定喘汤加减对小儿咳嗽变异性哮喘风热袭肺证患者气道功能、诱导痰指标及炎症因子的影响
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摘要
目的:探讨小儿咳嗽变异性哮喘(CVA)应用定喘汤加减治疗的临床效果。方法:选取2016年6月至2018年6月广州市花都区妇幼保健院收治的142例CVA患儿,采取随机数字表法将这142例患者随机分成观察组与对照组,各71例。对照组采取吸入布地奈德粉吸入剂+口服孟鲁司特钠咀嚼片治疗,观察组在此基础上内服定喘汤加减治疗。所有患儿均治疗8周。比较两组临床效果,治疗前后气道功能参数[第1秒用力呼气量占预计值百分比(FEV_1%)及用力呼气50%,75%肺活量时的呼气流速(FEF_(50),FEF_(75))],诱导痰指标[神经生长因子(NGF),嗜酸性粒细胞(EOS)百分比,P物质(SP)],炎症因子[超敏C反应蛋白(hs-CRP),白细胞介素(IL)-17,IL-23]水平变化,不良反应发生情况。结果:观察组总有效率为93. 0%(66/71),明显高于对照组的81. 7%(58/71)(P <0. 05)。观察组患儿起效时间和症状消失时间均明显小于对照组(P <0. 05)。与本组治疗前比较,两组治疗后FEV_1%,FEF_(50),FEF_(75)均明显增加(P <0. 05);且观察组升高更明显(P <0. 05)。两组治疗后诱导痰液中NGF,SP水平及EOS百分比和血清hs-CRP,IL-17,IL-23水平较本组治疗前均明显减少(P <0. 05),且观察组降低更明显(P <0. 05)。观察组不良反应率7. 0%(5/71)与对照组4. 2%(3/71)比较差异无统计学意义。结论:小儿CVA应用定喘汤加减治疗可有效缓解患儿咳嗽等症状,减轻气道炎症,下调血中炎症因子表达,改善气道功能,疗效确切,安全可靠。
Objective: To explore the clinical effect of the application of modified Dingchuantang in the treatment of children with cough variant asthma( CVA). Method: Totally 142 children with CVA admitted by our hospital from June 2016 to June 2018 were selected and randomly divided into observation group( 71 cases) and control group( 71 cases) according to the random number table method. Patients in control group were treated with inhaled budesonide powder inhalation + oral montelukast sodium chewable tablets,while patients in observation group were treated with modified Dingchuantang. All children were treated for 8 weeks. The two groups' clinical effects,changes of levels of airway function parameters [percentage of forced expiratory volume in the first second( FEV_1%) and expiratory flow rate of forced expiratory in 50% and 75% vital capacity( FEF_(50),FEF_(75)) ],sputum induction indexes [nerve growth factor( NGF), percentage of eosinophile( EOS), substance P( SP),inflammatory factors [hypersensitivity C reactive protein( hs-CRP),interleukin( IL)-17 and IL-23 ],and the occurrence of adverse reactions were compared. Result: The total effective rate of observation group was 93. 0%( 66/71),which was significantly higher than that of control group [81. 7%( 58/71),P < 0. 05]. Compared with control group,the onset time and symptom disappearance time of observation group were significantly lower than those of control group,with statistically significant differences( P < 0. 05). Compared with before treatment,the values of FEV_1%,FEF_(50) and FEF_(75) of two groups were increased significantly after treatment( P < 0. 05),particularly in observation group( P < 0. 05). After treatment,the levels of NGF,SP and the percentage of EOS in induced sputum and the concentrations of hs-CRP,IL-17 and IL-23 in serum were significantly decreased in both groups( P < 0. 05),particularly in observation group( P < 0. 05). The adverse reaction rate of observation group[7. 0%( 5/71) ] was higher than that of control group [4. 2%( 3/71) ],with no statistically significant difference. Conclusion: Modified Dingchuantang can effectively relieve cough and other symptoms in children with CVA,reduce airway inflammation,down-regulate the expressions of inflammatory factors in blood and improve airway function,with a definite curative effect,safety and reliability.
Objective: To explore the clinical effect of the application of modified Dingchuantang in the treatment of children with cough variant asthma( CVA). Method: Totally 142 children with CVA admitted by our hospital from June 2016 to June 2018 were selected and randomly divided into observation group( 71 cases) and control group( 71 cases) according to the random number table method. Patients in control group were treated with inhaled budesonide powder inhalation + oral montelukast sodium chewable tablets,while patients in observation group were treated with modified Dingchuantang. All children were treated for 8 weeks. The two groups' clinical effects,changes of levels of airway function parameters [percentage of forced expiratory volume in the first second( FEV_1%) and expiratory flow rate of forced expiratory in 50% and 75% vital capacity( FEF_(50),FEF_(75)) ],sputum induction indexes [nerve growth factor( NGF), percentage of eosinophile( EOS), substance P( SP),inflammatory factors [hypersensitivity C reactive protein( hs-CRP),interleukin( IL)-17 and IL-23 ],and the occurrence of adverse reactions were compared. Result: The total effective rate of observation group was 93. 0%( 66/71),which was significantly higher than that of control group [81. 7%( 58/71),P < 0. 05]. Compared with control group,the onset time and symptom disappearance time of observation group were significantly lower than those of control group,with statistically significant differences( P < 0. 05). Compared with before treatment,the values of FEV_1%,FEF_(50) and FEF_(75) of two groups were increased significantly after treatment( P < 0. 05),particularly in observation group( P < 0. 05). After treatment,the levels of NGF,SP and the percentage of EOS in induced sputum and the concentrations of hs-CRP,IL-17 and IL-23 in serum were significantly decreased in both groups( P < 0. 05),particularly in observation group( P < 0. 05). The adverse reaction rate of observation group[7. 0%( 5/71) ] was higher than that of control group [4. 2%( 3/71) ],with no statistically significant difference. Conclusion: Modified Dingchuantang can effectively relieve cough and other symptoms in children with CVA,reduce airway inflammation,down-regulate the expressions of inflammatory factors in blood and improve airway function,with a definite curative effect,safety and reliability.
引文
[1] LI W,BAN C,ZHANG J,et al. Correlation study of cough variant asthma and mycoplasma pneumonia infection in children[J]. Pak J Pharm Sci,2017,30(3):1099-1102.
[2] WU Y L,ZHANG H L. Progress of diagnosis and treatment of cough variant asthma in children[J].Chinese J Pediatr,2016,54(4):314-317.
[3]中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童支气管哮喘诊断与防治指南(2016年版)[J].中华儿科杂志,2016,54(3):167-181.
[4]苏保宁,虞坚尔.定喘汤治疗儿童哮喘的系统综述和Meta分析[J].中国中医急症,2016,25(6):1008-1010,1017.
[5]中华医学会儿科学分会呼吸学组慢性咳嗽协作组,《中华儿科杂志》编辑委员会.中国儿童慢性咳嗽诊断与治疗指南(2013年修订)[J].中华儿科杂志,2014,52(3):184-188.
[6]中华中医药学会发布.中医内科常见病诊疗指南·中医病证部分[M].北京:中国中医药出版社,2008:129-131.
[7]孙传兴.临床疾病诊断依据治愈好转标准[M].2版.北京:人民军医出版社,2002:43-44.
[8] ZHANG Y X,LIU Y,XUE Y,et al. Correlational study on atmospheric concentrations of fine particulate matter and children cough variant asthma[J]. Eur Rev Med Pharmacol Sci,2016,20(12):2650-2654.
[9] WEI Y,LI D S,LIU J J,et al. Therapeutic effect and safety of montelukast sodium combined with budesonide in children with cough variant asthma:a Meta analysis[J]. Chinese J Pediatr,2016,18(11):1100-1105.
[10]戴红红,朱佳.从“辨证论治”及“辨时论治”两个角度探究咳嗽变异性哮喘的治疗[J].辽宁中医药大学学报,2018,20(3):49-51.
[11]谢彬.定喘汤加减方配合气道吸入糖皮质激素与β2受体激动剂治疗小儿支气管哮喘[J].中国实验方剂学杂志,2011,17(6):247-248.
[12]陈树煜,方泽葵,方思,等.典型哮喘与咳嗽变异性哮喘的小气道功能差异分析[J].南方医科大学学报,2017,37(3):330-336.
[13]陈垣,洪岩,佟丹.清肺止咳颗粒联合孟鲁司特钠治疗小儿咳嗽后变异性哮喘的研究[J].现代中西医结合杂志,2017,26(11):1211-1214.
[14]王瑶,冷军,李万斌.咳嗽变异性哮喘患儿接受疏风化痰通络汤治疗后气道功能以及血清指标、诱导痰指标评估[J].临床和实验医学杂志,2016,15(9):878-881.
[15]黄静.清气化痰汤对小儿咳嗽变异性哮喘血清指标和诱导痰指标的影响[J].海南医学院学报,2016,22(10):1020-1023.
[16]陈勤,赵金华.咳嗽变异性哮喘病儿血清IL-17与IL-23水平测定及意义[J].青岛大学医学院学报,2016,52(6):686-687,691.
[17]李杰,伍参荣,陈伶利,等.定喘汤对哮喘大鼠肺组织和胸腺神经生长因子表达的影响[J].中国中医药信息杂志,2009,16(4):21-22.
[18]谢颖,汤庆发,宋帅,等.药对麻黄-杏仁配伍对哮喘大鼠干预的尿液代谢组学研究[J].时珍国医国药,2015,26(4):815-817.
[19]张轶,李晶.麻杏石甘汤合苇茎汤治疗老年痰热郁肺型吸入性肺炎临床观察[J].中国实验方剂学杂志,2017,23(20):190-194.
[20]陈伟,马磊,杨立山.甘草次酸对支气管哮喘大鼠Ig E、IL-4及TNF-α的影响[J].中药药理与临床,2015,31(3):52-55.
[2] WU Y L,ZHANG H L. Progress of diagnosis and treatment of cough variant asthma in children[J].Chinese J Pediatr,2016,54(4):314-317.
[3]中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童支气管哮喘诊断与防治指南(2016年版)[J].中华儿科杂志,2016,54(3):167-181.
[4]苏保宁,虞坚尔.定喘汤治疗儿童哮喘的系统综述和Meta分析[J].中国中医急症,2016,25(6):1008-1010,1017.
[5]中华医学会儿科学分会呼吸学组慢性咳嗽协作组,《中华儿科杂志》编辑委员会.中国儿童慢性咳嗽诊断与治疗指南(2013年修订)[J].中华儿科杂志,2014,52(3):184-188.
[6]中华中医药学会发布.中医内科常见病诊疗指南·中医病证部分[M].北京:中国中医药出版社,2008:129-131.
[7]孙传兴.临床疾病诊断依据治愈好转标准[M].2版.北京:人民军医出版社,2002:43-44.
[8] ZHANG Y X,LIU Y,XUE Y,et al. Correlational study on atmospheric concentrations of fine particulate matter and children cough variant asthma[J]. Eur Rev Med Pharmacol Sci,2016,20(12):2650-2654.
[9] WEI Y,LI D S,LIU J J,et al. Therapeutic effect and safety of montelukast sodium combined with budesonide in children with cough variant asthma:a Meta analysis[J]. Chinese J Pediatr,2016,18(11):1100-1105.
[10]戴红红,朱佳.从“辨证论治”及“辨时论治”两个角度探究咳嗽变异性哮喘的治疗[J].辽宁中医药大学学报,2018,20(3):49-51.
[11]谢彬.定喘汤加减方配合气道吸入糖皮质激素与β2受体激动剂治疗小儿支气管哮喘[J].中国实验方剂学杂志,2011,17(6):247-248.
[12]陈树煜,方泽葵,方思,等.典型哮喘与咳嗽变异性哮喘的小气道功能差异分析[J].南方医科大学学报,2017,37(3):330-336.
[13]陈垣,洪岩,佟丹.清肺止咳颗粒联合孟鲁司特钠治疗小儿咳嗽后变异性哮喘的研究[J].现代中西医结合杂志,2017,26(11):1211-1214.
[14]王瑶,冷军,李万斌.咳嗽变异性哮喘患儿接受疏风化痰通络汤治疗后气道功能以及血清指标、诱导痰指标评估[J].临床和实验医学杂志,2016,15(9):878-881.
[15]黄静.清气化痰汤对小儿咳嗽变异性哮喘血清指标和诱导痰指标的影响[J].海南医学院学报,2016,22(10):1020-1023.
[16]陈勤,赵金华.咳嗽变异性哮喘病儿血清IL-17与IL-23水平测定及意义[J].青岛大学医学院学报,2016,52(6):686-687,691.
[17]李杰,伍参荣,陈伶利,等.定喘汤对哮喘大鼠肺组织和胸腺神经生长因子表达的影响[J].中国中医药信息杂志,2009,16(4):21-22.
[18]谢颖,汤庆发,宋帅,等.药对麻黄-杏仁配伍对哮喘大鼠干预的尿液代谢组学研究[J].时珍国医国药,2015,26(4):815-817.
[19]张轶,李晶.麻杏石甘汤合苇茎汤治疗老年痰热郁肺型吸入性肺炎临床观察[J].中国实验方剂学杂志,2017,23(20):190-194.
[20]陈伟,马磊,杨立山.甘草次酸对支气管哮喘大鼠Ig E、IL-4及TNF-α的影响[J].中药药理与临床,2015,31(3):52-55.