加味定喘汤对儿童哮喘临床效果及炎性介质水平的影响

Clinical Efficacy and Effects on Inflammatory Mediator Levels of Modified Dingchuan Decotion in Children with Asthma

目的观察加味定喘汤对儿童支气管哮喘急性发作期炎症介质嗜酸性细胞阳离子蛋白(ECP)、IL-2、IL-4、IL-5和IFN-γ水平的影响。方法选择2015年1月—2017年6月厦门中医院小儿哮喘专科门诊和病房的80例支气管哮喘患儿,按随机数字表法分为对照组和观察组,每组40例。对照组给予吸入布地奈德混悬液+特布他林溶液+异丙托溴铵溶液雾化治疗,观察组在此基础上加服加味定喘汤治疗,疗程均为2周。观察两组治疗前、治疗3天后、治疗2周后临床症状体征评分情况以评判疗效。比较两组治疗前、治疗2周后患儿血清炎性介质(IL-2、IL-4、IL-5、IFN-γ、ECP)浓度变化,并分析其与哮喘急性发作期的相关性。结果与本组治疗前比较,两组治疗3天、2周后临床评分积分降低(P<0.01),且观察组积分降低更明显(P<0.01)。哮喘患儿急性发作期血清IL-2、IFN-γ水平与哮喘的严重程度呈负相关(r s=-0.917、-0.944),ECP、IL-4、IL-5与哮喘严重程度呈正相关性(rs=0.942、0.878、0.874,均P<0.01)。与本组治疗前比较,两组患儿治疗后ECP、IL-4、IL-5含量降低,IL-2、INF-γ含量升高(均P<0.01),且观察组炎症介质水平较对照组改善更明显(P<0.01)。结论加味定喘汤通过升高IL-2、INF-γ水平,降低ECP、IL-4、IL-5水平,调节EOS的活化及其ECP的分泌,改善临床症状,从而达到比单用西药雾化吸入有较好的治疗效果。

Objective To investigate the effects of modified Dingchuan Decotion on the changes of inflam-matory mediators,including eosinophil cationic protein(ECP),IL-2,IL-4,IL-5,and IFN-γ in children with acute exacerbation of bronchial asthma.Methods A total of 80 children with bronchial asthma,who visited pediatric asthma clinic department and ward at Xiamen Hospital of Traditional Chinese Medicine from January 2015 to June 2017,were assigned to control group and observation group using random number table,40 in each group.Patients in the control group inhaled budesonide,terbutaline and pratropium bromide for atomization,while patients in the observation group additionally took modified Dingchuan Decotion.The treatment course for all was 2 consecutive weeks.The changes of scores of clinical symptoms and signs were observed before treatment,3 days and 2 weeks after treatment in the control group and the observation group,in order to evaluate the therapeutic efficacy.The serum levels of ECP,IL-2,IL-4,IL-5 and IFN-γwere compared before treatment and 2 weeks after treatment in both groups,followed by analysis of their correlation with the acute exacerbation of asthma.Results Compared with the group before treatment,the scores of clinical symptoms and signs were significantly de-creased after treatment in both groups(P<0.01),and the observation group changed more than those in the control group(P<0.01).The serum levels of IL-2 and IFN-γwere negatively correlated with the severity of asthma during acute exacerbation in asthmatic children(rs=-0.917,-0.944),while the levels of ECP,IL-4 and IL-5 were positively correlated with the severity of asthma(rs=0.942,0.878,0.874,allP<0.01).The serum levels of ECP,IL-4 and IL-5 were lower than before,and the levels of IL-2 and INF-γ were higher than before in both groups,with superior effects in the observation group.Conclusion Modified Dingchuan Decotion could relieve the clinical symptoms of asthma by increasing the levels of IL-2 and INF-γ,decreasing the levels of ECP,IL-4 and IL-5,regulating the activation of EOS and the secretion of ECP,thereby achieving better therapeutic effects than inhalation of Western medicine alone.