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目的探讨温补肺肾、活血化瘀法联合硝苯地平治疗慢性阻塞性肺疾病(COPD)伴肺动脉高压(PH)疗效及对血管内皮功能的影响。方法将96例COPD伴PH患者随机分为2组,对照组48例于常规西医治疗基础上给予硝苯地平治疗,观察组48例在此基础上给予温补肺肾联合活血化瘀法治疗,2组均连续治疗4周。观察2组治疗前后中医证候积分、血管内皮功能、肺功能和肺动脉收缩压变化情况,统计2组不良反应发生情况。结果 2组治疗后中医证候评分均显著降低(P均<0.05),且观察组中医证候评分显著低于对照组(P均<0.05);2组治疗后血清t PA水平和FEV1、FVC均高于治疗前(P均<0.05),血清PAI-1、ET-1水平和肺动脉收缩压均低于治疗前(P均<0.05),且观察组各指标改善程度明显优于对照组(P<0.05);2组不良反应发生率比较差异无统计学意义(P>0.05)。结论温补肺肾、活血化瘀法联合硝苯地平治疗COPD伴PH疗效较佳,可有效降低肺动脉高压,调节血管内皮功能,从而改善COPD症状。
Objective To investigate the effects of warming and tonifying the lung and kidney, promoting blood flow and removing blood stasis combined with nifedipine on chronic obstructive pulmonary disease (COPD) with pulmonary hypertension (PH) and its effect on vascular endothelial function. Methods Ninety-six COPD patients with PH were randomly divided into two groups. The control group of 48 patients were treated with nifedipine on the basis of routine Western medical treatment. Forty-eight patients in the observation group were treated with warming, tonifying lung and kidney combined with activating blood and removing blood stasis method, 2 groups were treated for 4 weeks. The TCM syndrome scores, vascular endothelial function, pulmonary function and pulmonary artery systolic pressure were observed in two groups before and after treatment, and the occurrence of adverse reactions in two groups were observed. Results The scores of TCM syndromes were significantly lower in both groups after treatment (P <0.05), and the scores of TCM syndromes in the observation group were significantly lower than those in the control group (all P <0.05). The levels of t PA and FEV1, FVC (P <0.05), serum PAI-1, ET-1 and pulmonary artery systolic pressure were lower than those before treatment (all P <0.05), and the improvement of each index in the observation group was better than that in the control group P <0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P> 0.05). Conclusions The combination therapy of warming and tonifying the lung and kidney, promoting blood circulation and removing blood stasis combining with nifedipine is effective in treating COPD with PH, which can effectively reduce pulmonary hypertension and regulate the function of vascular endothelium, thereby improving the symptoms of COPD.