中医分期论治小儿咳嗽变异性哮喘临床观察

Clinical Effect of Chinese Medicine Treatment by Stage for Children with Cough Variant Asthma

目的:观察中医药疗法分期论治小儿咳嗽变异性哮喘(CVA)的临床疗效。方法:将纳入研究的120例患儿随机分为观察组和对照组各60例。对照组使用西替利嗪和雾化治疗。观察组使用中药分期论治,急性发作期以泻白散合定喘汤加减,慢性持续期以沙参麦冬汤加减,临床缓解期以生脉饮合枳术丸加减。观察患儿治疗后临床症状、T淋巴细胞亚群、嗜酸性粒细胞计数(EOS)、血清IgE改变情况。随访6月,统计患儿复发率。结果:观察组临床控制率和总有效率分别为46.67%、88.33%,高于对照组的28.33%、78.33%。2组临床控制率比较,差异有显著性意义(P<0.05),2组总有效率比较,差异无显著性意义(P>0.05)。2组患儿治疗后CD4/CD8比值、EOS和血清IgE均较治疗前降低(P<0.05),以观察组降低更明显,2组CD8均较治疗前升高(P<0.05);治疗后2组CD8、CD4/CD8比值、EOS和IgE分别比较,差异均有显著性意义(P<0.05)。观察组复发率17.86%,对照组复发率76.47%,2组比较,差异有非常显著性意义(P<0.01)。结论:中医分期论治有助于降低CVA患儿的CD4/CD8比值、EOS和血清IgE,提高临床疗效,降低近期复发率。

Objective： To observe the clinical effect of Chinese medicine（CM）treatment by stage for children with cough variant asthma（CVA）. Methods： A total of 120 eligible patients were equally randomized into observation group and control group. The control group was given ketotifen and aminophylline treatment. The observation group received CM treatment based on the stage of CVA, which meant that Xiebai powder combined with Dingchuan decoction was for acute stage of attack, modified Shashen Maidong decoction for chronic persistent period, and Shengmai decoction plus ZiLizhu pills for clinical remission stage. Clinical symptoms after treatment, T lymphocyte subsets, eosinophils （EOS） count, and serum IgE level were observed. After 6-month follow-up, the recurrence rate was evaluated. Results： The clinical control rate and total effective rate were 46.67% and 88.33% in the observation group, and were 28.33% and 78.33% in the control group respectively. The difference of clinical control rate was significant（P 〈 0.05）, but the difference of the total effective rate was insignificant（P 〉 0.05）. After treatment, CD4/CD8 ratio, EOS count and serum IgE level in both groups were decreased（P 〈 0.05 compared with those before treatment）, and the decrease of the indexes in the observation group were superior to that in the control group（P〈0.05）. The recurrence rate was 17.86% in the observation group, and was 76.47% in the control group, the difference being significant（P〈0.01）. Conclusion： CM treatment by stage is helpful for reducing CD4/CD8 ratio, EOS count and serum IgE level of CVA children, which results into the enhancement of clinical effect and the decrease of recurrence rate.