【目的】 观察薛己分时补益法对慢性阻塞性肺疾病（简称慢阻肺）稳定期肺肾亏虚证患者营养不良状况及膈肌厚度的影 响。【方法】 选取 2024年 1月 1日至 2024年 10月 1日在广州中医药大学第一附属医院重庆医院（即重庆市北碚区中医院）呼吸 科门诊及住院部就诊的慢阻肺稳定期肺肾亏虚证患者共80例，采用随机数字表法将患者随机分为试验组和对照组，每组各 40例。对照组给予沙美特罗替卡松粉吸入剂（舒利迭）吸入治疗，试验组在对照组基础上给予薛己分时补益法治疗，分别于 早晨7-9点服用补中益气丸、傍晚17-19点服用六味地黄丸，2组疗程均为3个月。观察2组患者治疗前后体质量、体质量指 数（BMI）、营养学指标（包括血红蛋白、白蛋白、总蛋白）、辅助呼吸肌动用评分、膈肌厚度[包括平静吸气末膈肌厚度 （TDI）、平静呼气末膈肌厚度（TDE）、用力吸气末膈肌厚度（TDImax）]及膈肌增厚率（TF指数）、中医证候积分、改良版英国 医学研究委员会呼吸困难问卷（mMRC）评分、慢阻肺患者自我评估测试问卷（CAT）评分的变化情况，并比较2组患者的临床 疗效。【结果】（1）脱落情况方面，研究过程中，共脱落 5例，最终共纳入 75例患者，其中试验组 38例、对照组 37例。（2）疗 效方面，治疗3个月后，试验组的总有效率为 86.84%（33/38），对照组为 72.97%（27/37），组间比较（χ2 检验），试验组的疗效 明显优于对照组（P＜0.05）。（3）营养状况方面，治疗后，2组患者的体质量、BMI及血红蛋白、白蛋白、总蛋白等营养学指标 均较治疗前改善（P＜0.05），且试验组的改善幅度均明显优于对照组（P＜0.05或P＜0.01）。（4）膈肌功能方面，治疗后，2组患 者的膈肌厚度（TDI、TDE和TDImax）及膈肌增厚率（TF指数）均较治疗前明显升高（P＜0.05），且试验组的升高幅度均明显优 于对照组（P＜0.05或P＜0.01）。（5）各项评分方面，治疗后，2组患者的中医证候积分、辅助呼吸肌动用评分、mMRC评分和 CAT评分均较治疗前明显降低（P＜0.05或P＜0.01），且试验组的降低幅度均明显优于对照组（P＜0.05或P＜0.01）。【结论】 薛己 分时补益法联合舒利迭治疗慢阻肺稳定期肺肾亏虚证患者疗效显著，能有效改善患者咳嗽、咳痰、呼吸困难等症状，明显 改善患者的营养不良状况和膈肌功能，增加膈肌厚度，一定程度上减少膈肌疲劳的发生，其疗效优于单纯西医治疗，具有 较高的临床应用价值。

Objective To evaluate the effects of Xue Ji’s time-based tonic therapy on nutritional status and diaphragm thickness in stable chronic obstructive pulmonary disease （COPD） patients with lung-kidney deficiency syndrome. Methods Eighty eligible patients were treated at the First Affiliated Hospital of Guangzhou University of Chinese Medicine （Chongqing Hospital/Beibei District Hospital of Traditional Chinese Medicine） between January 1 and October 1，2024. The patients were randomly divided into trial group and control group by random number table method， 40 cases in each group. The control group was treated with Salmeterol-Fluticasone Propionate （Seretide） plus Xue Ji’s time-based tonic therapy. The trial group was treated with Xue Ji’s time-based tonic therapy on the basis of treatment for the control group. The trial group took Buzhong Yiqi Pills at 7-9 AM and Liuwei Dihuang Pills at 5-7 PM daily for 3 months. The changes in body mass， BMI， nutritional markers （hemoglobin，albumin，total protein），accessory respiratory muscle use score，diaphragm thickness [TDI （endinspiration），TDE （end-expiration），TDImax （maximal inspiration）]，diaphragm thickening rate （TF index）， TCM syndrome scores，mMRC dyspnea scale，and CAT scores，and the clinical efficacy was compared between the two groups. Results （1） A total of 5 cases fell off during the study，and a total of 75 patients were finally included， including 38 in the trial group and 37 in the control group.（2） After 3 months of treatment，the total effective rate of the trial group was 86.84% （33/38）， and that of the control group was 72.97% （27/37）. The intergroup comparison （by chi-square test） showed that the curative effect of the trial group was significantly superior to that of the control group （P＜0.05）.（3） In terms of nutritional status，the body mass，BMI，hemoglobin，albumin， total protein and other nutritional indexes of the two groups were improved compared with those before treatment （P＜0.05），and the improvement of the trial group was significantly superior to that of the control group （P＜0.05 or P＜0.01）.（4） In terms of diaphragm function， after treatment， the diaphragm thickness （TDI， TDE and TDImax） and diaphragm thickening rate （TF index） in the two groups were significantly higher than those before treatment （P＜0.05），and the increase in the trial group was significantly superior to that in the control group （P＜ 0.05 or P＜0.01）. （5） In terms of each score， after treatment， the scores of TCM syndromes， auxiliary respiratory muscle use，mMRC and CAT in the two groups were significantly lower than those before treatment （P＜0.05 or P＜0.01），and the decrease in the trial group was significantly superior to that in the control group （P＜0.05 or P＜0.01）. Conclusion Xue Ji’s time-based tonic therapy combined with Seretide significantly improves symptoms （cough，expectoration，dyspnea），nutritional status and diaphragm function，and increases diaphgram thickness in stable COPD with lung-kidney deficiency， demonstrating higher clinical value than western treatment alone.

R259.63

重庆市科技卫生联合中医药科研项目（编号：2019ZY023409）