安宫牛黄丸联合神经节苷脂治疗儿童病毒性脑炎的临床研究

Clinical study on Angong Niuhuang Pills combined with ganglioside in treatment of viral encephalitis in children

目的观察安宫牛黄丸联合单唾液酸四己糖神经节苷脂钠注射液治疗儿童病毒性脑炎的临床疗效。方法选取2016年12月—2017年12月新乡市中心医院收治的128例病毒性脑炎患儿作为研究对象,采用随机数表法将所有患儿随机分为对照组和治疗组,每组各64例。对照组静脉滴注单唾液酸四己糖神经节苷脂钠注射液,20 mg加入10%的葡萄糖溶液100 mL中,1次/d。治疗组在对照组的基础上口服或鼻饲安宫牛黄丸,3岁以下患儿每次1/4丸,4～6岁每次1/2丸,7～13岁每次1丸,生理盐水15～20mL研成匀浆,每日1～2次。两组患儿均连续治疗2周。观察两组患者的临床疗效,同时比较两组治疗前后的临床症状、体征改善情况、神经功能指标、炎症因子水平和脑脊液检查结果。结果治疗后,对照组和治疗组的总有效率分别为76.57%、96.88%,两组比较差异具有统计学意义(P<0.05)。治疗后,治疗组呕吐消失时间、意识清醒时间、头痛消失时间、锥体束征消失时间均显著短于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组血清S100β蛋白、神经元特异性烯醇化酶(NSE)、神经生长因子(NGF)、髓磷脂碱性蛋白(MBP)水平均显著降低,同组治疗前后比较差异具有统计学意义(P<0.05);治疗后治疗组S100β、NSE、NGF、MBP水平显著低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组血清白细胞介素-1(IL-1)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)水平均显著降低,同组治疗前后比较差异具有统计学意义(P<0.05);治疗后治疗组血清IL-1、TNF-α、CRP水平显著低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组总细胞数、单核细胞数、蛋白含量均显著降低,同组治疗前后比较差异具有统计学意义(P<0.05);治疗后治疗组总细胞数、蛋白含量显著低于对照组,两组比较差异具有统计学意义(P<0.05)。结论安宫牛黄丸联合单唾液酸四己糖神经节苷脂钠注射液可显著提高病毒性脑炎临床疗效,改善患儿的临床症状和神经功能,减轻炎症反应,具有一定的临床推广应用价值。

Objective To observe the clinical effect of Angong Niuhuang Pills combined with Monosialotetrahexosylganglioside Sodium Injection in treatment of viral encephalitis in children. Methods Children(128 cases) with viral encephalitis in Xinxiang Central Hospital from December 2016 to December 2017 were randomly divided into control and treatment groups, and each group had 64 cases. Children in the control group were iv administered with Monosialotetrahexosylganglioside Sodium Injection, 20 mg added into 10% glucose solution 100 mL, once daily. Children in the treatment group were po or nasal feeding administered with Angong Niuhuang Pills on the basis of the control group, 1/4 pill per time for children under 3 years old, 1/2 pill per time for children aged 4 - 6 years old, and 1 pill per time for children aged 7 - 13 years old. The pills were ground into homogenate with 15 - 20 mL normal saline, 1 - 2 times daily. Children in two groups were treated for 2 weeks. After treatment, clinical efficacy was evaluated, and the clinical symptoms and signs recovery time, neurological function indexes, inflammatory factors level, and the cerebrospinal fluid examination results in two groups before and after treatment were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 76.57% and 96.88%, respectively, and there were differences between two groups(P < 0.05). After treatment, the time of vomiting disappearance, consciousness awakening, headache disappearance, and pyramidal tract sign disappearance in the treatment group were significantly shorter than those in the control group, and there were differences between two groups(P < 0.05). After treatment, the levels of S100β, NSE, NGF, and MBP in two groups were significantly decreased,and the difference was statistically significant in the same group(P < 0.05). After treatment, the levels of S100β, NSE, NGF, and MBP in the treatment group were significantly lower than those in the control group, with significant difference between two groups(P <0.05). After treatment, the levels of IL-1, TNF-α, and CRP in two groups were significantly decreased, and the difference was statistically significant in the same group(P < 0.05). After treatment, the levels of IL-1, TNF-α, and CRP in the treatment group were significantly lower than those in the control group, with significant difference between two groups(P < 0.05). After treatment, the total cell number, monocyte number, and protein content in two groups were significantly decreased, and the difference was statistically significant in the same group(P < 0.05). After treatment, the total cell number and protein content in the treatment group were significantly lower than those in the control group, with significant difference between two groups(P < 0.05). Conclusion Angong Niuhuang Pills combined with Monosialotetrahexosylganglioside Sodium Injection can significantly improve the clinical efficacy of viral encephalitis, improve clinical symptoms and neurological function of children, and reduce inflammatory response, which has a certain clinical application value.