【目的】 基于白细胞介素33（IL-33）/可溶性生长刺激表达基因2蛋白（ST2）信号通路，探讨二陈汤合三子养亲汤治疗老 年慢性阻塞性肺病（COPD）急性发作期痰湿蕴肺证患者的疗效及其可能的作用机制。【方法】 将2021年1月至2023年6月海口 市中医医院收治的92例老年COPD急性发作期痰湿蕴肺证患者按随机数字表法随机分为对照组和观察组，每组各46例。对 照组给予西医常规治疗，观察组在对照组的基础上联合二陈汤合三子养亲汤治疗，疗程为2周。观察2组患者治疗前后中医 证候积分、肺功能指标、白细胞计数（WBC）、中性粒细胞百分比（Neut%）及血清IL-33、ST2、IL-6和IL-8水平的变化情况， 评价2组患者的临床疗效及用药安全性。【结果】（1）疗效方面，治疗2周后，观察组的总有效率为86.96%（40/46），对照组为 67.39%（31/46），组间比较（χ2检验），观察组的疗效明显优于对照组（P < 0.05）。（2）中医证候方面，治疗后，2组患者的气喘、 胸闷、咳嗽、咳痰等各项中医证候积分均较治疗前降低（P < 0.05），且观察组的降低幅度均明显优于对照组（P < 0.01）。（3）肺 功能方面，治疗后，2组患者的用力肺活量（FVC）、第1秒用力呼气容积（FEV1）、呼气流量峰值（PEF）等各项肺功能指标均 较治疗前改善（P < 0.05），且观察组的改善幅度均明显优于对照组（P < 0.01）。（4）相关炎性指标方面，治疗后，2 组患者的 WBC、Neut%及血清IL-33、ST2、IL-6、IL-8水平均较治疗前降低（P < 0.05），且观察组对WBC、Neut%及血清IL-33、IL-6 及IL-8水平的降低幅度均明显优于对照组（P < 0.01）。（5）安全性方面，观察组和对照组患者的不良反应总发生率均为8.70% （4/46），组间比较，差异无统计学意义（P > 0.05）。【结论】 二陈汤合三子养亲汤治疗老年COPD急性发作期痰湿蕴肺证患者的 临床疗效显著，能有效改善患者中医证候、相关炎性指标及肺功能，其机制可能与降低患者血清IL-33水平，抑制IL-33/ST2 信号通路，抑制相关炎症因子表达，从而抑制炎症反应，改善COPD患者的病情有关。

Objective To investigate the therapeutic efficacy of Erchen Decoction plus Sanzi Yangqin Decoction in the treatment of elderly patients with acute exacerbation of chronic obstructive pulmonary disease （COPD）of phlegm-dampness accumulation in lung syndrome，and to explore its possible therapeutic mechanism through the interleukin 33/soluble growth stimulation expressed gene 2（IL-33/ST2）signaling pathway. Methods A prospective trial was conducted on 92 elderly patients with acute exacerbation of COPD of phlegm-dampness accumulation in lung syndrome who were treated in Haikou Hospital of Traditional Chinese Medicine from January 2021 to June 2023. The patients were randomly divided into the control group and the observation group according to the random number table method， with 46 cases in each group. The control group was treated with conventional western medicine， while the observation group was treated with Erchen Decoction plus Sanzi Yangqin Decoction on the basis of treatment for the control group，and the course of treatment covered two weeks. The changes of traditional Chinese medicine（TCM）syndrome scores，lung function indicators，white blood cell count（WBC），neutrophil percentage（Neut%），and serum IL-33，ST2，interleukin 6（IL-6）and interleukin 8（IL-8）levels of patients in the two groups before and after the treatment were observed，and the clinical efficacy and medication safety of the patients in the two groups were evaluated. Results（1）After two weeks of treatment，the total effective rate of the observation group was 86.96%（40/46）and that of the control group was 67.39%（31/46），and the intergroup comparison（tested by chi-square test）showed that the therapeutic effect of the observation group was significantly superior to that of the control group（P < 0.05）.（2）After treatment，the TCM syndrome scores such as dyspnea， suppression in the chest，cough and expectoration in the two groups were decreased compared with 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）.（3）After treatment，the lung function indicators such as forced vital capacity（FVC），forced expiratory volume in one second （FEV1）， and peak expiratory flow （PEF） of the two groups all improved compared with those before treatment（P < 0.05），and the improvement in the observation group was significantly superior to that in the control group（P < 0.01）.（4）After treatment，the levels of inflammatory indicators such as WBC，Neut%，and serum IL-33，ST2，IL-6 and IL-8 in the two groups were all decreased compared with 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）.（5）The total incidence of adverse reactions in both groups was all 8.70%（4/46），and the intergroup comparison showed that the difference was not statistically significant（P > 0.05）. Conclusion The clinical efficacy of Erchen Decoction plus Sanzi Yangqin Decoction in the treatment of elderly patients with acute exacerbation of COPD of phlegm-dampness accumulation in lung syndrome is remarkable，and it is effective on improving the TCM syndromes，related inflammatory indicators and lung function. Its mechanism may be related to the reduction of the patients􀆳 serum IL-33 level，the inhibition of IL-33/ST2 signaling pathway and the expression of related inflammatory factors，so as to inhibit inflammatory response and improve the progression of COPD.

R259.63

海南省卫生计生行业科研项目（编号：15A200059，18A200026，18A200005）