标准桃金娘油肠溶胶囊联合曲安奈德注射液对儿童分泌性中耳炎听阈、T细胞亚群的影响

Effects of myrtol standardized enteric capsules combined with triamcinolone acetonide injection on hearing threshold and T cell subsets in children with secretory otitis media

目的研究标准桃金娘油肠溶胶囊联合曲安奈德注射液治疗儿童分泌性中耳炎对患儿听阈、T细胞亚群的影响及疗效分析。方法 2016年3月至2017年1月在耳鼻喉科住院治疗的分泌性中耳炎患儿98例,随机分为曲安奈德组和联合治疗组,每组49例。2组患者均口服头孢地尼分散片,连用1周。曲安奈德组首先对患儿抽取积液,完毕后向鼓室内注射曲安奈德注射液0.5~1 ml,每周1次,2周为1个疗程。联合治疗组在曲安奈德组治疗基础上,加用标准桃金娘油肠溶胶囊1粒/次,2次/d,连用2周。观察2组治疗前后听阈(0.250、0.500、1.000、2.000、4.000 kHz)、T淋巴细胞亚群(CD_4^+、CD_8^+、CD_4^+/CD_8^+)水平,观察不良反应发生情况,并对2组治疗效果进行判定。结果 2组治疗后0.250、0.500、1.000、2.000、4.000 kHz听阈检测结果均明显低于治疗前,差异有统计学意义(P<0.05)。联合治疗组治疗后0.250、0.500、1.000、2.000、4.000 kHz听阈检测结果低于曲安奈德组,但差异无统计学意义(P>0.05)。2组治疗后CD_4^+、CD_4^+/CD_8^+高于治疗前,CD_8^+低于治疗前,差异均有统计学意义(P<0.05)。联合治疗组治疗后CD_4^+和CD_4^+/CD_8^+均高于曲安奈德组,差异有统计学意义(P<0.05),CD_8^+与曲安奈德组比较,差异无统计学意义(P>0.05)。2组治愈率、有效率比较,差异无统计学意义(P>0.05),联合治疗组总有效率高于曲安奈德组,差异有统计学意义(P<0.05)。2组恶心、鼻腔异味、鼓室粘连发生率比较,差异无统计学意义(P>0.05),联合治疗组不良反应总发生率低于曲安奈德组,差异有统计学意义(P<0.05)。结论标准桃金娘油肠溶胶囊联合曲安奈德注射液治疗儿童分泌性中耳炎,可以显著提高患儿听阈,促进T淋巴细胞亚群水平恢复正常,改善患儿听力下降或减退、出现耳鸣、耳痛、耳内憋闷等临床症状,有利于患儿恢复,且不良反应发生率少,安全性高。

Objective To investigate the therapeutic effects of myrtol standardized enteric capsules combined with triamcinolone acetonide injection on secretory otitis media in children and its effects on hearing threshold and T cell subsets of patients. Methods A total of 98 children patients with secretory otitis media who were admitted and treated in our hospital from March 2016 to January 2017 were randomly divided into triamcinolone acetonide treatment group and combination treatment group,with 49 patients in each group. The patients in both groups were treated by oral cefdinir dispersible tablets for1 week,and the patients in triamcinolone acetonide treatment group were extracted hydrops firstly,then were injected into triamcinolone acetonide injection 0. 5 to 1 ml into the tympanic cavity,once a week,with a treatment course of 2 weeks. On the basis of triamcinolone acetonide treatment group,the patients in combination treatment group were treated by myrtol standardized enteric capsules,1 capsule once,2 times a day for 2 weeks. The levels of hearing threshold（ 0. 250,0. 500,1,2,4 kHz）,T lymphocyte subsets（ CD4＋,CD8＋,CD4＋/CD8＋） before and after treatment were observed and compared between two groups,moreover,the therapeutic effects and incidence rate of adverse reactions were observed and compared between two groups. Results The hearing thresholds of 0. 250,0. 500,1,2 and 4 kHz after treatment were significantly decreased in both groups,as compared with those before treatment（ P 0. 05）,moreover,which in combination treatment group were lower than those in triamcinolone acetonide treatment group,but there were no significant differences between two groups（ P 0. 05）.After treatment,the levels of CD4＋ and CD4＋/CD8＋ in both groups were significantly higher than those before treatment,and the levels of CD8＋ were significantly lower than those before treatment（ P 0. 05）,moreover,the levels of CD4＋ and CD4＋/CD8＋ in combination treatment group were significantly higher than those in triamcinolone acetonide treatment group（ P 0. 05）,however,there were no significant differences in the levels of CD8＋ between two groups（ P 0. 05）. Moreover there were no significant differences in cure rate and effective rate between two groups（ P 0. 05）,but the total effective rate in combination treatment group was significantly higher than that in triamcinolone acetonide treatment group（ P 0. 05）. There were no significant difference in the incidence rates of nausea,nasal odor and tympanum adhesion between two 2 groups（ P 0. 05）,however,the total incidence rate of adverse reactions in combination treatment group was significantly higher than that in triamcinolone acetonide treatment group（ P 0. 05）. Conclusion The myrtol standardized enteric capsules combined with triamcinolone acetonide injection in treatment of secretory otitis media in children can significantly improve patients＇ hearing threshold,promote the recovery of T lymphocyte subsets,improve clinical symptoms including hearing loss or decline,tinnitus,ear pain and ear suffocation,which is beneficial to the recovery of patients,with less incidence of adverse reactions and higher safety.