柴胡加芒硝汤加减辅助治疗急性期布鲁氏菌病临床研究及对CRP、NLR、IL-6影响观察

Clinical Study on Modified Chaihu Plus Mangxiao Decoction in Adjuvant Treatment of Acute Brucellosis and Its Effect Observation on CRP, NLR and IL-6

摘要: 目的：探究柴胡加芒硝汤加减辅助多西环素联合利福平治疗急性期布鲁氏菌病的临床疗效，明确其对患者C反应蛋白(CRP)、中性粒细胞与淋巴细胞比值(NLR)、白细胞介素-6 (IL-6)的调控作用，结合炎症通路机制阐释其干预价值，为急性期布鲁氏菌病中西医结合规范化治疗提供高质量临床证据与理论支撑。方法：选取2024年9月~2026年3月本院感染科确诊收治的90例急性期布鲁氏菌病患者作为研究对象，采用SPSS 25.0软件生成随机数字序列，按1:1比例分为对照组与实验组，分配方案置于密封、不透光的按顺序编码信封中，由专人负责分配隐藏，确保分组完全随机且研究者与患者均不可预知分组情况，每组各45例。对照组给予多西环素联合利福平西医标准抗菌治疗，实验组在对照组治疗方案基础上加服柴胡加芒硝汤加减辨证施治，两组均连续规范治疗2周为1个疗程。治疗结束后，对比两组临床疗效分级，核心临床症状(发热、乏力、多汗)缓解时间及关节肌肉疼痛VAS评分变化，采用中文版EQ-5D-5L量表评估健康相关生命质量(QoL)，检测两组治疗前后CRP、NLR、IL-6 3项炎症相关指标水平变化，监测并统计两组治疗全程不良反应发生情况，同时结合布鲁氏菌病相关炎症通路探讨中药方剂的作用机制。结果：实验组治疗总有效率达95.56%，显著高于对照组的77.78%，组间疗效差异经统计学检验具有显著性(P < 0.05)；实验组发热、乏力、多汗等核心症状完全缓解时间均显著短于对照组，各项症状缓解时间组间对比差异均有统计学意义(P < 0.05)；实验组关节肌肉疼痛VAS评分下降幅度大于对照组，实验组EQ-5D-5L各维度评分显著高于对照组(P < 0.05)；治疗前，两组患者CRP、NLR、IL-6水平基线一致，组间对比差异无统计学意义(P > 0.05)，治疗后两组上述炎症指标均较治疗前呈显著性下降，且实验组各指标下降幅度显著大于对照组，组间治疗后数据对比差异具有统计学意义(P < 0.05)；两组治疗期间均未出现严重不良反应，不良反应发生率对比差异无统计学意义(P > 0.05)，且不良反应经对症处理后均快速缓解，不影响治疗进程。结论：多西环素联合利福平可有效控制急性期布鲁氏菌病的病原感染，在此基础上加用柴胡加芒硝汤加减辅助治疗，可显著提升临床总有效率，加速临床症状消退，客观改善生命质量，其作用机制与靶向调控布鲁氏菌病相关炎症通路、强效下调CRP、NLR、IL-6等炎症因子水平、减轻机体免疫炎症损伤密切相关，且安全性良好，具备较高的临床推广价值与应用前景。

Abstract: Objective: This paper aims to explore the clinical efficacy of modified Chaihu Plus Mangxiao Decoction as adjuvant therapy combined with doxycycline and rifampicin in the treatment of acute brucellosis, clarify its regulatory effects on C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR) and interleukin-6 (IL-6) in patients, and interpret its intervention value based on inflammatory pathway mechanisms, so as to provide high-quality clinical evidence and theoretical support for standardized integrated traditional Chinese and Western medicine treatment of acute brucellosis. Methods: A total of 90 patients with acute brucellosis diagnosed and admitted to the Department of Infectious Diseases of our hospital from September 2024 to March 2025 were enrolled. SPSS 25.0 software was used to generate random number sequences, and the patients were divided into control group and experimental group at a 1:1 ratio. The allocation scheme was placed in sealed, opaque and sequentially coded envelopes with allocation concealment managed by dedicated personnel, ensuring completely random grouping that could not be predicted by researchers or patients, with 45 cases in each group. The control group received standard Western antibacterial treatment with doxycycline combined with rifampicin, while the experimental group received syndrome-differentiated treatment with additional oral modified Chaihu Plus Mangxiao Decoction on the basis of the control group’s regimen. Both groups received continuous standardized treatment for 2 weeks as one course. After treatment, clinical efficacy grading, relief time of core clinical symptoms (fever, fatigue, hyperhidrosis) and changes in visual analogue scale (VAS) score of joint and muscle pain were compared between the two groups. The Chinese version of EQ-5D-5L scale was adopted to evaluate health-related quality of life (QoL). The changes in levels of three inflammation-related indicators including CRP, NLR and IL-6 were detected before and after treatment. The incidence of adverse reactions throughout the treatment period was monitored and statistically analyzed. Meanwhile, the mechanism of action of the traditional Chinese medicine prescription was discussed in combination with brucellosis-related inflammatory pathways. Results: The total effective rate of treatment in the experimental group was 95.56%, which was significantly higher than 77.78% in the control group, with a statistically significant difference in efficacy between groups (P < 0.05). The complete relief time of core symptoms such as fever, fatigue and hyperhidrosis in the experimental group was significantly shorter than that in the control group, and the differences in symptom relief time between groups were statistically significant (P < 0.05). The reduction range of VAS score for joint and muscle pain in the experimental group was larger than that in the control group, and the scores of all dimensions of EQ-5D-5L in the experimental group were significantly higher than those in the control group (P < 0.05). Before treatment, the baseline levels of CRP, NLR and IL-6 were consistent between the two groups, with no statistically significant difference (P > 0.05). After treatment, the above inflammatory indicators in both groups decreased significantly compared with those before treatment, and the reduction range of each indicator in the experimental group was significantly greater than that in the control group, with a statistically significant difference in post-treatment data between groups (P < 0.05). No serious adverse reactions occurred in either group during treatment, and there was no statistically significant difference in the incidence of adverse reactions between groups (P > 0.05). All adverse reactions were rapidly relieved after symptomatic treatment without affecting the treatment process. Conclusion: Doxycycline combined with rifampicin can effectively control pathogenic infection of acute brucellosis. On this basis, adjuvant treatment with modified Chaihu Plus Mangxiao Decoction can significantly improve the total clinical effective rate, accelerate the regression of clinical symptoms and objectively improve quality of life. Its mechanism of action is closely related to targeted regulation of brucellosis-related inflammatory pathways, potent down-regulation of levels of inflammatory factors such as CRP, NLR and IL-6, and alleviation of immune-inflammatory damage in the body. It has good safety and high clinical promotion value and application prospect.