中医治未病方案治疗儿童变应性鼻炎合并哮喘及其免疫学机制探讨

Chinese Medicine Theory of“Treating Disease before Its Development”in Treatment of Allergic Rhinitis with Asthma and Discussion on Its Immunological Mechanism

目的探讨在中医“治未病”理论的基础上采用“温润辛金培脾”法治疗变应性鼻炎合并哮喘的临床疗效,并分析其对患儿免疫功能的影响。方法选取2016年11月-2018年12月医院收治的变应性鼻炎合并哮喘患儿108例,采用随机数字表法将患儿分为实验组和对照组,各54例,对照组给予丙酸氟替卡松治疗,实验组在中医“治未病”理论的指导下,采用“温润辛金培脾”法治疗,两组均连续治疗14 d。比较两组治疗前后临床症状改善情况、细胞及体液免疫功能变化及不良反应情况。结果与治疗前比较,治疗后两组患儿连续喷嚏个数、鼻痒、鼻堵及每日擤鼻次数评分均明显降低,喘息、呼吸困难、活动受限、急救药物使用频次评分均明显升高(P<0.01),但两组间差异无统计学意义(P>0.05)。与治疗前比较,治疗后实验组患儿CD^+3、CD^+4比例及CD^+4/CD^+8均明显升高,且明显高于对照组(P<0.05或P<0.01);CD^+8比例明显降低,且明显低于对照组(P<0.01)。与治疗前比较,治疗后两组患儿IgA、IgG、IgM表达水平均明显升高,且实验组明显高于对照组(P<0.05或P<0.01);两组IgE表达水平均明显降低,且实验组明显低于对照组(P<0.01)。实验组总不良反应发生率明显低于对照组(P<0.05)。结论在中医“治未病”理论的基础上采用“温润辛金培脾”法治疗变应性鼻炎合并哮喘可明显改善患儿细胞及体液免疫功能,缓解临床症状,且安全性高。

Objective To explore the clinical efficacy of“warming-nourishing-strengthening spleen”method in the treatment of allergic rhinitis with asthma on the basis of the Chinese medicine theory of“treating disease before its development”,and to analyze its effect on immune function of children.Methods A total of 108 case of children with allergic rhinitis and asthma admitted to our hospital from November 2016 to December 2018 were randomly divided into the experiment group and the control group,54 cases in each group.The control group was treated with fluticasone propionate and the experiment group was treated with the“warming-nourishing-strengthening spleen”method under the guidance of the Chinese medicine theory of“treating disease before its development”.The two groups were treated continuously for 14 days.The clinical symptoms,cell and humoral immune function changes before and after treatment and adverse reactions were compared.Results Compared with those before treatment,the scores of number of consecutive sneezing,nasal itching,nasal blockage,daily snoring times and wheezing,dyspnea,limited mobility,and frequency of first-aid drug use significantly decreased after treatment in the two groups(P<0.01),but there was no significant difference between the two groups(P>0.05).Compared with those before treatment,the proportions of CD^+3,CD^+4 and CD^+4/CD^+8 significantly increased after treatment in the experiment group,and were significantly higher than those of the control group(P<0.05 or P<0.01).The proportion of CD^+8 significantly decreased,and was significantly lower than that of the control group(P<0.01).Compared with those before treatment,the expression levels of IgA,IgG and IgM significantly increased after treatment in the two groups,and the experiment group's were significantly higher than those of the control group(P<0.05 or P<0.01).The expression level of IgE significantly decreased in the two groups,and the experiment group's was significantly lower than that of the control group(P<0.01).The incidence of total adverse reactions in the experiment group was significantly lower than that of the control group(P<0.05).Conclusion The“warming-nourishing-strengthening spleen”method under the guidance of the Chinese medicine theory of“treating disease before its development”in the treatment of allergic rhinitis with asthma can significantly improve the cellular and humoral immune function of children,relieve clinical symptoms,and it has high safety.