平喘汤治疗小儿非急性期哮喘的临床疗效研究

Study of Xingren Pingchuan Decoction on Treatment of Children with Asthma in Non-Acute Stage

目的研究平喘汤治疗小儿非急性期哮喘的疗效和作用机制。方法纳入我院80例非急性期哮喘患儿作为研究对象,随机抽签分为两组,各40例,观察组在常规糖皮质激素干预基础上加用平喘汤治疗,对照组行糖皮质激素干预治疗。比较两组治疗效果及治疗前后肺泡痰液中白细胞介素-4(IL-4)、白细胞介素-10(IL-10)、肿瘤坏死因子(TNF-α)、内皮素1(ET-1),分析患儿肺功能第1秒用力呼气量(FEV1)与免疫功能指标CD4+、CD8+T淋巴细胞、嗜酸性粒细肥(EOS)计数]表达的关系。结果观察组治疗总有效率为97.5%,显著高于对照组82.5%,差异有统计学意义(P<0.05)。观察组治疗后IL-4、TNF-α、ET-1、CD4+T淋巴细胞、EOS计数均显著低于治疗前和对照组治疗后,IL-10、CD8+T淋巴细胞显著高于治疗前和对照组治疗后,差异均有统计学意义(P<0.05)。两组患者治疗前后24小时尿游离皮质醇(24 h-UFC)、骨密度(BMD)、体质量水平及呼吸道感染发生率比较,差异无统计学意义(P>0.05)。经一元线性回归分析,CD4+T淋巴细胞和EOS计数与FEV1具有显著负相关性,CD8+T淋巴细胞计数与FEV1具有显著正相关性。结论平喘汤干预治疗非急性期哮喘患儿较单纯糖皮质激素治疗疗效更为显著,能显著缓解咳嗽、咳痰、喘息等临床症状,改善肺功能,且安全性高,其增效机制可能与强化抗炎效果,增强免疫功能有关。

Objective To investigate the effect and mechanism of Pingchuan decoction in the treatment of children with non-acute asthma. Methods Eighty children with non-acute asthma in our hospital were randomly divided into two groups, 40 cases in each group. Based on the conventional glucocorticoid intervention, the observation group was treated with Pingchuan decoction, while the control group was treated with glucocorticoid alone. The interleukin-4 （IL-4） and inter-leukin-10 （IL-10）, tumor necrosis factor alpha （TNF-α）, endothelin-1 （ET-1） in alveolar sputum before and after treatment were compared. The relationship of the first second forced expiratory volume （FEV1） of pulmonary function with immune func-tion inidicators [CD4＋, CD8＋ T lymphocyte and eosinophil （EOS） count] was analyzed. Results The total effective rate in the observation group （97.5%） was significantly higher than that in the control group （82.5%） （P〈0.05）. After treatment, IL-4, TNF-α, ET-1, CD4＋ T lymphocyte count and EOS count were significantly lower than those before treatment and the con-trol group, and IL-10 and CD8＋ T lymphocytes were significantly higher than those before treatment and the control group,the difference was statistically significant （P〈0.05）. After treatment, there were no significant differences in 24 h-UFC, BMD, weight and the incidence of respiratory tract infection between the two groups （P〉0.05）. The unitary linear regression analysis showed that CD4＋ T lymphocytes and EOS counts were significantly negatively correlated with FEV1. CD8＋ T lymphocyte count was significantly positively correlated with FEV1. Conclusion Pingchuan decoction in treatment of non -acute asthma shows more significant effect than glucocorticoid therapy alone, which could significantly relieve cough and expectoration, wheezing and other symptoms and improve lung function, with high safety. It may be related with enhancement of anti-inflam-matory effect and immune function.