中西医结合治疗发作期热哮型儿童哮喘临床研究

Clinical Research on Treatment of Onset Asthma of Heat Type Asthma in Children with Combination of TCM and Western Medicine

目的:观察定喘汤加味保留灌肠治疗发作期热哮型儿童哮喘患者的临床疗效。方法:110例发作期热哮型儿童哮喘患者随机分为对照组和观察组各55例。对照组均予沙丁胺醇气雾剂+氨茶碱注射雾化、氨溴索化痰等西医对症治疗,观察组在对照组基础上给予定喘汤加味保留灌肠疗法。观察两组治疗前后超敏-C反应蛋白(high sensitive c-reactive protein,hs-CRP)、白介素1β(interleukin-1β,IL-1β)及肿瘤坏死因子-α(tumornecrosis factor-α,TNF-α)的变化;治疗前后症状(喘息、咳嗽、胸膈满闷、咳痰、哮鸣)积分变化,由同一医师进行评分;观察临床疗效。结果:两组治疗后hs-CRP、IL-1β、TNF-α水平均明显低于同组治疗前(P<0.01);治疗后观察组患者血清中hs-CRP、IL-1β、TNF-α水平均低于对照组(P<0.05)。观察组治疗后喘息、咳嗽、胸膈满闷、咳痰、哮鸣音主要症状积分及症状总积分均低于对照组(P<0.05)。两组治疗后第1秒用力呼气量(forced expiratory volume in 1 second,FEV1)、用力肺活量(forced vital capacity,FVC)、FEV1/FVC%水平均明显高于同组治疗前(P<0.01);治疗后观察组患者血清中FEV1、FVC、FEV1/FVC%水平均高于对照组(P<0.05)。对照组有效率87.3%,观察组有效率为98.2%,两组有效率比较,差异有统计学意义(χ2=4.853,P=0.028<0.05)。结论:中西医结合治疗发作期热哮型儿童哮喘患者临床使用安全,能有效改善肺功能患,提高临床疗效;其作用机制可能与降低患者血清中hs-CRP、IL-1β、TNF-α水平相关。

Objective： To observe the clinical effect of Jiawei Dingchuan Tang retention enema in the treatment of onset asthma of heat type asthma patients. Methods： 110 patients with onset period of asthma of heat type asthma in children were randomly divided into the control group and the observation group,each group of 55 cases. The control group was given salbutamol aerosol aminophylline injection atomization,ambroxol and other western medicine symptomatic treatment and the observation group was treated with Jiawei Dingchuan Tang retention enema therapy based on the control group. Observed the change of two groups before and after treatment the high-sensitivity C-reactive protein（ hs-CRP）,interleukin-1β（ IL-1β） and tumornecrosis factor-α（ TNF-α）; before and after treatment of symptoms（ wheezing,cough,fullness and oppression in the chest and diaphragm,sputum,wheezing） integral change by the same physician to score; and evaluated the efficacy and safety of drug use. Results： After treatment,the levelsof hs-CRP,IL-1βand TNF-αin the two groups were significantly lower than that in the same group before treatment（ P〈0. 01）.After treatment,the serum levels of hs-CRP,IL-1β,TNF-α in the observation group were lower than those in the control group（ P〈0. 05）. After treatment,the main symptom score and total score of symptoms in the observation group of wheezing,cough,fullness and oppression in the chest and diaphragm,sputum,wheezing sound were lower than those in the control group（ P〈0. 05）. After treatment,forced expiratory volume in 1 second（ FEV1）,forced vital capacity（ FVC）,FEV1 / FVC% levels of the two groups were significantly higher than the same group before treatment（ P〈0. 01）; after treatment,the serum levels of FEV1,FVC and FEV1 / FVC% in the observation group were all higher than those in the control group（ P〈0. 05）. The effective rate of control group was 87. 3%,and the observation group was 98. 2%,and the difference was statistically significant（ χ2= 4. 853,P =0. 028 0. 05）. Conclusion： Combined Chinese medicine and western medicine treatment of onset stage of asthma of heat type asthma in children patients with clinical safe use,can effectively improve the pulmonary function of patients,improve the clinical efficacy; the mechanism of action may be related to the decrease of serum hs-CRP、IL-1β、TNF-α.