Clinical study on the treatment of bronchiectasis in remission period by embedding thread combined with Jianpi Qushi Huayu plaster

Jian Ai, Huan Qi, Wen-Jie Feng, Xiao-Hui Ji

Department of Pulmonary Medicine, Qinhuangdao Traditional Chinese Medicine Hospital, Qinhuangdao 066000, Hebei, China

Keywords:Acupoint catgut embedding Jianpi Qushi Huayu plaster Bronchiectasis remission period Inflammatory cytokines

ABSTRACT Objective: To explore the clinical effect of embedding thread combined with Jianpi Qushi Huayu ointment in the treatment of bronchiectasis in remission period, and to observe the effect on the level of inflammatory cytokines. Methods:150 patients with bronchiectasis in remission period were divided into three groups (50 cases in each group), western medicine group (treated with salmeterol fluticasone and low dose erythromycin), combined group (treated with Jianpi Qushi Huayu plaster), observation group (treated with western medicine + Jianpi Qushi Huayu plaster + embedding thread),and the clinical treatment of the three groups were compared. Result: before and after treatment, the improvement of TCM syndrome score, the improvement of pulmonary ventilation index,the improvement of inflammatory cytokines, and the change of adverse reactions. Results: the treatment efficiency of the observation group and the combination group was significantly higher than that of the western medicine group (P The peak level of expiratory flow velocity, the maximum expiratory flow, the forced expiratory volume in one second and the ratio of forced expiratory volume in one second to vital capacity in the observation group and the combined group were significantly better than those in the western medicine group and the pre-treatment level(P＜0.05),and the improvement in the observation group was better than that in the combined group After treatment,the expression of IL-13,IL-10 and IL-4 in the combined group was significantly better than that in the western medicine group and before treatment (P＜0.05),and the improvement in the observation group was better than that in the combined group; there was no significant difference in the incidence of adverse reactions among the three groups (P＞0.05). Conclusion: catgut embedding combined with Jianpi Qushi Huayu ointment can significantly alleviate the related clinical symptoms and signs,effectively control the further aggravation of the disease,improve the lung function of patients, regulate the level of inflammatory cytokines to reduce the degree of inflammatory reaction,and do not significantly aggravate the adverse reactions of drugs.

1. Introduction

Bronchiectasis is a common pulmonary disease in clinical diagnosis and treatment. The causes are more complicated, but there are few primary bronchodilators. Most patients are often secondary to bronchial obstruction infection, acute and chronic respiratory infections, pertussis, tuberculosis and other diseases. It will damage the muscle structure of the bronchial tube wall and the elasticity of the tube wall, leading to permanent and pathological expansion of the bronchial tree structure. As the disease progresses, the lung tissue is severely damaged and the lung function is reduced, and the quality of life of the patient is significantly reduced [1-2]. Clinical treatments mainly include asthma, cough, phlegm, and antibiotics, but the effects are quite different. The adverse reactions after Western medicine treatment are obvious, and the curative effect of disease control has a progressive decline. In recent years, the application of traditional Chinese medicine theory to treat bronchiectasis has obvious advantages, providing a safe and effective treatment for the clinical treatment of bronchiectasis [3]. Among them, acupoint embedding and traditional Chinese medicine ointment are the main representatives, which reflects the important role of comprehensive Chinese medicine treatment in the treatment of bronchiectasis during remission [4]. In this study, 150 patients with bronchiectasis in remission during the period from June 2017 to July 2019 in our hospital were taken as the research objects. They were treated with salmeterol and fluticasone combined with erythromycin, and western medicine combined with spleen and dampness and stasis. The treatment of cream and combined with buried thread treatment was used to investigate the clinical efficacy of buried thread combined with Jianpi Qushi Huayu plaster in the treatment of bronchiectasis in remission, and to observe the effect on the change of inflammatory cytokine levels. The observation results are reported below.

2. Materials and methods

2.1 General Information

150 clinically treated patients with bronchiectasis in remission were collected and divided into three groups (50 patients each) by random number table method. Western medicine group: 32 male patients, 18 female patients, age 29-72 (56.72) ± 6.95) years, with a course of 4 to 11 (6.58 ± 1.12) years; combined group: 34 male patients and 16 female patients, aged 31 to 74 (57.23 ± 7.49) years, with a course of 3 to 13 (6.41 ± 1.05) years ; Observation group: 31 male patients and 17 female patients, aged 30 to 75 (56.79 ± 6.83) years, with a course of 4 to 13 (6.98 ± 1.14) years. There were no significant differences in baseline data, course of disease, age, and gender between the three groups of patients (P＞ 0.05), and clinical comparison was possible.

2.1.1 Inclusion criteria

(1) All subjects were diagnosed with bronchiectasis through clinical medical records, laboratory indicators, and chest HRCT. (2) The research protocol has been reviewed and approved by the hospital medical ethics committee. (3) The patient obtained informed consent and signed the informed consent form.

2.1.2 Exclusion criteria

(1) Application of relevant research drugs for treatment 12 weeks before enrollment; (2) Tuberculosis, pulmonary interstitial fibrosis, chronic obstructive pulmonary disease; (3) Allergies to treatment drugs; (4) Mental illness, hematological diseases; (5) Malignant tumors and cardiac dysfunction; (6) Women in lactating pregnancy; (7) Incomplete clinical data.

2.2 Research methods

All three groups were treated with anti-infection, sedation, cough, and symptomatic treatment.

Western medicine group: Salmeterol and fluticasone (Chinese medicine standard H20090241, specification: 50ug / 250ug), 2 times / day, 1 inhalation / time, orally with erythromycin tablets (Chinese medicine standard H33022279, specification: 0.125g) , 2 times / day, 0.25g / time, the course of treatment is 2 months.

Combined group: Jianpi Qushi Huayu cream is treated on the basis of western medicine group. Composition: 10g of tortoise shell gum, 10g of staghorn gum, gelatin 10g, burdock seed 10g, gardenia 10g, codonopsis 15g, pinellia pinellia 15g, melon 15g of coriander skin, 15g of floating sea stone, 15g of Morinda officinalis, 10g of Asarum, 10g of aconite, 15g of Xu Changqing, 15g of wolfberry fruit, 10g of Qianhu, 15g of butterbur flower, 10g of whole scorpion, 20g of silkworm silk, 15g of aster , 15g of Ophiopogon japonicus, 15g of North American ginseng, 10g of orange tangerine, 10g of earthworms, 2 scallions, 10g of peony, 10g of peony peel, 15g of dogwood, 15g of rehmannia glutinosa, 30g of reed root, 30g of dilong, 30g of barberry 15g, yam 15g, atractylodes 15g, Ophiopogon 15g, Zhejiang Fritillaria 20g, Poria 15g, Zhuli 10g, ume plum 15g, Schisandra 15g, shoot dry 15g, perilla leaf 10g, windproof 15g, nepeta 15g, bellflower 10g, almond 15g , Ephedra 10g, Astragalus 15g, Licorice 10g. According to the specific condition of the patient to carry out syndrome differentiation, such as qi, blood, yin and yang deficiency, medication addition and subtraction. The ointment is prepared by uniform decoction in the ointment room of the hospital. The specific preparation method is to soak the Chinese medicine (except tortoise shell gum, staghorn gum, and gelatin) for 24 hours, decoction for 3 times with Wuhuo decoction, and then settle, bitumen, and then collect. Paste, add tortoise shell gum, antler gum, Ejiao, boil until dripping into beads. How to take: Take it with warm water, take it once a day in the morning and evening, 20g / time, and take it for 2 months.

Observation group: Acupoints were buried on the basis of treatment in combination group. Acupoint selection: Fenglong (double), Zusanli (double), Shenshu (double), Pishu (double), Feishu (double), Dingchuan (bilateral), Langzhong. The embedding material is absorbable surgical suture. The suture is cut to a length of 1 cm. The implantation tool is a 9th lumbar puncture needle. Specific operations: take a prone position during back acupoint operation, supine position for chest, lower limb acupoint operation, routine skin disinfection, place a suture in a disposable No. 9 puncture needle tube, and pierce quickly into the acupoint. Push the needle core and withdraw the needle tube, leaving the suture in the subcutaneous tissue of the acupoint. After removing the needle, press for a while (use a sterile cotton swab) to make sure the exposed thread ends, and finally cover the needle hole with an infusion patch to avoid contamination. After 15 days, the wire was buried once, and the wire was buried 4 times in total.

2.3 Observation indicators

(1) Formulate TCM syndrome scores with reference to the “Guidelines for Diagnosis and Treatment of Common Diseases in Traditional Chinese Medicine” [5]. Observe the symptoms of dark complexion, not sitting, asthma, full chest, sputum salivation, yellow tongue greasy, thick turbidity, pulse Smooth, each score ranges from 0 to 6 points, the higher the score, the more severe the symptoms. (2) Pulmonary function indicators: peak expiratory flow rate (PEFR%) level, maximum expiratory flow rate (PEF), forced expiratory volume in 1 second (FEV1), forced expiratory volume in 1 second as a proportion of vital capacity (FEV1%); detection FEV1 and FEV1% use AS-510 type automatic lung function tester (manufactured by Japan Minon); PEF-10 type automatic peak flow rate tester (manufactured by Barry) is used to detect PEF. (3) Inflammatory cytokine indicators: interleukin-13 (IL-13), interleukin-10 (IL-10), interleukin-4 (IL-4), detection using ELISA method (kit by (Provided by Shanghai Lianshuo). (4) Record the number of adverse reactions during the treatment, such as dry mouth, constipation, facial flushing, and skin allergies.

2.4 Evaluation Criteria

Formulated with reference to the "Clinical disease diagnosis based on the criteria for improvement" [6]. Cure: The lung lobe of the bronchiectasis lesion was removed without complications and residual lesions, and respiratory symptoms completely disappeared. Improvement: Sputum volume was significantly reduced, cough and expectoration symptoms were improved, no hemoptysis symptoms were detected, and wet snoring sounds in the lungs were reduced and disappeared. Chest DR examination showed obvious absorption or no inflammatory shadow, and body temperature and blood routine returned to normal levels. Unhealed: Symptoms and signs have not reached the standard of improvement or no significant change.

2.5 Statistical analysis

All research data were analyzed and processed by SPSS 21.0 statistical software. Measurement data conforming to the normal distribution are expressed as mean ± standard deviation (±s), and comparison is performed by t test; count data are expressed as percentage (%), comparison is performed by χ2test; the test level is α = 0.05. The difference was statistically significant with P ＜0.05.2

3. Results

3.1 Comparison of clinical efficacy of three groups of patients

Western medicine group cured 13 cases, improved 25 cases, uncured 12 cases, the total clinical effective rate was 76%; combined group cured 17 cases, improved 27 cases, uncured 6 cases, the total clinical effective rate was 88%; observation group cured 14 cases, 32 cases improved and 4 cases did not heal. The observation group and combination group had a significantly higher treatment efficiency than the western medicine group (P ＜0.05), and the observation group had a higher treatment efficiency than the combination group.

3.2 Comparison of TCM syndrome scores before and after treatment

Comparing before treatment, there was no significant difference in TCM syndrome scores between the three groups. Compared with before treatment, the scores of the three groups after treatment were significantly decreased (P ＜0.05). Compared with the western medicine group, the observation group and the combined group were treated. The scores of TCM syndromes were significantly reduced after the treatment (P ＜0.05), but the difference between the observation group and the combined group was not significant, as shown in Table 1;

Table 1 Comparison of TCM syndrome scores before and after treatment (±s, points)

Note: Compared with before treatment, * P ＜ 0.05. Compared with the western medicine group after treatment, #P ＜0.05.

Group Time Spitting Pant full Can't sit down Pale Thick moss or yellow greasy Smooth pulse Western medicine group Before treatment 4.12±1.01 4.12±0.85 3.76±0.91 3.79±0.83 3.91±0.88 3.98±0.80 After treatment 2.36±0.42* 2.16±0.42* 1.95±0.41* 2.04±0.39* 2.06±0.45* 2.16±0.42*tComparison before and after treatment in western medicine group 11.377 14.617 12.823 13.493 13.235 14.243 PComparison before and after treatment in western medicine group 0.000 0.000 0.000 0.000 0.000 0.000 Joint group Before treatment 4.16±1.04 4.18±0.94 3.81±0.87 3.81±0.43 3.87±0.76 4.06±0.79 After treatment 1.19±0.48*# 1.01±0.32*# 0.97±0.12*# 1.02±0.35*# 0.92±0.13*# 0.93±0.14*#tComparison before and after treatment in combination group 18.334 22.573 22.866 35.582 27.054 27.585 PComparison before and after treatment in combination group 0.000 0.000 0.000 0.000 0.000 0.000 Observation group Before treatment 4.07±1.01 4.20±0.92 3.80±0.12 3.85±0.74 3.84±0.79 4.03±0.81 After treatment 0.72±0.15*# 0.79±0.21*# 0.66±0.15*# 0.69±0.20*# 0.76±0.19*# 0.74±0.13*#tComparison of observation group before and after treatment 23.199 25.551 115.585 29.149 26.803 28.357 PComparison of observation group before and after treatment 0.000 0.000 0.000 0.000 0.000 0.000 tComparison of the combined group with the control group after treatment 12.971 15.401 16.221 13.763 17.209 19.645 PComparison of the combined group with the control group after treatment 0.000 0.000 0.000 0.000 0.000 0.000 tComparison between observation group and control group after treatment 26.002 20.630 20.893 21.779 18.818 22.838 PComparison between observation group and control group after treatment 0.000 0.000 0.000 0.000 0.000 0.000 tComparison between observation group and combination group after treatment 6.608 4.064 11.411 5.788 4.914 7.032 PComparison between observation group and combination group after treatment 0.000 0.000 0.000 0.000 0.000 0.000

Table 2 Comparison of pulmonary ventilation function levels before and after treatment (±s, n = 50)

Table 2 Comparison of pulmonary ventilation function levels before and after treatment (±s, n = 50)

Note: Compared with before treatment, * P ＜ 0.05. Compared with the western medicine group after treatment, #P ＜0.05.

Group Time FEV1% FEV1(L) PEF(L/s) PEFR%(%)Western medicine group Before treatment 69.77±3.26 1.77±0.45 4.38±0.30 31.99±5.13 After treatment 74.45±5.64* 2.48±0.70* 5.89±0.45* 11.97±2.54*tComparison before and after treatment in western medicine group 5.079 6.033 19.742 24.729 PComparison before and after treatment in western medicine group 0.000 0.000 0.000 0.000 Joint group Before treatment 70.02±3.67 1.80±0.51 4.41±0.29 31.81±4.98 After treatment 82.49±4.87*# 3.16±0.58*# 6.43±0.47*# 7.03±1.34*#tComparison before and after treatment in combination group 14.459 12.451 25.863 33.976 PComparison before and after treatment in combination group 0.000 0.000 0.000 0.000 Observation group Before treatment 69.93±3.29 1.82±0.47 4.43±0.34 31.85±5.04 After treatment 85.97±7.26*# 3.49±0.93*# 6.71±0.58*# 6.36±1.66*#tComparison of observation group before and after treatment 14.229 9.975 23.980 33.301 PComparison of observation group before and after treatment 0.000 0.000 0.000 0.000 tComparison of the combined group with the control group after treatment 7.629 5.289 5.868 12.163 PComparison of the combined group with the control group after treatment 0.000 0.000 0.000 0.000 tComparison between observation group and control group after treatment 8.860 5.921 7.898 13.908 PComparison between observation group and control group after treatment 0.000 0.000 0.000 0.000 tComparison between observation group and combination group after treatment 2.814 2.129 2.652 2.220 PComparison between observation group and combination group after treatment 0.006 0.035 0.009 0.028

Table 3 Comparison of inflammatory cytokine levels before and after treatment (±s, ng / L)

Table 3 Comparison of inflammatory cytokine levels before and after treatment (±s, ng / L)

Note: Compared with before treatment, * P ＜ 0.05. Compared with the western medicine group after treatment, #P ＜0.05.

Group Time IL-4 IL-10 IL-13 Western medicine group Before treatment 148.44±11.29 205.55±33.46 132.74±14.16 95.37±7.27* 230.84±40.16* 87.77±10.19*After treatment 27.945 3.421 18.227 tComparison before and after treatment in western medicine group 0.000 0.001 0.000 PComparison before and after treatment in western medicine group 148.92±11.53 206.58±30.89 133.47±15.31 Joint group Before treatment 75.62±6.38*# 270.63±48.76*# 68.92±9.85*#After treatment 39.333 7.846 25.072 tComparison before and after treatment in combination group 0.000 0.000 0.000 PComparison before and after treatment in combination group 147.28±10.75 203.72±32.89 131.28±14.01 Observation group Before treatment 73.14±5.81*# 285.61±21.35*# 65.07±8.29*#After treatment 42.555 8.684 28.629 tComparison of observation group before and after treatment 0.000 0.000 0.000 PComparison of observation group before and after treatment 14.438 4.454 9.404 tComparison of the combined group with the control group after treatment 0.000 0.000 0.000 PComparison of the combined group with the control group after treatment 16.434 6.181 12.057 tComparison between observation group and control group after treatment 0.000 0.000 0.000 PComparison between observation group and control group after treatment 2.032 1.990 2.114 tComparison between observation group and combination group after treatment 0.045 0.049 0.037

3.3 Comparison of pulmonary ventilation function levels before and after treatment

The peak expiratory flow rate, maximum expiratory flow rate, forced expiratory volume for 1 second, and forced expiratory volume for 1 second in the vital capacity of the observation group and combination group were significantly better than those of the western medicine group and the pre-treatment level (P ＜0.05) , And the improvement of the observation group was better than that of the combined group, see Table 2;

3.4 Comparison of changes in inflammatory cytokines before and after treatment

The improvement of the expression levels of interleukin-13, interleukin-10, interleukin-4 after observation group and combination group was significantly better than that of western medicine group and before treatment (P ＜0.05), and the improvement of observation group was better than Joint group, see Table 3;

3.5 Comparison of adverse reactions after treatment in three groups of patients

Five patients in the western medicine group had adverse reactions, including 1 case of facial flushing, 2 cases of constipation, and 2 cases of dry mouth; 5 cases of adverse reactions in the combination group, including 1 case of skin allergy, 2 cases of facial flushing, 1 case of constipation, and dry mouth 1 There were 6 cases of adverse reactions in the observation group, including 1 case of skin allergies, 2 cases of facial flushing, 1 case of constipation, and 2 cases of dry mouth. There was no significant difference in the incidence of adverse reactions among the three groups of patients (P＞ 0.05).

4. Discussion

Bronchodilator disease is characterized by high secretion of airway mucus and secretions. The disease is caused by abnormal clearance of the ciliary system and impaired ciliary swing, which accelerates the reproduction and growth of Staphylococcus aureus and Pseudomonas aeruginosa. Clinical manifestations For cough and sputum, the main symptoms are purulent sputum, and the disease is easy to repeat, and the delay is difficult to heal. The disease will be further aggravated by the reproduction and growth of pathogenic microorganisms, which will cause repeated lung infections and cause severe damage to lung function [7]. The current clinical treatment of bronchiectasis is mainly to clear airway secretions, resist infection, and improve the body's immunity. Therapeutic drugs include inhaled glucocorticoids, macrolides, inhaled glucocorticoids for tissue cystic fibrosis, The improvement of lung function has better effects, but it is still controversial which glucocorticoid treatment can be used to achieve safe and effective purposes. And western medicine treatment has poor compliance, many adverse reactions, and has a higher disease recurrence rate [8-9].

Salmeterol and fluticasone belong to β2 receptor agonists, which can effectively improve lung function and airway obstruction, inhibit bronchiectasis, stimulate tracheal mucosal epithelial cells, promote sputum excretion, and effectively improve the symptoms of lung infection; In addition, the drug has a longlasting effect, can protect the bronchus, and alleviate symptoms such as dyspnea, wheezing, sputum and chest tightness in patients with bronchiectasis. Erythromycin is a macrolide antibiotic, which has strong anti-inflammatory activity, and has good antibacterial effect and immunoregulatory effect. Erythromycin treatment can reduce the production of alginic acid bacterial salts in the body, thereby reducing the damage to the membrane structure. The anti-inflammatory drugs and the penetration of salmeterol and fluticasone into the membrane can promote the antibacterial effect. Erythromycin can also inhibit bacterial migration, bacterial flagella synthesis, and significantly reduce the pathogenicity of Pseudomonas aeruginosa [10-11].

The medicinal composition of Jianpi Qushi Huayu cream is mainly based on Tongluo Huayu, Qushi Jianpi, Yiqi Yangyin, and at the same time, it is combined with phlegm and wind relieving drugs to eliminate the evil inside and outside the body [12]. Fangzhong plum, Schisandra chinensis, and lung cough; Fuhaishi, Pueraria, Lycium barbarum, Aster, Rehmannia glutinosa, Ophiopogon japonicus, Dogwood, Reed Root, Fritillaria cirrhosa, Qianhu, Tussilago farfara, Zhimu, Ophiophyllum, Beishan It can clear heat, relieve phlegm, relieve cough, and nourish lung and kidney yin; Zhuli, Pinellia ternata, almonds, cough and phlegm; burdock, melon peel, platycodon, gardenia, ephedra, wide chest, qi, asthma, expectorant and lung; Ze Xie, Coix seed, Chinese yam, Poria, Atractylodes, Codonopsis spleen and dampness; Xu Changqing Xingqi expelling wind and dehumidifying; Perilla leaf, windproof, nepeta, expelling wind; earthworm, maggot, whole scorpion, stiff silkworm, earth dragon , Sheganping asthma, relieve spasm, Tongluo quenching wind, chronic illness into the network into the evil qi; orange network, peony skin, phlegm and Tongluo; tortoise shell glue, staghorn gum, Ejiao Ziyin tonic blood; Morinda officinalis, Asarum, Aconite Warm the kidney and yang to reach the yin and seek yin; yam, atractylodes, Poria, Codonopsis and Astragalus can supplement the qi. The combination of various medicines can relieve spasm and cough, eliminate evils and go out, nourish yin and kidney, and regulate the balance of yin and yang in the body's internal organs [13-14].

Acupoint embedding is mainly based on acupuncture and meridian theory for dialectical treatment. Selecting acupoints to implant biological protein lines can form soft and durable physical and chemical stimuli for acupoints, which can regulate viscera, yin and yang, reconcile qi and blood, and stimulate essence. "The person with the twelve meridians of the husband belongs to the internal organs and the outer limbs are connected to the limbs." ("Lingshu · Theory of the Sea"), "The skin is also the part of the pulse." The line can closely communicate and connect with the viscera through the body's meridian system, so the acupoint selection is mainly based on the viscera and yushu acupoints [15-16]. Feishu acupoint Feishu can relieve asthma, relieve cough, and regulate lung air; Shenshu can absorb air temperature and kidneys, and improve the essence and spleen; Spleen Beishu acupoint spleen and spleen cultivates gold, which can nourish Qi and strengthen the spleen, and disseminate viscera Qi [17]; Dingchuan point is "qihui", which is a strange point through the outside, which can relieve asthma; Qiongzhong is the place where the qi is gathered, which is the sea of qi, which can declare lung ventilation and adjust the balance of yin and yang of the body Fenglong, don't take the Taiyin spleen meridian, which belongs to the point of the stomach meridian of the foot Yangming, can dampen phlegm and bujin qi; Zusanli has the effect of relieving the evil and strengthening the body [18]. The above points are used for the lung system. Diseases can relieve asthma, relieve spleen and reduce phlegm. The acupuncture points cooperate to correct the evil and regulate the lungs and kidneys. In the operation method, through the acupoint embedding operation, a soft and durable physical and chemical stimulation effect can be formed on the acupuncture point, and the balance of viscera, yin and yang can be adjusted. At the same time, the number of consultations can be avoided, and the treatment of patients with chronic diseases can be facilitated.

The results of this study show that the treatment efficiency of the observation group and the combined group is significantly higher than that of the western medicine group, and the treatment efficiency of the observation group is higher than that of the combined group. After the treatment, the scores of the three groups were significantly reduced. The scores of TCM syndromes in the combination group were significantly reduced after treatment; the peak expiratory flow rate, maximum expiratory flow rate, forced expiratory volume in 1 second, and forced expiratory volume in 1 second in the observation group and the combined group were significantly improved after treatment In the western medicine group and pre-treatment levels, and the observation group improved better than the combined group; the observation group and the combined group improved the expression levels of interleukin-13, interleukin-10, and interleukin-4 after treatment were significantly better than Western medicine group and before treatment, and the observation group improved better than the combined group. Prove that the buried thread combined with Jianpi Qushihuayu cream can significantly relieve the relevant clinical symptoms and signs during the remission period of bronchiectasis, effectively control the further aggravation of the disease, improve the patient's lung function, and adjust the level of inflammatory cytokines to reduce the degree of inflammatory response. Aggravate the adverse effects of the drug.