温肺散寒法对毛细支气管炎患儿血中肿瘤坏死因子-α 及嗜酸细胞阳离子蛋白的影响

Effect of therapy of warming lung to eliminate cold （温肺散寒法） on serum tumor necrosis factor-α and eosinophil cationic protein in infants with bronchiolitis

目的 探讨温肺散寒法对毛细支气管炎患儿血中肿瘤坏死因子-α（TNF-α）及嗜酸细胞阳离子蛋白（ECP）的影响并观察其疗效.方法 将2005年12月至2009年6月本院儿科住院的162例2～18个月毛细支气管炎患儿按随机原则分为温肺散寒治疗组和西医常规治疗组,每组81例.常规治疗组给予止咳、化痰、氧气驱动雾化吸入、镇静、吸氧、退热等西医常规综合治疗;温肺散寒组在西医常规治疗基础上,给予温肺定喘方（药物组成：炙麻黄3～6 g,桂枝5 g,炒白芍6 g,细辛3 g,姜半夏6 g,五味子6 g,车前子5 g,莱菔子8 g,地龙6 g,生甘草3 g）,每日1剂,连用7 d.选择同期20例门诊健康体检儿童作为健康对照组.于治疗前和治疗7 d后取血,用酶联免疫吸附法（ELISA）检测TNF-α及ECP水平,并观察两组患儿症状、体征恢复时间.结果 治疗前温肺散寒组和常规治疗组TNF-α及ECP水平明显高于健康对照组（均P〈0.01）.治疗后两组血TNF-α及ECP水平均较治疗前显著下降,且以温肺散寒组下降更为显著[TNF-α（ng/L）：39.44±11.83比46.43±12.90,ECP（μg/L）：2.73±1.18比3.39±1.71,P〈0.01和P〈0.05];温肺散寒组患儿临床症状和体征恢复时间均较常规治疗组明显缩短（均P〈0.05）.结论 温肺散寒法能降低毛细支气管炎患儿TNF-α及ECP水平,在毛细支气管炎的抗炎机制中起重要作用,可缩短病程,对疾病康复有明显促进作用.

Objective To investigate the effects of the therapy of warming lung to eliminate cold （温肺散寒法） on the serum tumor necrosis factor-α （TNF-α） and eosinophil cationic protein （ECP） in infants with bronchiolitis and its therapeutic effects. Methods One hundred and sixty-two infants with bronchiolitis aged 2 - 18 months and hospitalized from December 2005 to June 2009 in Pediatrics Department of Jiaxing Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Traditional Chinese Medical University were randomly divided into two groups： warming lung to eliminate cold treatment group （81 cases） and routine western treatment group （81 caese）. The patients in both groups were treated with conventional therapies, such as relief of cough, reduction of phlegm, atomizing inhalation, sedation, oxygen, abatement of fever, etc. additionally, the patients in warming lung to eliminate cold treatment group received the prescription of warming the lung and eliminating cold, taking 1 dose of decoction daily which was divided into two equal parts, one taken in the morning and the other, in the evening, and a treatment course being 7 days [drugs： Sunburn ephedra （炙麻黄） 3- 6 g, Cinnamon twig （桂枝） 5 g, Fried white peony （炒白芍） 6 g, Asarum （细辛） 3 g, Penillis tuber （姜半夏） 6 g, Schisandra （五味子） 6 g, Plantagenis （车前子） g g, Radish seed （菜菔子） 8 g, Earthworm （地龙） 6 g, Raw licorice （生甘草） 3 g]. Twenty cases of healthy children over the same period were chosen to be the healthy control group. Before treatment and 7 days after treatment, the blood was collected to detect TNF-α and ECP levels by enzymeqinked immunosorbent assay （ELISA）, and recovery time of clinical symptoms and signs in the two groups were observed. Results Before treatment, the levels of TNF-α and ECP of the patients in the two groups were significantly higher than those in healthy control group （all P~ 0. 01）. After treatment, the serum levels of TNF-α and ECP in them were markedly decreased compared with those before treatment, and in the warming lung to eliminate cold treatment group, they were decreased more obviously [TNF-α （ng/L）： 39.4±11.83 vs. 46. 43±12.90, ECP（μg/L）： 2.73±1.18 vs. 3. 39±1.71, P〈0. 01 and P〈0. 05], and the recovery time of clinical symptoms and signs in this group was manifestly shorter than that in the routine western treatment group （all P〈0.05）. Conclusion Warming lung to eliminate cold therapy can lower the levels of TNF-α and ECP in infant patients with bronchiolitis, which plays an important role for antagonizing airway inflammation of bronchiolitis, meanwhile it can reduce the course of the illness and obviously promote the disease recovery.