加味取渊汤结合西医常规疗法治疗小儿上气道咳嗽综合征痰热郁肺证临床研究

The efficacy of modified Quyuan decoction in treating children upper airway cough symptom complex with syndrome of phlegm and heat accumulated in lung

目的评价加味取渊汤结合西医常规疗法治疗小儿上气道咳嗽综合征(upper airway cough syndrome,UACS)痰热郁肺证的疗效。方法将符合入选标准的82例UACS患儿采用随机数字表法分为2组,每组41例。对照组口服孟鲁司特钠咀嚼片,雾化吸入布地奈德混悬液;观察组在对照组基础上服用加味取渊汤。2组均连续治疗2周,随访6个月。采用双抗夹心ELISA法检测血清IL-8、IL-13水平,并分别于治疗前后进行症状、体征评分,痰热郁肺证症状评分,咳嗽症状评分,咽部症状评分;评价临床疗效,记录复发率。结果观察组总有效率为95.1%(39/41)、对照组为75.6%(31/41),2组比较差异有统计学意义(χ^2=4.783,P=0.029)。治疗后,观察组血清IL-8[(51.61±5.94)ng/L比(71.25±7.99)ng/L,t=12.631]、IL-13[(27.62±3.20)ng/L比(34.91±4.01)ng/L,t=9.099]水平均低于对照组(P<0.01)。治疗后,观察组咳嗽、鼻塞、流涕、鼻痒、咳痰、喷嚏、咽后壁分泌物、咽黏膜评分均低于对照组(t值分别为7.762、6.831、6.217、6.944、6.408、6.212、7.268、7.109,P值均<0.01);咳嗽、咳痰、痰中血丝、胸痛、口干、发热评分均低于对照组(t值分别为9.439、6.831、6.982、10.115、12.031、10.443,P值均<0.01);日间和夜间咳嗽症状评分均低于对照组(t值分别为7.012、7.241,P值均<0.01);咽痛、咽干、咽异物感评分均低于对照组(t值分别为6.003、6.106、6.318,P值均<0.01)。随访6个月,观察组复发率为17.7%(3/17)、对照组为53.9%(7/13),2组比较差异有统计学意义(χ^2=4.344,P=0.037)。结论加味取渊汤结合西医常规疗法可有效改善UACS痰热郁肺证患儿的临床症状,提高疗效,降低复发率。

Objective To investigate the efficacy of modified Quyuan decoction in the treatment of Children upper airway cough symptom complex with syndrome of phlegm and heat accumulated in lung.Methods Eighty-two Children with upper airway cough symptom complex who met the inclusion criteria were randomly divided into 2 groups with 41 in each group.In the control group,monteluster sodium chewing tablets were taken orally and budesonide suspension was inhaled.The observation group took modified Quyuan decoction on the basis of the control group.Both groups were treated continuously for 2 weeks and followed up for 6 months.The levels of interleukin(IL)-8 and IL-13 were detected by double-antibody-sandwich ELISA,and the symptoms and signs were scored before and after treatment,as well as the symptoms of phlegm,heat and stagnation of lung,cough and pharynx.The efficacy was evaluated and recurrence rate was recorded.Results The total effective rate 95.12%(39/41)in the observation group was obviously higher than 75.61%(31/41)in the control group(χ^2=4.783,P=0.029).After treatment,the serum level of IL-8(51.61±5.94 ng/L vs.71.25±7.99 ng/L,t=12.631)and IL-13(27.62±3.20 ng/L vs.34.91±4.01 ng/L,t=9.099)in the observation group were significantly lower than those in the control group(P<0.01).After treatment,the scores of cough,nasal obstruction,runny nose,nasal itching,expectoration,sneezing,secretion of posterior pharyngeal wall and pharyngeal mucosa in the observation group were all significantly lower than those in the control group(t values were 7.762,6.831,6.217,6.944,6.408,6.212,7.268,7.109,all Ps<0.01).The scores of cough,expectoration,blood in sputum,chest pain,dry mouth and fever were significantly lower than those of the control group(t values were 9.439,6.831,6.982,10.115,12.031 and 10.443,all Ps<0.01).Scores of daytime and nighttime cough symptoms were significantly lower than those of the control group(t values were 7.012,7.241,respectively,all Ps<0.01).The scores of pharyngeal pain,pharyngeal dryness and pharyngeal foreign body sensation were significantly lower than those of the control group(t values were 6.003,6.106,6.318,respectively,all Ps<0.01).In the 6 months'follow-up observation,the recurrence rate was 17.7%(3/17)in the observation group and 53.9%(7/13)in the control group,and the difference between the two groups was statistically significant(χ^2=4.344,P=0.037).Conclusions The modified Quyuan decoction combined with conventional western medicine can improve the symptoms and signs of upper airway cough symptom complex of children with syndrome of phlegm and heat accumulated in lung.