1.广州中医药大学第二临床医学院/省部共建中医湿证国家重点实验室,广东省广州市白云区机场路12号,510405
2.河南中医药大学第一附属医院
3.广东省中医院
4.广东省中医证候临床研究重点实验室
chenyuanbin110@163.com
收稿:2024-05-07,
修回:2024-07-26,
纸质出版:2024-10-17
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陈晓纯,杨建雅,肖晶旻等.仙芪青龙方治疗咳嗽变异性哮喘肺肾两虚、风盛挛急证的随机、阳性对照、非劣效性临床试验[J].中医杂志,2024,65(20):2109-2115.
CHEN Xiaochun,YANG Jianya,XIAO Jingmin,et al.Xianqi Qinglong Formula (仙芪青龙方) for the Treatment of Cough Variant Asthma with Lung and Kidney Deficiency and Exuberant Wind-induced Spasm and Tension Syndrome: A Randomized, Positive-controlled, Non-inferiority Clinical Trial[J].Journal of Traditional Chinese Medicine,2024,65(20):2109-2115.
陈晓纯,杨建雅,肖晶旻等.仙芪青龙方治疗咳嗽变异性哮喘肺肾两虚、风盛挛急证的随机、阳性对照、非劣效性临床试验[J].中医杂志,2024,65(20):2109-2115. DOI: 10.13288/j.11-2166/r.2024.20.009.
CHEN Xiaochun,YANG Jianya,XIAO Jingmin,et al.Xianqi Qinglong Formula (仙芪青龙方) for the Treatment of Cough Variant Asthma with Lung and Kidney Deficiency and Exuberant Wind-induced Spasm and Tension Syndrome: A Randomized, Positive-controlled, Non-inferiority Clinical Trial[J].Journal of Traditional Chinese Medicine,2024,65(20):2109-2115. DOI: 10.13288/j.11-2166/r.2024.20.009.
目的
2
评价仙芪青龙方治疗咳嗽变异性哮喘肺肾两虚、风盛挛急证患者的临床疗效和安全性。
方法
2
采用随机、阳性对照、非劣效临床试验设计,将102例咳嗽变异性哮喘肺肾两虚、风盛挛急证患者随机分为治疗组52例和对照组各50例。治疗组给予仙芪青龙方颗粒口服,每日1剂,每次2袋(9.25 g/袋),每日2次,早晚餐后服用;对照组给予口服仙芪青龙方颗粒安慰剂联合吸入丙酸氟替卡松吸入气雾剂(每次125 μg,每日2次)。两组均治疗12周,随访12周,共24周。主要结局指标为两组患者咳嗽症状评分(包括日间评分、夜间评分和总分),于治疗前(入组时)、治疗中(入组第6周后)、治疗结束(入组第12周后)、随访结束(入组第24周后)各评价1次,采用单侧95%可信区间下限(
LCL
)进行非劣效性判定。次要结局指标包括咳嗽缓解和消失情况、中医证候积分、咳嗽视觉模拟量表(VAS)评分、莱切斯特咳嗽问卷(LCQ)评分和肺功能指标[第1秒用力呼气容积(FEV
1
)、第1秒用力呼气容积占预计值百分比(FEV
1
%pred)、用力肺活量(FVC)、呼气峰值流量(PEF)]。治疗前后检测血常规和肝肾功能,并详细记录不良事件发生情况。
结果
2
101例患者纳入全分析集(FAS)分析,治疗组52例,对照组49例。与本组治疗前比较,两组患者治疗中、治疗结束及随访结束时日间咳嗽症状评分、夜间咳嗽症状评分及咳嗽症状总分均下降(
P
<0.01)。两组患者在治疗中、治疗结束、随访结束时咳嗽症状总分的单侧95%
LCL
分别为-0.14、-0.47、-0.27(95%
LCL
均>-0.6)。两组患者各时间点咳嗽缓解率、咳嗽消失率、咳嗽缓解天数及咳嗽消失天数的组间比较,差异均无统计学意义(
P
>0.05)。与本组治疗前比较,两组患者治疗中、治疗结束以及随访结束时的中医证候积分、咳嗽VAS评分均下降,LCQ评分均上升(
P
<0.01),但FEV
1
、FEV
1
%、FVC、PEF治疗前后差异无统计学意义(
P
>0.05)。两组患者各时间点中医证候积分、咳嗽VAS评分、LCQ评分、FEV
1
、FEV
1
%、FVC、PEF组间比较,差异均无统计学意义(
P
>0.05)。治疗前后两组患者肝肾功能均未发现具有临床意义的异常检验结果。
结论
2
仙芪青龙方治疗咳嗽变异性哮喘肺肾两虚、风盛挛急证患者的临床疗效非劣效于丙酸氟替卡松吸入气雾剂,可有效缓解咳嗽症状、降低咳嗽评分、减少咳嗽发作天数,提高生存质量,且安全性较好。
Objective
2
To evaluate the clinical efficacy and safety of
Xianqi Qinglong Formula
(仙芪青龙方, XQF) in the treatment of cou
gh variant asthma (CVS) patients with lung and kidney deficiency and exuberant wind-induced spasm and tension syndrome.
Methods
2
A randomized, positive-controlled, non-inferiority clinical trial was designed. Totally, 102 CVS patients with lung and kidney deficiency and exuberant wind-induced spasm and tension syndrome were randomly divided into a treatment group (52 cases) and a control group (50 cases). The treatment group was given XQF granules orally, 1 dose per day, 2 bags each time (9.25 g/bag), twice a day, after breakfast and dinner; the control group was given XQF granules placebo orally combined with inhaled fluticasone propionate inhalation aerosol (125 μg each time, twice a day). Both groups were treated for 12 weeks and followed up for 12 weeks, with a total of 24 weeks. The primary outcome was the cough symptom score (including daytime, nighttime and total score), evaluated before treatment (at enrollment), during treatment (after the 6th week of enrollment), at the end of treatment (after the 12th week of enrollment), and at the end of follow-up (after the 24th week of enrollment). The non-inferiority was determined by the lower limit (LCL) of the unilateral 95% confidence interval. The secondary outcomes included cough relief and disappearance, total score of TCM syndrome, cough visual analogue (VAS) score, Leicester Cough Questionnaire (LCQ) score, and lung function indicators including forced expiratory volume in 1 second (FEV1), percentage of predicted forced expiratory volume in 1 second (FEV1%pred), forced vital capacity (FVC), and peak expiratory flow (PEF). Blood routine and liver and kidney function were tested before and after treatment, and the adverse events were recorded.
Results
2
A total of 101 patients were included in the full analysis set (FAS), including 52 cases in the treatment group and 49 cases in the control group. After treatment, the daytime, nighttime and total cough symptom scores during treatment, at the end of
treatment and at the end of follow-up all decreased in both two groups (
P
<0.01). The unilateral 95%
LCL
of the total cough symptom scores during treatment, at the end of treatment and at the end of follow-up of the two groups were -0.14, -0.47 and -0.27 (95%
LCL
all>-0.6). There were no significant differences in the cough relief rate, cough disappearance rate, cough relief days and cough disappearance days between the two groups at each time point (
P
>0.05). Compared to those before treatment, the TCM syndrome scores and cough VAS scores during treatment, at the end of treatment and at the end of follow-up decreased in both groups, while the LCQ scores increased (
P
<0.01), but there were no significant differences in FEV1, FEV1%, FVC and PEF before and after treatment (
P
>0.05). There were no significant differences in TCM syndrome scores, cough VAS scores, LCQ scores, FEV1, FEV1%, FVC, and PEF between the two groups at each time point (
P
>0.05). No clinically significant abnormal liver and kidney function were found in the two groups before and after treatment.
Conclusion
2
XQF is not inferior to fluticasone propionate inhalation aerosol in relieving cough symptoms, reducing cough scores, decreasing the number of cough attack days, and improving the quality of life when treating CVS patients with lung and kidney deficiency and exuberant wind-induced spasms and tension syndrome, and relatively safe.
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