活血化瘀法對結締組織疾病併發間質性肺病變療效之研究

　　　　　間質性肺病變為結締組織疾病常見之併發症，但目前尚無理想之療法。由於其病 理機轉與中醫血瘀症相當，本研究以活血化瘀法合併西藥治療，追蹤患者肺功能之變化，而 進行療效之評估。由風濕科門診篩選結締組織疾病併發間質性肺病變患者，以西藥治療其原 發性疾病達穩定狀態後，使用最低維持劑量。依患者之意願分為兩組，實驗組會診中醫，依 雷諾氏症候群之有無，給予當歸四逆湯或血府逐瘀湯濃縮粉劑，連續治療六個月; 對照組則 不會診中醫。十四個月間共有實驗組 23 例，對照組 16 例，均為女性患者。以壓縮性肺容 量 (FVC) 、 肺總容量 (TLC) 、 一氧化碳擴散率 (DLCO) 、 肺泡平均一氧化碳擴散率 (DLCO/VA) 等為指標，進行盒形圖、肺功能受損程度分級、肺功能損失計分系統等評估，結 果顯示實驗組之肺功能較治療前有所改善，優於對照組。肺功能之相關變數經以一般線性模 式進行分析，建立 TLC 及 FVC 之模式，發現後者在實驗組與療程長短呈正相關，且其療效 明顯改善之轉折點與 DLCO 及 DLCO/W 大致同步出現於第 12 週。
　　　　　The interstitial lung disease is a common complication of connective tissue diseases. At the present time, there is no ideal treatment. Because its pathogenetic mechanism is quite compatible with that of " Blood stasis' syndrome of Chinese medicine, this study utilized the combinedtherapy of Western medicine and the method of "quickening blood and transforming stasis "of Chinese medicine for the treatment.The therapeutic effects were assessed with the pulmonary function test. We collected the patients of connective tissue diseases associated with the interstitial lung disease in the outpatient department of rheumatology. After stabilizing the activity of primary diseases with Western medicine, we kept the drug dosage to the minimum required. According to the patient's will, we separated them into two groups. The study group consulted the Chineses medicine department. Then, depending on the presence or absence of Raynaud's phenomenon, the patients of the study group were given the powders of DQ-4 or SF-U respectively. The treatment continued for six months. as for the control group, no consultation with the Chinese medicine department was sought. During the period of fourteen months, we collected 23 cases for the study group and 16 casses for the control group. All patients were female. Using forced vital capacity (FVC), total lung capacity (TLC), diffusion capacity of lung for carbon monoxide (DLGO) and the ratio of DLCO over alveolar air volume (VA) as indicators, we proceeded the analysis with box plot, degree of pulmonary function impairment and modified CRP scoring system. The results showed that the improvement of pulmonary function in the study group was greater than that of the control group. Applying the analysis of covariance to the parameters of pulmonary function test and building the model of TLC and FVC, we discovered that FVC is proportional to the length of treatment in the study group. Also, the turning point of therapeutic improvement mostly coincided with the appearance of improvemrnt of DLCO and DLCO/VA in the twelfth week of treatment course in the study group.