[1]方小谦,唐鸿,祝颖,等.风咳方联合沙美特罗替卡松对稳定期哮喘-慢阻肺重叠征患者血清外泌体miR-34a和细胞因子的影响[J].陕西中医,2025,46(8):1053-1057.[doi:DOI:10.3969/j.issn.1000-7369.2025.08.008]
　FANG Xiaoqian,TANG Hong,ZHU Ying,et al.The effects of Fengke formula combined with salmeterol and fluticasone on serum extracellular vesicle miR-34a and cytokines in patients with asthma-COPD overlap[J].,2025,46(8):1053-1057.[doi:DOI:10.3969/j.issn.1000-7369.2025.08.008]
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风咳方联合沙美特罗替卡松对稳定期哮喘-慢阻肺重叠征患者血清外泌体miR-34a和细胞因子的影响

《陕西中医》[ISSN:1000-7369/CN:61-1281/TN]

卷:
46
期数:
2025年8期
页码:
1053-1057
栏目:
临床研究
出版日期:
2025-08-05

文章信息/Info

Title:
The effects of Fengke formula combined with salmeterol and fluticasone on serum extracellular vesicle miR-34a and cytokines in patients with asthma-COPD overlap
作者:
方小谦; 唐鸿; 祝颖; 颜延凤
（南京中医药大学附属南京市中西医结合医院肺病科，江苏 南京 230011）
Author(s):
FANG Xiaoqian; TANG Hong; ZHU Ying; YAN Yanfeng
(Department of Pulmonary Disease,Nanjing Integrated Traditional Chinese and Western Medicine Hospital,Nanjing University of Traditional Chinese Medicine,Nanjing 230011,China)
关键词:
哮喘-慢性阻塞性肺病重叠症; 风咳方; 沙美特罗替卡松; 外泌体; 高迁移率族蛋白1; 趋化因子配体13
Keywords:
Asthma-COPD overlap; Fengke formula; Salmeterol and fluticasone; Extracellular vesicles; High mobility group protein 1; Chemokine ligand 13
分类号:
R 563
DOI:
DOI:10.3969/j.issn.1000-7369.2025.08.008
文献标志码:
A
摘要:
目的：探讨风咳方联合沙美特罗替卡松治疗稳定期哮喘-慢阻肺重叠征（ACO）的临床疗效，以及对血清外泌体miR-34a和细胞因子表达的影响。方法：随机纳入ACO患者188例，根据随机数字表法分为对照组和观察组各94例，对照组采用沙美特罗替卡松吸入治疗，观察组联合应用自拟风咳方，疗程均为2周。比较两组中医证候积分，肺功能[FEV1%预计值、FEV1/FVC、最大呼气中段流量（MMEF）和呼气峰流速（PEF）]，炎症介质[hs-CRP、中性粒细胞与淋巴细胞比值（NLR）、白细胞介素-6（IL-6）]，细胞因子[高迁移率族蛋白1（HMGB1）和趋化因子配体13（CXCL13）]，以及外泌体miR-34a表达量。评估临床疗效。结果：两组治疗后中医证候积分、HMGB1、CXCL13、hs-CRP、NLR、IL-6和miR-34a表达量较治疗前降低，且观察组明显低于对照组（均P＜0.05）；两组治疗后FEV1%预计值、FEV1/FVC、MMEF和PEF较治疗前升高，且观察组明显高于对照组（均P＜0.05）。观察组总有效率显著高于对照组（P＜0.05）。结论：风咳方联合沙美特罗替卡松治疗稳定期ACO可以进一步提高临床疗效，改善肺功能，减轻炎症反应，抑制外泌体miR-34a表达。
Abstract:
Objective:To investigate the clinical efficacy of Fengke formula combined with salmeterol and fluticasone in the treatment of asthma-COPD overlap (ACO),as well as its effects on serum exosomal miR-34a and cytokine expression.Methods:A total of 188 patients diagnosed as ACO were randomly included.According to the random number method,they were divided into control group and observation group,with 94 cases in each group.The control group was treated with inhaled salmeterol and fluticasone,while the observation group was treated with self-made Fengke formula.The treatment course was 2 weeks for both groups.The TCM syndrome scores,lung functions [predicted FEV1%,FEV1/FVC,mid-maximal expiratory flow (MMEF),and peak expiratory flow velocity (PEF)],inflammatory mediators [hs-CRP,neutrophil-to-lymphocyte ratio (NLR),interleukin-6 (IL-6)] of the two groups were compared.The expression levels of cytokines [high mobility group protein 1 (HMGB1) and chemokine ligand 13 (CXCL13)],as well as exosome miR-34a and the clinical efficacy were compared between the two groups.Results:After treatment,the TCM syndrome score,HMGB1,CXCL13,hs-CRP,NLR,IL-6,and miR-34a expression levels in both groups decreased compared to before treatment,and observation group was significantly lower than control group (all P<0.05).After treatment,the FEV1% predicted,FEV1/FVC,MMEF,and PEF in both groups increased compared to before treatment,and observation group was significantly higher (all P<0.05).The total effective rate of the observation group was significantly higher (P<0.05).Conclusion:The combination of Fengke formula and salmeterol/fluticasone in the treatment of ACO can furtherly improve clinical efficacy,improve lung function,alleviate inflammatory response,and inhibit the expression of extracellular vesicle miR-34a.

参考文献/References:

[1]周衍香,梅波,刘中洋.噻托溴铵联合沙美特罗替卡松治疗哮喘-慢性阻塞性肺疾病重叠综合征疗效Meta分析[J].陕西医学杂志,2021,50(1):111-116.
[2]王晶,汪玉龙,郭锋.中老年人群中慢性阻塞性肺疾病、哮喘和哮喘-慢阻肺重叠综合征的临床特征分析[J].临床和实验医学杂志,2020,19(24):2626-2630.
[3]LEUNG C,SIN D D.Asthma-COPD overlap:What are the important questions?[J].Chest,2022,161(2):330-344.
[4]MEKOV E,NUNEZ A,SIN D D,et al.Update on asthma-COPD overlap (ACO):A narrative review[J].Int J Chron Obstruct Pulmon Dis,2021,16(6):1783-1799.
[5]DEY S,EAPEN M S,CHIA C,et al.Pathogenesis,clinical features of asthma COPD overlap,and therapeutic modalities[J].Am J Physiol Lung Cell Mol Physiol,2022,322(1):64-83.
[6]DASGUPTA S,GHOSH N,BHATTACHARYYA P,et al.Metabolomics of asthma,COPD,and asthma-COPD overlap:An overview[J].Crit Rev Clin Lab Sci,2023,60(2):153-170.
[7]李伟超.布地奈德雾化吸入联合胸腺素在哮喘-慢阻肺重叠综合征患者中的应用[J].四川生理科学杂志,2024,46(8):1807-1809.
[8]ALSAYED A R,ABU-SAMAK M S,ALKHATIB M.Asthma-COPD overlap in clinical practice (ACO_CP 2023):Toward precision medicine[J].J Pers Med,2023,13(4):677-680.
[9]CAO X,WANG Y,CHEN Y,et al.Advances in traditional Chinese medicine for the treatment of chronic obstructive pulmonary disease[J].J Ethnopharmacol,2023,307(5):116229-116232.
[10]蒙绮,周进.益气宣肺汤治疗老年哮喘疗效及对患者炎症因子和免疫功能的影响[J].陕西中医,2024,45(10):1345-1348.
[11]FOUKA E,PAPAIOANNOU A I,HILLAS G,et al.Asthma-COPD overlap syndrome:Recent insights and unanswered questions[J].J Pers Med,2022,12(5):708-711.
[12]中华中医药学会.中医内科常见病诊疗指南·中医病证部分[M].北京:中国中医药出版社,2008:5-10.
[13]GROSSI I,RADEGHIERI A,PAOLINI L,et al.MicroRNA-34a-5p expression in the plasma and in its extracellular vesicle fractions in subjects with Parkinson’s disease:An exploratory study[J].Int J Mol Med,2021,47(2):533-546.
[14]MORISSETTE M,GODBOUT K,COTE A,et al.Asthma COPD overlap:Insights into cellular and molecular mechanisms[J].Mol Aspects Med,2022,85(6):101021-101025.
[15]VENKATA A N.Asthma-COPD overlap:Review of diagnosis and management[J].Curr Opin Pulm Med,2020,26(2):155-161.
[16]钟国就,肖剑,林娉,等.哮喘-慢阻肺重叠综合征的中医体质特点研究[J].实用中医内科杂志,2022,36(8):140-142.
[17]王娅萍,陈炜健.补肺平喘汤联合现代医学疗法治疗哮喘-慢阻肺重叠综合征临床研究[J].新中医,2022,54(9):77-80.
[18]文思敏,范玉琴,朱建平,等.名中医张震从虚、痰、瘀辨治慢性阻塞性肺疾病经验[J].陕西中医,2024,45(4):532-535,540.
[19]SKOWASCH D,PIZARRO C.Asthma-COPD-Overlap-diagnostic and therapeutic management[J].Dtsch Med Wochenschr,2021,146(21):1405-1409.
[20]苏倩,李常,雷婷,等.薛己朝夕补益法联合舒利迭对肺肾亏虚型慢性阻塞性肺疾病稳定期患者运动耐力的影响[J].广州中医药大学学报,2024,41(6):1430-1437.
[21]MILLS H,ACQUAH R,TANG N,et al.Biochemical behaviours of salmeterol/fluticasone propionate in treating asthma and chronic obstructive pulmonary diseases (COPD)[J].Emerg Med Int,2022,7(4):1546-1550.
[22]叶新萌,彭波,叶静,等.基于数据挖掘分析中医药治疗上气道咳嗽综合征用药规律[J].中国中医药图书情报杂志,2024,48(6):109-113.
[23]李宗广,张威,于书娴,等.哮喘合并COPD患者血清TLR4、HMGB1、Treg表达与肺功能和病情严重程度的关系[J].医学研究与战创伤救治,2023,36(8):833-838.
[24]王静,苗姝,佟金平,等.CXCL13在支气管哮喘患者的表达情况及其与IgE、EOS和肺功能的相关性[J].重庆医学,2022,51(18):3161-3165.
[25]毛俊,王柯.SP-D、CXCL13、lncRNA PVT1在老年COPD患者中的表达及与肺功能指标的相关性[J].国际检验医学杂志,2022,43(21):2630-2634.
[26]李思广,林凌桑,陈洁,等.香烟诱导支气管上皮细胞外泌体释放miR-34a靶向CASP2促进肺成纤维细胞增殖[J].海南医学院学报,2023,29(17):1288-1295.
[27]蔡武全,袁红利.miR-34、miR-126、miR-138、miR-218水平联合检测对支气管哮喘不同严重程度的鉴别价值[J].医学临床研究,2023,40(2):272-274.
[28]栾英,李敬蕊,刘林林,等.基于miR-34a/Notch信号通路研究补肺益肾方对慢性阻塞性肺疾病大鼠模型免疫失衡和炎症反应的影响[J].中国免疫学杂志,2022,38(9):1075-1081.

备注/Memo

备注/Memo:
江苏省卫生健康委员会老年健康科研项目（LKM2022035）
更新日期/Last Update: 2025-08-08