【目的】探讨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 （COPD） 稳定期患者运动耐力的影响。 【方法】 将92例肺肾亏虚型COPD稳定期患者随机分为治疗组和对照组，每组各46例。对照组给予沙美特罗/氟替卡松吸入粉雾剂 （舒利迭） 治疗，治疗组在对照组的基础上给予朝服补中益气丸、夕服六味地黄丸治疗，疗程均为3个月。观察2组患者治疗 前后中医证候积分、生活质量圣乔治呼吸问卷 （SGRQ） 评分、运动耐力6 min步行试验 （6MWT） 距离和肺功能指标第1秒用力 呼气容积 （FEV1） 、用力肺活量 （FVC） 及其比值 （FEV1/FVC） 的变化情况，并比较2组患者临床疗效和不良反应发生情况。 【结果】（1） 研究过程中，共脱落3例，最终共纳入89例患者，其中治疗组45例、对照组44例。 （2） 治疗3个月后，治疗组的 总有效率为82.22% （37/45） ，对照组为72.73% （32/44） ，组间比较 （χ2 检验） ，治疗组的疗效明显优于对照组 （P＜0.05） 。 （3） 治 疗后，2组患者的中医证候积分均较治疗前明显降低 （P＜0.01） ，且治疗组的降低幅度明显优于对照组 （P＜0.01） 。 （4） 治疗后， 2组患者的FEV1、FVC及FEV1/FVC等肺功能指标均较治疗前明显改善 （P＜0.05） ，且治疗组的改善幅度均明显优于对照组 （P＜0.05） 。 （5） 治疗后，2组患者的SGRQ的呼吸症状、疾病影响、活动受限评分均较治疗前明显降低 （P＜0.01） ，且治疗组 的降低幅度均明显优于对照组，差异均有统计学意义 （P＜0.01） 。 （6） 治疗后，2组患者的6MWT距离均较治疗前明显改善 （P＜0.01） ，且治疗组的改善幅度明显优于对照组 （P＜0.01） 。 （7） 治疗期间，2组患者的血常规、肝肾功能、心电图、大小便 常规均未发生异常变化。 【结论】采用薛己朝夕补益法联合舒利迭治疗肺肾亏虚型COPD稳定期患者疗效良好，可有效缓解患 者临床症状，一定程度上改善患者肺功能，提高患者运动耐力和生活质量，且具有较高的安全性。

Objective To investigate the effect of XUE Ji’ s morning-evening supplementing method，a therapy by tonification according to the alteration of daily yang-qi in the human body and the nature proposed by practitioner XUE Ji in Ming Dynasty，combined with Seretide on exercise endurance in patients with stable chronic obstructive pulmonary disease （COPD） of lung and kidney deficiency type. Methods Ninety-two patients with stable COPD of lung and kidney deficiency type were randomly divided into treatment group and control group，with 46 cases in each group. The control group was given inhalation of Salmeterol/Fluticasone Inhalation Powder （Seretide），and the treatment group was treated with Buzhong Yiqi Pills in the morning and Liuwei Dihuang Pills at evening on the basis treatment for the control group. The course of treatment covered 3 months. The changes of the scale scores of traditional Chinese medicine （TCM） syndrome and St Georges respiratory questionnaire （SGRQ） for quality of life， the distance of 6-minute walking test （6MWT） for exercise endurance，and pulmonary function indicators of forced expiratory volume in one second （FEV1） ，forced vital capacity （FVC） and their ratio （FEV1/FVC） in the two groups before and after treatment were observed. After treatment，the clinical efficacy and the incidence of adverse reactions were compared between the two groups. Results （1） During the trial，a total of 3 cases were lost， and a total of 89 patients were eventually included，including 45 cases in the treatment group and 44 cases in the control group. （2） After 3 months of treatment，the total effective rate of the treatment group was 82.22% （37/45） ， and that of the control group was 72.73% （32/44） . The intergroup comparison by chi-square test showed that the efficacy of the treatment group was significantly superior to that of the control group （P＜0.05） . （3） After treatment， the scores of TCM syndromes in the two groups were significantly decreased compared with those before treatment （P＜0.01） ，and the decrease in the treatment group was more significant than that in the control group （P＜0.01） . （4） After treatment， the lung function indicators of FEV1， FVC and FEV1/FVC in the two groups were significantly improved compared with those before treatment （P＜0.05），and the improvement in the treatment group was significantly superior to that in the control group （P＜0.05） . （5） After treatment，the scores of SGRQ items of respiratory symptoms，disease impact and activity limitation in the two groups were significantly lower than those before treatment 0.01 and the decrease in the treatment group was significantly superior to that in the control group，the differences being statistically significant （P＜0.01） . （6） After treatment，the 6MWT distance of the two groups was significantly improved compared with that before treatment （P＜0.01） ，and the improvement in the treatment group was significantly superior to that in the control group （P＜0.01） . （7） During the treatment，no abnormal changes in the indicators of blood routine test，liver and kidney function，electrocardiogram，and urine and stool routine were found in the two groups. Conclusion XUE Ji’ s morning-evening supplementing method combined with Seretide exert certain effect in treating stable COPD patients with lung and kidney deficiency syndrome. The therapy can effectively alleviate the clinical symptoms ofnd improve the lung function，exercise endurance and quality of life of the patients，with high safety.

R259.63

重庆市科技卫生联合中医药科研项目 （编号：2019ZY023409）