足三里穴位注射黄芪注射液联合肺康复训练对老年慢性阻塞性肺疾病病人抗菌肽LL-37和免疫功能的影响

doi:10.3969/j.issn.1003-9198.2024.01.011

摘要/Abstract

摘要： 目的研究足三里穴位注射黄芪注射液联合肺康复训练对老年COPD稳定期病人的疗效、血清抗菌肽LL-37水平、炎症因子及外周血T淋巴细胞亚群的影响。方法选择98例老年COPD稳定期病人,根据治疗方法分为黄芪组(50例)和对照组(48例)。对照组予以肺康复训练及常规西药治疗,黄芪组在对照组基础上予以足三里穴位注射黄芪注射液,疗程均为12周。比较2组治疗前后肺功能、6分钟步行试验(6MWT)结果、改良版英国医学研究委员会呼吸问卷(mMRC)呼吸困难程度分级,血清抗菌肽LL-37、TNF-α、IL-6、CRP水平及T淋巴细胞亚群变化。结果 2组治疗后肺功能(FVC、FEV1、FEV1%pred、FEV1/FVC)、6MWT结果及mMRC分级均较治疗前明显改善(P<0.05),且黄芪组较对照组改善更为明显(P<0.05)。2组治疗后血清抗菌肽LL-37、CD3⁺ T淋巴细胞、CD4⁺T淋巴细胞及CD4⁺/CD8⁺水平均较治疗前升高,且黄芪组高于对照组(P<0.05);2组治疗后TNF-α、IL-6、CRP水平均低于治疗前,且黄芪组低于对照组(P<0.05)。结论足三里穴位注射黄芪注射液联合肺康复训练可改善老年COPD稳定期病人的肺功能和运动耐力,提高血清抗菌肽LL-37水平并改善免疫功能。

关键词: 慢性阻塞性肺疾病, 肺康复, 抗菌肽LL-37, T淋巴细胞亚群, 黄芪注射液, 穴位注射

Abstract: Objective To investigate the efficacy of Huangqi injection at Zusanli acupoint combined with pulmonary rehabilitation in the elderly patients with stable chronic obstructive pulmonary disease (COPD), and to analyze the effects on serum antimicrobial peptide LL-37, inflammatory factors and T lymphocyte subsets. Methods A total of 98 elderly patients with stable COPD were divided into the Huangqi group and the control group. The control group (n=48) was given lung rehabilitation training and conventional western medicine, and the Huangqi group (n=50) received Huangqi injection at zusanli acupoint on the basis of the control group. Both groups were treated for 12 weeks. The lung function, the results of 6-minute walking test (6MWT) and dyspnea scale (mMRC), the levels of LL-37, tumor necrosis factor-α (TNF-α), interleukin 6 (IL-6) and C-reaction protein (CRP), T lymphocyte subsets count were detected and compared between the two groups before and after treatment. Results After treatment, the levels of forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), the percentage of FEV1 in the predicted value (FEV1%pred), FEV1/FVC and the results of 6MWT and mMRC were significantly improved in both groups. The levels of LL-37, CD3⁺ T lymphocyte count, CD4⁺ T lymphocyte count and CD4⁺/CD8⁺ were increased, and the levels of TNF-α, IL-6 and CRP were decreased in both groups, especially in the Huangqi group (P<0.05). Conclusions Huangqi injection at Zusanli acupoint combined with pulmonary rehabilitation training can improve the lung function and exercise endurance, increase antimicrobial peptide LL-37 level and improve the immune function in the elderly patients with stable COPD.

Key words: chronic obstructive pulmonary disease, pulmonary rehabilitation, antibacterial peptide LL-37, T lymphocyte subsets, Huangqi injection, acupoint injection

中图分类号:

R 563.9

邓在勤, 周海波. 足三里穴位注射黄芪注射液联合肺康复训练对老年慢性阻塞性肺疾病病人抗菌肽LL-37和免疫功能的影响[J]. 实用老年医学, 2024, 38(1): 44-48.

DENG Zaiqin, ZHOU Haibo. Effect of Huangqi injection at Zusanli acupoint combined with pulmonary rehabilitation on antimicrobial peptide LL-37 and immune function in elderly patients with chronic obstructive pulmonary disease[J]. Practical Geriatrics, 2024, 38(1): 44-48.

参考文献

[1] PACHÓN-IBÁÑEZ M E, SMANI Y, PACHÓN J, et al. Perspectives for clinical use of engineered human host defense antimicrobial peptides[J]. FEMS Microbiol Rev, 2017, 41(3): 323-342.
[2] NAGAOKA I, TAMURA H, REICH J. Therapeutic potential of cathelicidin peptide LL-37, an antimicrobial agent, in a murine sepsis model[J]. Int J Mol Sci, 2020, 21(17): 5973.
[3] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南(2021年修订版)[J]. 中华结核和呼吸杂志, 2021, 44(3): 255-264.
[4] 黄茉莉, 梅晓冬, 王卫阳. 慢性阻塞性肺疾病患者血清炎症因子水平及其临床意义[J]. 中国老年学杂志, 2019, 39(24): 5973-5976.
[5] 李永兴, 杨剑烨, 陶学芳. 河车大造胶囊对慢性阻塞性肺疾病稳定期患者血清炎症因子和纤维化指标的影响[J]. 中国慢性病预防与控制, 2019, 27(1): 55-58.
[6] MESSOUS S, ELARGOUBI A, PILLET S, et al. Bacterial andviral infection in patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease: implication for antimicrobial management and clinical outcome[J]. COPD, 2021, 18(1): 53-61.
[7] KAHLENBERG J M, KAPLAN M J. Little peptide, big effects: the role of LL-37 in inflammation and autoimmune disease[J]. J Immunol, 2013, 191(10): 4895-4901.
[8] 杨翼萌, 张洪胜, 孙铁英. 慢性阻塞性肺疾病与支气管哮喘患者血浆抗菌肽LL-37水平的比较[J]. 国际呼吸杂志, 2020, 40(8): 561-565.
[9] 张群先, 蓝晨, 韦振雷. 抗菌肽LL-37和维生素D受体在呼吸机相关性肺损伤大鼠肺组织中的表达及作用机制[J]. 河北医药, 2020, 44(18): 2746-2750.
[10] 武莉莉, 黄河, 刘春丽, 等. 补充维生素D₃治疗对成人支气管扩张症患者肺功能、LCQ 评分、抗菌肽LL-37和IL-8水平的影响[J]. 内科, 2019, 14(6): 629-632.
[11] CHATZILEONTIADOU D S M, SLOANE H, NGUYEN A T, et al. The many faces of CD4⁺ T cells: immunological and structural characteristics[J]. Int J Mol Sci, 2020, 22(1): 73.
[12] WU J J, ZHANG Y X, XU H R, et al. Effect of acupoint application on T lymphocyte subsets in patients with chronic obstructive pulmonary disease: a meta-analysis[J]. Medicine: Baltimore, 2020, 99(16): e19537.
[13] 姜辉, 顾胜龙, 张玉婷, 等. 黄芪化学成分和药理作用研究进展[J]. 安徽中医药大学学报, 2020, 39(5): 93-96.
[14] 石贵昌, 望开森, 邹龑, 等. 电针联合黄芪注射液对稳定期慢性阻塞性肺疾病患者的影响[J]. 重庆医学, 2018, 47(22): 2992-2994, 3004.

[1]	王丹凤, 王兰, 吴晓东. 舒利迭吸入剂联合复方血栓通胶囊对老年稳定期COPD患者血栓前状态的影响[J]. 实用老年医学, 2016, 30(8): 651-.
[2]	杜强, 朱成华, 蔡健康. 黄芪颗粒对慢性阻塞性肺疾病患者肺功能的影响及可能机制[J]. 实用老年医学, 2016, 30(8): 679-.
[3]	熊玮, 曾玉兰. 无创通气对重度Ⅱ型呼吸衰竭患者炎性指标及预后的影响[J]. 实用老年医学, 2016, 30(6): 461-.
[4]	王永, 魏哲芬, 陈如健. 老年慢性阻塞性肺疾病合并2型糖尿病患者检测血清高敏C反应蛋白和D-二聚体的临床意义[J]. 实用老年医学, 2016, 30(2): 132-.
[5]	蔡开霞, 王春雷. 降钙素原对老年慢性阻塞性肺疾病急性加重合并肺炎的预测价值[J]. 实用老年医学, 2015, 29(8): 628-.
[6]	冯涛. 痰热清联合头孢曲松钠对慢性阻塞性肺疾病急性加重期的影响[J]. 实用老年医学, 2015, 29(8): 656-.
[7]	王兴德, 蒋兆华, 陈彬, 孔志斌, 左晟, 刘华. 老年慢性阻塞性肺疾病伴室性心动过速患者的心率减速力分析[J]. 实用老年医学, 2015, 29(5): 365-.
[8]	姚远. 老年慢性阻塞性肺疾病继发肺真菌病的危险因素研究[J]. 实用老年医学, 2015, 29(5): 391-.
[9]	李敬会, 蔡莉莉, 李丽娜. N-乙酰半胱氨酸对老年慢性阻塞性肺疾病炎性反应的影响[J]. 实用老年医学, 2015, 29(4): 330-.
[10]	金玉玲, 邱昕光, 刘敏, 王可. 老年慢性阻塞性肺疾病稳定期综合干预效果评价[J]. 实用老年医学, 2015, 29(3): 229-.
[11]	吴小玲, 邓治平. 肺康复训练对慢性阻塞性肺疾病患者急性加重期的影响[J]. 实用老年医学, 2015, 29(1): 42-.
[12]	李报春, 刘大锐, 魏彩云. 噻托溴铵治疗老年慢性阻塞性肺疾病稳定期患者的临床观察[J]. 实用老年医学, 2014, 28(8): 667-.
[13]	仲昭双, 孔灵菲. 老年慢性阻塞性肺疾病患者FEV1／FVC诊断标准探讨[J]. 实用老年医学, 2014, 28(7): 566-.
[14]	余艳芳, 刘锦铭, 梁凯轶, 屠春林, 陈珠, 常伟. 上海市嘉定区社区慢性阻塞性肺疾病防治状况调查[J]. 实用老年医学, 2014, 28(6): 478-.
[15]	陈姬, 张键. 老年慢性阻塞性肺疾病急性发作期合并2型糖尿病患者血清同型半胱氨酸水平分析[J]. 实用老年医学, 2014, 28(5): 383-.