[目的]探讨芪术肺纤汤对特发性肺间质纤维化(idiopathic pulmonary fibrosis,IPF)患者血清涎液化糖链抗原6(Krebs Von Den Lungen-6,KL-6)水平和肺功能的影响.[方法]搜集2019年10月1日至2021年12月31日于中国中医科学院广安门医院就诊的IPF患者40例,分为试验组和对照组各20例,对照组口服乙酰半胱氨酸胶囊加百令胶囊,试验组在此基础上加用芪术肺纤汤,3个月后观察两组患者治疗前后肺功能、中医症状积分、血清KL-6水平变化及不良反应.[结果]与治疗前比较,治疗后试验组最大肺活量占预计值的百分比(vital capacity max/predict value,V Cmax％)、一氧化碳弥散量占预计值的百分比(carbon monoxide diffusing capacity/predict value,DLCO％)及肺总量占预计值的百分比(total lung capacity/predict value,TLC％)均上升,TLC％差异有统计学意义(P＜0.05);对照组TLC％、DLCO％及VCmax％均下降,且VCmax％差异有统计学意义(P＜0.01).治疗后组间比较,试验组VCmax％、TLC％和DLCO％均高于对照组,且DLCO％差异有统计学意义(P＜0.01).与治疗前比较,治疗后两组患者中医症状总积分、主症总积分及次症总积分均较前下降(P＜0.01,P＜0.05).其中试验组主症喘息、气短、咳痰积分及次症乏力积分均较前显著下降(P＜0.01,P＜0.05),对照组仅主症气短积分显著下降(P＜0.05),余如喘息、咳嗽、咳痰、乏力等症状积分略有下降,差异无统计学意义(P＞0.05).治疗后组间比较,试验组症状总积分、主症总积分、主症喘息、气短、咳嗽积分显著低于对照组,差异具有统计学意义(P＜0.01,P＜0.05).与治疗前比较,治疗后试验组血清KL-6水平下降,但差异无统计学意义(P＞0.05);对照组血清KL-6水平上升(P＜0.01).治疗后组间比较,试验组血清KL-6水平明显低于对照组,差异具有统计学意义(P＜0.05).两组患者均无不良反应发生.[结论]芪术肺纤汤可提高IPF患者肺功能,显著升高DLCO％指标,改善喘息气短、咳痰乏力等症状,并能降低血清KL-6水平,延缓肺纤维化进程,治疗干预期间未见不良反应,安全可靠.

Objective To observe the clinical efficacy of transdermal penetration of Qingfei Huatan Huoxue Formula at acupoints for elderly patients with non-severe pneumonia（phlegm-heat obstructing lung type）. Methods A total of 120 elderly patients with non-severe pneumonia（phlegm-heat obstructing lung type） were randomly assigned into the treatment group（n=60） and the control group（n=60）. All patients were managed by conventional Western medicine, and those in the treatment group were additionally treated with transdermal penetration of Qingfei Huatan Huoxue Formula at acupoints. Treated for 10 days, the aim was to compare procalcitonin（PCT）, C-reactive protein（CRP）, White blood cell count（WBC）, Traditional Chinese Medicine Syndrome Score Scale（TCMSSS）, clinical pulmonary infection score（CPIS）, Pneumonia Severity Index（PSI）. The curative effect was assessed. Results The overall effective rate in the treatment group was better than that in the control group（93.3% [56/60] vs 80.0% [48/60], [P＜0.05], respectively）. After treatment, PCT, CRP, WBC in groups were decreased（P＜0.05）, which were decreased in the treatment group compared with the control group（P＜0.05）. TCMSSS, CPIS, PSI in groups after treatment were decreased（P＜0.05）, the reduction in the treatment group was more common than the control group（P＜0.05）. Conclusion For elderly patients with non-severe pneumonia（phlegm-heat obstructing lung type）, transdermal penetration of Qingfei Huatan Huoxue Formula at acupoints can relieve symptoms of patients, reduce inflammatory response, and improve clinical efficacy.

重度哮喘气道重塑严重、糖皮质激素反应性降低,是哮喘致残、致死的主要原因.目前指南推荐的生物制剂靶向治疗价格昂贵,且仅对Th2高表达型哮喘疗效明显,低Th2表达型重度难治性哮喘患者的治疗仍然面临巨大挑战.李国勤教授擅长中西医结合治疗呼吸系统疑难危重症.李国勤治疗重度哮喘善用风药以祛散风邪,善用虫类药以祛伏邪,善用疏肝药物以调畅气机、舒畅情志,善用补肾药以纳气固本,并强调哮喘共患疾病的治疗.

目的 评价金花清感颗粒治疗流感样病例风热犯肺证的有效性及安全性.方法 采用多中心、随机、双盲、安慰剂对照的设计方法,将480 例流感样病例风热犯肺证患者分为治疗组 360 例、安慰剂组120 例,分别给予金花清感颗粒5 g/次,3 次/d;金花清感颗粒模拟剂5 g/次,3 次/d.疗程均为连续服药3 d.观察2 组退热时间及退热率、中医证候积分、中医证候疗效、流感主要症状/体征消失率及安全性指标.结果 治疗组中位退热时间为25.7(24.0,28.0)h,安慰剂组中位退热时间为38.0(34.7,47.5)h.随时间增长,2 组退热率均上升,治疗组总体退热情况较安慰剂组好,差异有统计学意义(log-rank χ2=10.822,P=0.001).中医证候积分 2 组治疗后较本组治疗前均下降,差异有统计学意义(P＜0.05).2 组治疗前后差值比较,差异有统计学意义(P＜0.05),治疗组在改善中医证候积分方面优于安慰剂组.治疗后,治疗组中医证候疗效总有效率为 97.2%,安慰剂组总有效率为85.7%,治疗组疗效优于安慰剂组,差异有统计学意义(P＜0.05).除咽部充血、扁桃体肿大外,其他流感主要症状/体征包括发热、头痛、全身酸痛、咽痛、咳嗽等消失率,治疗组均优于安慰剂组,差异有统计学意义(P＜0.05).2 组均未出现严重不良事件.结论 金花清感颗粒治疗流感样病例(风热犯肺证)有较好的临床疗效和安全性.

多发性肌炎和皮肌炎属特发性炎性肌病范畴，肺间质疾病是本病患者较为常见的临床表现。李国勤教授治疗肌炎相关肺间质疾病经验丰富，临床多从脾肾辨治，认为病机以肺脾肾不足为本，以痰瘀阻络、热毒互结为标，病久则多以脾肾两虚为主，因痰瘀互结，耗乏正气，故外邪更易乘虚而入，终致病情反复。治疗应把握核心病机，以培补肺脾肾为主，兼顾活血化瘀、清热养阴，需衷中参西，坚持辨病辨证相结合、宏观微观相结合，以取得更好疗效。

目的 研究医院家庭联动管理模式在煤工尘肺合并慢性阻塞性肺疾病(COPD)稳定期的应用效果.方法 选取2018年1月-2019年6月北京市东城区第一人民医院收治的病情好转出院的120例煤工尘肺合并COPD稳定期患者,随机分为对照组和研究组各60例.对照组采用常规管理模式,研究组采用基于网络平台的医院家庭联动管理模式,比较2组治疗效果.结果 出院6个月后,研究组肺功能指标[第1 s用力呼气容积量(FEV1)、第1s用力呼气容积占用力肺活量百分比(FEV1/FVC)、每分钟静息通气量(VE)]和6min步行试验(6MWD)分别为(1.64±0.08)L、(67.39±5.83)％、(12.75±1.42)L/min、(516.35±35.62)m,对照组分别为(1.60±0.11)L、(63.27±5.75)％、(12.21±1.31)L/min、(481.26±37.51)m.研究组自我管理能力各项评分分别为33.64±4.28、40.39±4.83、36.16±5.52、45.72±5.81、38.72±5.43,圣乔治呼吸问卷(SGRQ)各项评分分别为45.76±4.36、38.78±5.29、42.89±5.53;对照组自我管理能力各项评分分别为27.60±4.11、34.27±4.75、31.39±5.61、40.26±5.93、33.26±5.57,SGRQ各项评分分别为58.38±5.57、49.53±6.51、51.35±6.32,差异均有统计学意义(均P＜0.05).研究组急性加重次数、住院次数及急诊就诊次数分别为(0.71±0.43)、(0.58±0.26)、(0.27±0.13)次,对照组分别为(1.16±0.51)、(0.94±0.39)、(0.65±0.32)次,差异均有统计学意义(均P＜0.05).结论 基于网络平台的医院家庭联动管理模式用于煤工尘肺合并COPD稳定期治疗能够有效提高患者自我管理能力,改善肺功能和运动能力,缓解临床症状,减少急性加重发生率,提高生活质量.

Objective:To investigate the effect of Qingre-Tongfu enema combined with noninvasive positive pressure ventilation on the ventilation function of elderly patients with severe pneumonia. Methods:A total of 60 elderly patients with severe pneumonia with syndrome of excess of Yangming fushi from September 2017 to August 2019 in the respiratory department of the First People’s Hospital of Dongcheng District, Beijing were randomly divided into two groups, 30 cases in each group. The control group was treated with western medicine to control infection and noninvasive positive pressure ventilation. The treatment group was treated with Qingre-Tongfu enema on the basis of the control group. The Traditional Chinese Medicine Syndrome score (TCMSSS), Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE-Ⅱ) and Clinical Pulmonary Infection Score (CPIS) were compared before and after treatment, The Pneumonia Severity Index (PSI) was compared. Serum procalcitonin (PCT) was detected by upconversion luminescence immunoassay, CRP was detected by double antibody sandwich ELISA, WBC was detected by automatic hematology analyzer; partial pressure of carbon dioxide (PaCO 2), oxygen saturation (SaO 2), partial pressure of oxygen (PaO 2) were detected by blood gas analyzer, oxygenation index (OI) and respiratory rate (RR) were calculated. The complications were investigated and the clinical efficacy was evaluated. Results:The total effective rate was 96.7% (29/30) in the treatment group and 73.3% (22/30) in the control group, with significant difference between the two groups ( χ2=4.706, P=0.030). After treatment, the levels of serum PCT, CRP and WBC in the treatment group were significantly lower than those in the control group ( t=15.359, 25.784 and 13.460, respectively, P<0.01); after treatment, the levels of SaO 2 [(93.18 ± 3.79)% vs. (88.78 ± 5.56)%, t=3.584], PaO 2 [(86.81 ± 4.01) mmHg vs. (80.01 ± 4.76) mmHg, t=5.975], OI [(285.53 ± 15.05) mmHg vs. (227.65 ± 12.37) mmHg, t=16.272] in the treatment group significantly were higher than those in the control group ( P<0.01); PaCO 2 [(43.28 ± 6.84) mmHg vs. (48.83 ± 7.66) mmHg, t=-2.956], RR [(22.00 ± 3.79) times/min vs. (26.30 ± 3.73) times/min, t=-4.434] in the treatment group were significantly lower than those in the control group ( P<0.05). After treatment, the scores of TCMSSS, APACHE-Ⅱ, CPIS and PSI in the treatment group were significantly lower than those in the control group ( t=41.310, 11.035, 8.399, 5.752, P<0.01). The treatment group in the course of antibiotics, mechanical ventilation time, hospital stay were significantly shorter than the control group ( P<0.01). Conclusion:Qingre-Tongfu enema combined with noninvasive positive pressure ventilation can improve the clinical symptoms of elderly patients with severe pneumonia, reduce inflammatory reaction, shorten the time of mechanical ventilation and antibiotic treatment, and improve the clinical efficacy.

目的 观察补肺健脾、化痰祛瘀法治疗轻中度小儿闭塞性细支气管炎的临床疗效和安全性.方法 将66例轻中度小儿闭塞性细支气管炎患儿按随机数字表法分为试验组和对照组,每组33例.试验组予补肺健脾、化痰祛瘀中药汤剂治疗,对照组予西药联合中成药治疗,疗程6个月.观察两组治疗前后临床观察表总评分(包括咳嗽、喘息、痰量、呼吸频率、肺部听诊、三凹征、血氧饱和度、单月感染次数、半年住院次数)、临床症状(咳嗽、喘息、痰量)及血氧饱和度评分、肺功能[第一秒钟呼气容积(FEV1)、第一秒钟呼气节容积占用力肺活量的百分比(FEV1/FVC)、最大呼气中段流量(MMEF)]、胸部高分辨CT(HRCT)评分.结果 两组最终纳入合格病例共60例,试验组30例,对照组30例.试验组总有效率为86.67％(26/30),对照组为66.67％ (20/30),试验组优于对照组(x2=4.056,P＜0.05).与治疗前比较,两组治疗后临床观察表总评分、临床症状(咳嗽、喘息、痰量)及血氧饱和度评分、肺功能指标、胸部HRCT评分均改善(P＜0.05),且试验组优于对照组(P＜0.05).结论 采用补肺健脾、化痰祛瘀法治疗轻中度小儿闭塞性细支气管炎,可改善患儿的症状、体征、肺功能及胸部HRCT.

嗜酸性肉芽肿性血管炎(eosinophilic granulomatosis with polyangiitis,EGPA)是一种主要累及中、小动脉和静脉的抗中性粒细胞胞浆抗体(antinertrophil cytoplasmic antibody,ANCA)相关性小血管炎,多在20 ～40岁起病,可累及肺、心、神经、皮肤、肾及胃肠道等多个器官.糖皮质激素是EGPA的首选治疗,单用临床缓解率高达93％[1],但因其所需剂量较大,常出现明显不良反应,从而影响疗效.李国勤教授是全国第四批名老中医药传承工作指导老师,在呼吸系统疑难病诊疗方面有着丰富经验,通过中医辨证论治联合全身激素治疗血管炎,在一定程度上减轻激素不良反应、稳固了疗效.现介绍李国勤教授中西医结合治疗ANCA阴性的EGPA的验案一则如下.

目的 研究皮内针调理肝肺法治疗慢性难治性咳嗽的临床效果.方法 根据Excel生成随机数字表,采用随机、对照、单盲的方法将2015年6月—2016年3月中国中医科学院广安门医院门诊诊断为肝火犯肺型慢性难治性咳嗽24例患者分为治疗组和对照组,每组各12例.两组均予以基础治疗,在此基础上,治疗组给予皮内针治疗,对照组给予真穴安慰针治疗.治疗4周及治疗结束4周随访1次.以咳嗽症状积分、莱切斯特咳嗽量表(LCQ)和咳嗽视觉模拟评分(VAS)得分作为主要评估指标.结果 研究过程中对照组脱落3例,失访2例,出差1例,剩余9例.咳嗽症状积分:日间咳嗽时间点比较差异、交互作用差异均有统计学意义(均P<0.05),组间比较差异无统计学意义(P>0.05).夜间咳嗽评分时间点比较差异有统计学意义(均P<0.05),组间比较及交互作用差异均无统计学意义(均P>0.05).组内比较:治疗4周后、疗程结束后4周,治疗组日间咳嗽积分和夜间咳嗽积分均较治疗前降低,对照组夜间咳嗽积分较治疗前降低(均P<0.05).VAS评分:咳嗽程度、咳嗽频率评分组间比较、时间点比较差异均有统计学意义(均P<0.05),交互作用差异无统计学意义(P>0.05).夜间咳嗽评分时间点比较差异有统计学意义(均P<0.05),组间比较及交互作用差异均无统计学意义(均P>0.05).组内比较:治疗4周后、疗程结束后4周,两组的咳嗽程度、咳嗽频率和夜间咳嗽评分均较治疗前降低(均P<0.05).组间比较:治疗4周后、疗程结束后4周,治疗组的咳嗽程度、咳嗽频率评分均低于对照组(均P<0.05).LCQ评分:生理部分、心理部分、社会部分评分时间点比较差异有统计学意义(均P<0.05),组间比较及交互作用差异均无统计学意义(均P>0.05).总分的组间比较、时间点比较、交互作用差异均无统计学意义(均P>0.05).组内比较:治疗4周后、疗程结束后4周,治疗组生理部分、心理部分、社会部分评分均高于治疗前,差异均有统计学意义(均P<0.05),疗程结束后4周,对照组心理部分、社会部分评分均高于治疗前,差异均有统计学意义(均P<0.05).结论 皮内针治疗慢性难治性咳嗽安全有效.治疗效果主要体现在减轻咳嗽的严重程度及减少咳嗽的频率方面.

李国勤教授认为支气管扩张症临床上可分为急性发作期和迁延缓解期.急性发作期可分为痰热壅肺、肝火犯肺、热伤肺络等证;缓解期可分为肺气阴两虚、肺脾两虚等证.治疗上急性期以清热化痰、清肝凉血、清热养阴为主,缓解期以益气养阴、润肺止咳、健脾化痰、活血化瘀为主.李国勤教授治疗上分期辨治,擅用清法,兼顾血证,顾护脾胃,辅以扶正,临床上获得了较好的疗效.

儿童肺炎支原体肺炎合并肺不张属中医学“肺炎喘嗽”范畴.小儿外感热病,耗气伤阴,娇脏受损,卫气不固,脾失健运,致痰热瘀阻而发病.核心病机为痰瘀阻肺、气阴两虚,清热化痰、活血化瘀治其标,益气养阴、培土生金治其本,并配合体位引流,内外同治,以期收到尽快激素减量,促进肺叶复张,改善患儿肺发育受损的效果.

Objective To observe the effect of traditional Chinese medicine (TCM) lung rehabilitation therapy and drug treatment on patients with chronic obstructive pulmonary disease (COPD).Methods From November 2015 to November 2016,94 COPD stable patients were selected,by random number table,they were divided into rehabilitation group (47 cases) and control group (47 cases).The control group was treated by simple drug therapy,and the rehabilitation group was treated with traditional Chinese medicine pulmonary rehabilitation therapy on the basis of drug treatment.The data were collected before treatment,1 month after treatment,3 months after treatment,6 months after treatment,and the therapeutic effect was analyzed and evaluated.The indexes included St Georges Respiratory Questionnaire (SGRQ);a second forced expiratory volume (FEV1),forced expiratory volume in one second percentage of predicted value (FEV 1％pred),forced vital capacity (FVC),forced expiratory volume in one second forced vital capacity ratio (FEV1/FVC),per minute ventilation volume (MVV);6 minutes walk test and BODE score.And the effect of treatment was analyzed and evaluated.Results The number of admissions in two groups after the treatment were less than before the treatment,and that in rehabilitation group was less than control group,the differences were statistically significant (P ＜ 0.05).After the treatment,the SGRQ scores of the rehabilitation group was lower than control group (P ＜ 0.05);MVV detection in the rehabilitation group after 1 months treatment was better than control group at the same period (P ＜ 0.05);FEV1％pred,FVC and MVV detection after 3 months treatment were better than control group at the same time (P ＜ 0.05);FEV1,FEV1％pred,FVC,MVV and FEV1/FVC detection after 6 months treatment were better than control group at the same time (P ＜ 0.05);6 minutes walking test results in rehabilitation group after treatment were better than the control group (P ＜ 0.05);the BODE index scores of rehabilitation group after treatment were lower than control group (P ＜ 0.05).Conclusion TCM pulmonary rehabilitation model can improve COPD patients daily living and quality of life,improve exercise tolerance and respiratory muscle function,thereby improve the lung function that drugs is difficult to reverse.

Objective To improve the understanding of the clinical characteristics of anti-synthetase syn-drome related interstitial lung disease ( ASS-ILD ) . Methods The clinical data and relevant literature of anti-synthetase syndrome patient complicated with Sjogren ' s syndrome with lung involvement as the first manifestation were reviewed. Results The initial clinical manifestations of a 65-year-old woman were cough and shortness of breath. She was diagnosed as chronic bronchitis based on a chest radiography in a county hospital. When the symp-tom of muscle involvement appeared, she was admitted to another hospital and diagnosed as myositis combined inter-stitial lung disease. After approximately 2-year treatment of prednisone and CTX therapy, radiographic changes still aggravated continuously. She was hospitalized in our department afterwards. The spectrum of antinuclear antibodies showed ANA 1:100, anti-Jo1 antibody ( + + +);pulmonary function test indicated diffusing capacity decreased sig-nificantly. The pathological examination of the muscle biopsy tissue found infiltration by inflammatory cells. Salivary flow test ( +) , schirmer test ( +) and diffuse lesions of parotid glands were detected. Considering the manifesta-tions of Reynaud' s phenomenon and mechanic hands, the patient was finally diagnosed as anti-synthetase syndrome complicated by Sjogren' s syndrome. The treatments were consisted of small dose prednisone plus CTX and individu-alized therapy of Chinese traditional medicine. 8 months later, her chest CT revealed improvement and serum anti-Jo1-antibody concentration decreased dramatically. Conclusion Lung involvement is common in ASS. ILD is the major determinant of morbidity and mortality in patient with ASS. HRCT and lung function test are important in early diagnose. Integrative medicine may provide fresh ideas in treatment.

OBJECTIVE:To examine the variations in the prevalence of skin reactions and the association between skin reactions and efficacy of summer acupoint application treatment (SAAT) on chronic pulmonary disease (CPD).METHODS:A total of 2,038 patients with CPD were enrolled at 3 independent hospitals (defined as Groups A, B and C, respectively) in China. All patients were treated by SAAT, as applying a herbal paste onto the acupoints of Fengmen (BL 12) and Feishu (BL 13) on the dog days of summer, according to the lunar calendar, in 2008. Ten days after treatment, skin reaction data (no reaction, itching, stinging, blistering, and infection) were obtained via face-to-face interviews. Patients were retreated in the same hospital one year later, thereby allowing doctors to assess treatment efficacy based on the patients' symptoms, the severity of the spirometric abnormalities, and the concomitant medications used.RESULTS:A large number of patients (85.3%) displayed reactive symptoms; however, the marked associations between reactive symptoms and age or gender were not observed. An increased number of patients from Group B (99.3%) and Group C (76.5%) displayed reactive symptoms due to the increased mass of crude Semen Sinapis Albae. The effective rate of SAAT was as high as 90.4% for patients of Group B, which was followed by Group A (70.9%) and Group C (42.2%). Using stratified analyses, a convincing association between reactive symptoms and therapeutic efficacy was observed for patients with asthma [itching: odds ratio (OR)=2.17, 95% confidence interval (CI): 1.49 to 3.14; blistering: OR=0.43, 95% CI: 0.25 to 0.73; and no reaction: OR=0.56, 95% CI: 0.35 to 0.90]. However, the same tendency was not observed for patients with chronic bronchitis and chronic obstructive pulmonary disease.CONCLUSIONS:SAAT can induce very mild skin reactions for patients with CPD, among which patients with asthma displayed a strong association between skin reactions and therapeutic efficacy. The skin reactions may be induced by the crude Semen Sinapis Albae.

俗话说:“吃五谷杂粮,没有不得病的.”那么,怎样保持健康,预防和治疗疾病呢?中医在几千年前就提出了“上工治未病”的观点:保持健康的生活方式和饮食习惯,适当锻炼身体,调节心理情绪,是预防疾病的基本措施.在防病失败的情况下,我们要积极治疗.很多常见病经过家庭的初步治疗就可以痊愈或好转;或者在疾病还不算紧急、又暂时没有时间去医院就诊等情况下,一个家庭小药箱就必不可少了.

OBJECTIVE: To evaluate the self-efficacy and satisfaction of asthma patients subjected to summer acupoint application treatment (SAAT).METHODS: A two-year follow-up clinical study was conducted. Patients with asthma were treated by applying a herbal paste onto the Feishu (BL 13) and Fengmen (BL 12) acupoints on the three hottest days of summer, according to the traditional Chinese calendar, from 2008 to 2010. During a two-year follow-up, these patients were asked to fill out a questionnaire evaluating asthma degree, exacerbation frequency, concomitant medications and self-satisfaction. The self-rate and doctor-report outcomes obtained in parallel were evaluated to assess the efficacy of SAAT.RESULTS: A total of 527 asthma patients were initially enrolled in this study, of which 97 elderly patients and those with more severe cases of asthma were lost to follow-up. Thus, a total of 430 patients were valid for analysis using self-rate data. Nevertheless, occasional negative returns were obtained; almost all of the outcomes were rated as "No change", "Moderate effective", or "Very effective". In addition, 80% of the patients were satisfied with this treatment. Moreover, 391 (91.4%) patients were somewhat improved after SAAT in 2009, and further improvement was observed in 2010. After SAAT, the average asthma-degree score decreased from 5.3 in 2008 to 4 in 2009 and, subsequently to 3.5 in 2010.CONCLUSION: With pronounced patient satisfaction, SAAT can reduce the exacerbation severity and frequency, concomitant medications and asthma degree. Prolonging the treatment course might enhance the efficacy of SAAT. (C) 2015 JTCM. All rights reserved.

社区获得性肺炎属中医“风温肺病”或“肺热证”范畴,我们辨证治疗社区获得性肺炎主张早期祛除病邪,后期益气养阴,并灵活运用健脾和胃、活血祛瘀、通腑泄热等方法,并介绍两则单纯用中药治疗社区获得性肺炎病案.

特发性肺纤维化(IPF)属中医学“肺痿”“肺痹”范畴.本病病机为肺肾气虚、气滞血瘀,中医药对于延缓本病进程、改善预后及提高患者生活质量等有较好的疗效,但缺乏远期疗效的循证医学证据.现将中西医结合诊治IPF的相关文献综述如下.

It is well documented that the psychiatric disorders are common in Asthma patients in China while the studies on the relationship between asthma control and psychological disorder are comparatively rare. We therefore performed a cross-sectional study on asthmatic outpatients in one Chinese tertiary center to investigate the correlation among asthma, anxiety and depression. Demographic data, anxiety and depression scores, the level of asthma control were collected in 261 patients. All patients were evaluated with Asthma Control Test (ACT), Self-Rating Anxiety Scale (SAS) and Self-rating depression scale (SDS) questionnaires. A multivariate analysis was performed to investigate the relationship between asthma control and psychological disorder. The result showed that 31 asthma patients had anxiety symptom while thirty-five asthma patients had depression. One hundred and ninety-two asthma patients were well controlled and 69 patients were not. The study found a negative correlation between ACT and SAS(r = -0.231, p<0.001) as well as ACT and SDS(r = -0.23, p<0.001) and depression (OR: 12.295, 95% CI: [5.374-28.128], p<0.001) were both independently associated with poor asthma control. We concluded that Asthma control is greatly affected by psychological disorder in Chinese patients.