芩柴抗毒合剂对小儿EB病毒感染传染性单核细胞增多症气营两燔型的作用分析

An analysis on clinical efficacy of Qinchai Kangdu mixture for treatment of infantile EB virus infectious mononucleosis with flaring heat in Qifen and Yingfen

目的：观察自拟芩柴抗毒合剂治疗小儿EB病毒（EBV）感染传染性单核细胞增多症（IM）的临床疗效及作用机制。方法采用前瞻性研究方法，选择武汉市儿童医院收治的西医诊断为EBV感染IM，且中医辨证为气营两燔型的患儿120例，按随机数字表法分为观察组和对照组，每组60例。对照组患儿给予常规治疗，疗程7∽10 d；观察组患儿在常规治疗基础上给予芩柴抗毒合剂（组成：黄芩10 g，柴胡10 g，青蒿10 g，连翘20 g，牛蒡子10 g，赤芍10 g，桂枝6 g，牡丹皮10 g，鳖甲10 g，板蓝根20 g，陈皮10 g，甘草10 g）口服，每日1剂，疗程7∽10 d。观察两组患儿临床疗效、临床症状和体征恢复情况及白细胞计数（WBC）、外周血异型淋巴细胞比例、丙氨酸转氨酶（ALT）等指标恢复至正常的时间，并观察中医症状积分的变化和不良反应。结果观察组总有效率明显高于对照组〔93.33%（56/60）比76.67%（46/60），P＜0.05〕，观察组发热持续时间（d：6.9±2.3比7.7±3.4）、体温恢复正常时间（d：2.9±1.4比4.8±1.7）、咽峡炎痊愈时间（d：7.2±3.3比8.0±3.2）、淋巴结缩小时间（d：6.6±2.1比10.2±2.0）、肝脏回缩至正常时间（d：7.8±1.7比9.6±2.0）、WBC恢复正常时间（d：7.22±1.78比10.67±1.97）、异型淋巴细胞比例恢复正常时间（d：7.24±1.86比11.15±1.65）、ALT恢复正常时间（d：8.44±1.83比11.43±2.65）均较对照组明显缩短（均P＜0.05）。两组患儿治疗过程中均无不良反应发生。结论芩柴抗毒合剂治疗小儿EBV感染传染性IM气营两燔型，能有效改善IM患儿的临床症状，有助于肝脾肿大早期回缩，能促进外周血异型淋巴细胞比例等检验指标及时恢复至正常。

Objective To observe the clinical efficacy of self made Qinchai Kangdu mixture for treatment of infantile EB virus （EBV） infectious mononucleosis and explore its potential mechanism. Methods A prospective study was conducted. One hundred and twenty children with pediatric EBV infectious mononucleosis and traditional Chinese medicine （TCM） syndrome of flaring heat in Qifen and Yingfen in Wuhan Children Hospital were randomly divided into observation group and control group （each, 60 cases）. Conventional western medical treatment was given to the two groups for 7-10 days;the observation group was additionally given Qinchai Kangdu mixture which included the following ingredients：Scutellariae Radix 10 g, Bupleuri Radix 10 g, Artemisiae Annuae Herba 10 g, Forsythiae Fructus 20 g, Arctii Fructus 10 g, Paeoniae Radix Rubra 10 g, Cinnamomi Ramulus 6 g, Moutan Cortex 10 g, Trionycis Carapax 10 g, Isatidis Radix 20 g, Citri Reticulatae Pericarpium 10 g, Glycyrrhizae Radix 10 g, orally, once daily for 7-10 days. The times of returning to normal for clinical symptoms and signs, white blood cell count （WBC）, peripheral blood abnormal lymphocyte ratio and the level of alanine aminotransferase （ALT） were observed in the two groups. And the clinical efficacy, changes in score of TCM syndrome and adverse reactions were also investigated in the two groups. Results The total effective rate in the observation group was significantly higher than that in the control group [93.33%（56/60） vs. 76.67%（46/60）, P〈0.05]. In observation group, the duration of fever （days：6.9±2.3 vs. 7.7±3.4）, and the recovery times to normal for body temperature （days：2.9±1.4 vs. 4.8±1.7）, angina （days：7.2±3.3 vs. 8.0±3.2）, lymph node reduction in size （days： 6.6±2.1 vs. 10.2±2.0）, enlarged liver bounce back in size （days： 7.8±1.7 vs. 9.6±2.0）, WBC （days：7.22±1.78 vs. 10.67±1.97）, peripheral blood abnormal lymphocyte ratio （days：7.24±1.86 vs. 11.15±1.65）, and ALT （days：8.44±1.83 vs. 11.43±2.65） were all significantly shorter than those in the control group （all P 〈 0.05）. No adverse reactions occurred in the therapeutic course in the two groups. Conclusions Qinchai Kangdu mixture can effectively improve the clinical symptoms of infantile EBV infectious mononucleosis with TCM syndrome of flaring heat in Qifen and Yingfen. The mixture may also promote the enlarged liver and spleen to contract in size at early stage and peripheral blood abnormal lymphocyte ratio and other laboratory indexes return to normal in time.