treatment of lung-heat syndrome.Under the guidance of these theory,we observe the clinical effect of acupoint sticking therapy,which could clearing heat,transforming phlegm and relaxing bowels,on AECOPD patients with syndrome of phlegm-heat obstructing lung.There are few related studies in academia at present,and this study has certain clinical value.Objective.To observe the clinical effects on AECOPD patients with syndrome of phlegm-heat obstructing lung by common therapy and Acupoint sticking therapy,which could clearing heat,transforming phlegm and relaxing bowels.Also to observe the improvement of questionnaire scores like Chronic Obstructive Pulmonary Disease Assessment Test(CAT)and serological indexes like C-reactive protein(CRP)after the treatment.At last to evaluate the safety of Acupoint sticking therapy after the study.In addition,we conducted the cross-sectional study by combining the clinical data,also analyzed the correlation between each observation item and the disease.Method:We divided 56 patients into 2 groups with a simple random method.These patients were diagnosed with the standard of AECOPD and the syndrome of phlegm-heat obstructing lung,28 of them were in the experimental group and the others were in the control group.Record gender,age,course of disease,Body Mass Index(BMI),history of past illness and etcetera for all patients in two groups.The control group was treated by conventional therapy including controlled oxygen therapy,using bronchodilator,using antibiotic and symptomatic treatments.The experimental group was treated on the basic of the control group treatment puls Acupoint sticking therapy,which could clearing heat,transforming phlegm and relaxing bowels.The Acupoint sticking therapy was made of rhubarb for 8g,fructus aurantii immaturus for 3g,mangnolia officinalis for 2g,scutellariae radix for 2g,trichosanthis fructus for 3g,bomeolum syntheticum for 1g,menthae haplocalycis herba for 1g.The acupoint including both Tianshu point,Shenque piont,Shimen point,Zhongwan point.We did the Acupoint sticking therapy once for one day and maintained it 4-6 hours for once.The course of treatment was 7 days.Before and after the treatment,recording patients’ clinical symptoms,scores of scales like COPD Assessment Test(CAT),Modified British Medical Research Council(mMRC),Bristol Stool Scale(BSS)and TCM Symptoms and Signs of AECOPD Assessment Scale(TCMAS).Calculating the total effective rate and integral improvement rate according to TCMAS scales.Testing routine blood test liver function and renal function before and after treatment,serological indexes like white blood cell count(WBC),percentage of neutrophils(NE%),neutrophils count(NE#),red blood cell distribution width(RDW),percentage of eosnophils(EO%),eosnophils count(EO#)and C-reactive protein(CRP)were treated as the therapeutic evaluation,aspartate aminotransferase(AST),alanine aminotransferase(ALT),creatinine(CREA)and etcetera were treated as the safety evaluation indices.After the research,collecting data and analyzing it with statistics by SPSS 20.0,a P value of<0.05 was considered statistically significance.Result:1.Baseline level comparison between the two groups before treatment:(1)There was no statistical differences in demographic data including gender,age,BMI,course of disease between two groups(P>0.05);(2)Patients belonged to D group were in majority in both control group and experimental group,which means they had more symptom and higher risk of exacerbation.(3)Cardiovascular disease was the major COPD complications in both two groups,and there was no statistical differences about the incidence of COPD complications between two groups(P>0.05).(4)There was no statistical differences in both AECOPD relevant scale,including TCMAS,CAT,mMRC,BSS,and serological indexes,including WBC,NE%,NE#,CRP,RDW,between two groups(P>(0.05).Overall,the baseline between the two groups was comparable.2.The total effective rate of treatment and the improvement of scales in the two groups after treatment:(1)The total effective rate and the integral improvement rate of the experimental group was higher than that of the control group,but there was no statistical differences between two groups(P>0.05);(2)The TCMAS scores,CAT scores,mMRC scores were both reduced in two groups after treatment,there was statistical differences within two groups(P<0.05),there was no statistical differences between two groups(P>0.05),but the improvement of TCMAS scores in the experimental group was higher than that in the control group;the BSS of both two groups were significantly improved after treatment(P<0.05),the clinic effect shown in the experimental group was better than that in the control group,there was statistical differences within two groups(P<0.05).3.Improvement of serological indexes in two groups after treatment:(1)The CRP were higher than the upper limit of normal values in two groups before treatment,and they were both reduced after treatment,the improvement of CRP in the experimental group had statistical differences(P<0.05),and there was no statistical differences of that in the control group(P>0.05).There was no statistical differences between two groups(P>0.05).But the decrease of CRP in the experimental group was higher than that in the control group;(2)The NE%,NE#were higher than the upper limit of normal values in two groups before treatment,the WBC were within the normal range in both two groups before treatment.The WBC,NE%,NE#were both reduced in two groups after treatment,there was statistical differences within two groups(P<0.05),there was no statistical differences between two groups(P>0.05),but the improvement of NE%and NE#in the experimental group was higher than that in the control group;(3)The EO%.、EO#were within the normal range in both two groups before treatment,EO%were both risen in two groups after treatment,there was stat:istical differences within two groups(P<0.05),there was no statistical differences between two groups(P>0.05),but the improvement of EO%in the experimental group was higher than that in the control group;there was no statistical differences about EO#between two groups before and after treatment(P>0.05).(4)The RDW were within the normal range in both two groups before treatment.There was no statistical differences about RDW between two groups before and after treatment(P>0.05).4.Analysis of the syndrome curative effect of ACOPD subgroup patients combined with constipation:(1)50%AECOPD patiens suffered from astriction before treatment;(2)analysing the ACOPD subgroup patients combined with constipation,the experimental group was found had a better clinic effect improvement in the total effective rate,integral improvement rate,TCMAS scores and BSS scores than that in the control group,which was statistical different(P<0.05).5.Relevance analysis of indicators:(1)relevance analysis of scales:relevance analysis between TCMAS scores,CAT score and mMRC score showed a linear positive correlation between the each two of them(P<0.01);BSS score was negatively correlated with TCMAS score,CAT score and mMRC score(P<0.01);(2)relevance analysis between scales and serological indexes:TCMAS score was positively correlated with NE%and NE#(P<0.05);CAT score was positively correlated with RDW(P<0.05);BSS score was negatively correlated with NE%(P<0.05);(3)The EO%and EO#had no correlation with the rate of exacerbation in the previous year(P>0.05).6.Safety evaluation:there was no untoward effect or any difference in serological indexes like AST,ALT,CREA in two groups before and after the treatment.Conclusion:(1)The RDW was valuable in COPD assessment,the correlation between EO and AECOPD needs further study;(2)The Acupoint sticking therapy,which could clearing heat,transforming phlegm and relaxing bowels,could assist in improving clinical symptoms of AECOPD patients with syndrome of phlegm-heat obstructing lung.Also could improve defecation condition and BSS scores of these patients,which is better than common therapy only.The Acupoint sticking therapy had a better trend of improving patients’ TCMAS scores and inflammatory biomarkers like NE and CRP,especially shown in patiens with astriction. |
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