【目的】 分析六君子汤对慢性阻塞性肺疾病（COPD）患者血清磷酸化-P38丝裂原活化蛋白激酶（p-P38MAPK）水平的影 响。【方法】 选取杭州市临安区中医院2020年9月至2022年9月收治的112例COPD肺脾气虚型患者为研究对象，根据治疗方 法的不同将其分为观察组和对照组，每组各56例。对照组给予常规西医治疗，观察组在对照组的基础上给予六君子汤治疗， 每疗程为7 d，共治疗 3 个月。观察 2 组患者治疗前后肺功能指标、6 min 步行距离（6MWD）、慢阻肺临床问卷（CCQ）评分、 血清炎症因子和 p-P38MAPK 水平的变化情况，比较 2组患者的临床疗效、不良反应发生率和 1年内急性发作次数。【结果】 （1）治疗 3个月后，观察组的总有效率为 94.64%（53/56），对照组为 73.21%（41/56），组间比较（χ2检验），观察组的疗效明显 优于对照组（P＜0.01）。（2）治疗后，2组患者的用力肺活量（FVC）、第1秒用力呼气容积（FEV1）、FEV1/FVC、6MWD均较治疗 前升高（P＜0.05），CCQ 评分均较治疗前降低（P＜0.05），且观察组对 FVC、FEV1、FEV1/FVC、6MWD 的升高幅度及对 CCQ 评分的降低幅度均明显优于对照组（P＜0.01）。（3）治疗后，2组患者血清白细胞介素 4（IL-4）、白细胞介素 6（IL-6）、白细胞 介素8（IL-8）及p-P38MAPK水平均较治疗前降低（P＜0.05），且观察组的降低幅度均明显优于对照组（P＜0.01）。（4）观察组的 不良反应发生率为 3.57%（2/56），对照组为 7.14%（4/56），组间比较，差异无统计学意义（P＞0.05）。（5）观察组 1年内急性发 作次数为（0.68 ± 0.12）次，明显低于对照组的（1.46 ± 0.37）次，差异有统计学意义（P＜0.01）。【结论】 六君子汤治疗COPD肺 脾气虚型患者疗效确切，可有效抑制 p-P38MAPK 信号通路活化，缓解咳痰、呼吸困难等症状，改善肺功能，减轻炎症反 应，降低急性发作次数，且具有较高的安全性。

Objective To analyze the effect of Liujunzi Decoction on serum phosphorylated P38 mitogen-activated protein kinase（p-P38MAPK）in patients with chronic obstructive pulmonary disease（COPD）. Methods A total of 112 patients with COPD of lung-spleen qi deficiency type who were treated in Hangzhou Lin’an District Hospital of Traditional Chinese Medicine from September 2020 to September 2022 were selected as the research objects. According to the treatment method，the patients were divided into an observation group and a control group，with 56 cases in each group. The control group was treated with conventional western medicine，and the observation group was treated with Liujunzi Decoction on the basis of treatment for the control group. Seven days constituted a course of treatment，and the two groups were treated for 3 months. The changes of lung function indicators，6- minute walking distance（6MWD），clinical chronic obstructive pulmonary disease questionnaire（CCQ）score， and serum levels of inflammatory factors and p-P38MAPK in the two groups were observed before and after treatment. Moreover，the clinical efficacy，incidence of adverse reactions and number of acute episodes within one year were compared between the two groups. Results（1）After 3 months of treatment，the total effective rate of the observation group was 94.64%（53/56）， and that of the control group was 73.21%（41/56）. The intergroup comparison（tested by chi-square test）showed that the curative effect of the observation group was significantly superior to that of the control group（P＜0.01）.（2）After treatment，the forced vital capacity（FVC），forced expiratory volume in one second（FEV1），FEV1/FVC and 6MWD in the two groups were increased（P＜0.05）， and the CCQ scores were decreased（P＜0.05）when compared with those before treatment，and the increase of FVC，FEV1，FEV1/FVC and 6 MWD and the decrease of CCQ scores in the observation group were significantly superior to those in the control group（P＜0.01）.（3）After treatment，the levels of serum interleukin 4（IL-4）， interleukin 6（IL-6）， interleukin 8（IL-8）and p-P38MAPK in the two groups were lower than those before treatment（P＜0.05），and the decrease in the observation group was significantly superior to that in the control group（P＜0.01）.（4）The incidence of adverse reactions in the observation group was 3.57%（2/56）and that in the control group was 7.14%（4/56），and there was no significant difference between the two groups（P＞0.05）.（5）The number of acute episodes within one year in the observation group was （0.68 ± 0.12） times， which was significantly less than that in the control group （[ 1.46 ± 0.37） times]， and the difference was statistically significant（P＜0.01）. Conclusion Liujunzi Decoction exerts certain effect in the treatment of COPD patients with lung-spleen qi deficiency syndrome. It can effectively inhibit the activation of p-P38MAPK signaling pathway， relieve the symptoms such as expectoration and dyspnea，improve lung function，alleviate inflammatory response， reduce the number of acute episodes，and has high safety.

R259.414

国家自然科学基金项目（编号：82160002）；杭州市临安区农业与社会发展项目（编号：2020D011）